Of all the shibboleths used to denigrate the Affordable Care Act, perhaps the most persistent is to label it a “job-killer.”

The label was strong on the wing during the presidential campaign, when one could hear it uttered by Sen. Ted Cruz (R-Texas), who called it “the biggest job-killer in this country,” and Donald Trump, who said repealing the law would save “2 million American jobs.” The notion had a long history: In January 2011, only a few months after the law had been passed and three years before its major provisions went into effect, the newly Republican House was trying to pass a measure entitled the “Repealing the Job-Killing Health Care Law Act.”

This attack on the ACA never was based on facts. But a new report from the Altarum Institute, a nonprofit healthcare think tank in Ann Arbor, Mich., adds evidence that, in fact, the law is a job-creator. From 2014 through 2016, the researchers found, the law triggered the creation of 240,000 jobs in the healthcare field alone. The main reason is that increased insurance enrollments spurred more demand for healthcare services.

More growth is happening among physicians, registered nurses, nurse practitioners, and therapists — the practitioners who interact with patients. Ani Turner, Altarum Institute


“It really was the total change in coverage that made the difference,” Ani Turner, one of the report’s authors, told me. Turner wrote the report with Charles Roehrig of Altarum and Katherine Hempstead of the Robert Wood Johnson Foundation, who have been tracking job statistics in healthcare for several years.

These are good jobs too, Turner says. Although the available statistics breaking down jobs by occupation are a bit sketchier than the overall job growth numbers, it’s clear that “more growth is happening among physicians, registered nurses, nurse practitioners and therapists — the practitioners who interact with patients.”

That reflects the long-term trend of job growth in healthcare, according to another paper published by Turner, Roehrig and Hempstead in March. They found that growth in 2007 to 2015 was strongest among the diagnosing/treating categories of employment (doctors, nurses, et. al.), at more than 20%, followed by other health occupations and non-health support occupations such as clerical workers.

The strong growth in healthcare professional employment has been accompanied by expanded enrollment in medical and nursing schools, as one would expect — the demand for doctors and nurses has to be filled somehow. Enrollment in U.S. medical schools reached a record 20,630 in 2015, up 25% from 2002, according to the Assn. of American Medical Colleges. Nursing schools reported 320,000 enrollees in 2014, a 7% increase over the previous year.


The Altarum researchers warn that the job gains could be reversed if the ACA is repealed, whether through the GOP’s misbegotten and (thankfully) moribund American Health Care Act or some other device. “Providers and health systems may have already begun to slow hiring” in early 2017, they observe, though they’re not sure whether the reason is the uncertainty about the ACA’s future created by Republican dithering, or merely a return to the average growth rate of the pre-ACA era.

The Altarum paper measured the ACA-generated job growth in healthcare by examining the growth rate in healthcare jobs in 2015 and 2016, when coverage expansion began, compared to the average 1.7% growth rate in 2010-2013. They found that the increase in jobs lagged the coverage expansion by several quarters, but on the whole the rate jumped to 2.5% in 2015 and 2016. That yielded the figure of 240,000 new jobs directly attributable to Obamacare’s coverage expansion, which was about one-third of all the job growth in healthcare in those years.

When they checked the national trend against state average, they found that the that their expectations held: States with the highest percentage gains in their insured populations, such as Kentucky and California, also tended to experience the largest increases in healthcare job growth rates.

The anti-Obamacare crowd has been trying to torture job statistics almost from the inception to try to justify their job-killer meme. As part of their campaign, they’ve claimed that the law has pushed more Americans into part-time work, since the mandate requiring employers to provide employees with coverage won’t apply to part-timers.


The truth about Obamacare’s effect on part-time work: Voluntary part-timers have increased since 2010 (top graph), while involuntary part-time work has fallen (bottom). (Bureau of Labor Statistics)

Right-wing billionaire Charles Koch floated this claim via USA Today in 2014 and Andy Puzder, the CEO of the Carl’s Jr. and Hardee’s fast-food chains who was briefly a nominee for Trump’s Labor secretary, tried it on for size last year. They were wrong. The truth is that the ranks of workers who are part-time for economic reasons — that is, because they can’t find work or are given fewer hours than they want or need — has come down sharply since the enactment of the ACA — to 5.5 million in March 2017 from 9.1 million in March 2010, a reduction of 40%.

The voluntary part-time workforce, however, has increased. These are people who choose not to take full-time jobs because they have better things to do, such as caring for their children or elderly family members. They’ve increased to 20.4 million last March from 17.9 million in March 2010. Full-time employment, meanwhile, has increased to 153 million in March 2017 from 138.8 million in the same month in 2010. (All these figures are from the Bureau of Labor Statistics.)

The trend was well understood by the Congressional Budget Office, which projected in 2014 that the ACA would shrink the supply of labor, not the availability of jobs, by about 2.5 million full-time equivalents by 2024. The reason is that the ACA would decouple health coverage from employment, allowing more people to stay home without losing their insurance. It’s not the CBO’s fault that its projection was misinterpreted by politicians and business leaders like Trump, who were either too ignorant to understand it or deliberately out to mislead the public.


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