Lawmakers in California may finally offer a raise to the state’s woefully underpaid health care workforce. The legislature is debating a bill introduced by state Sen. María Elena Durazo that would raise the minimum wage for a wide range of health care workers to $25 per hour by June 1, 2025.
This would be especially beneficial to Black women, who are disproportionately represented in the health care sector — particularly in the lowest-paying jobs. The passage of the bill would provide a much needed and deserved income boost for employees throughout the health sector: from nurses to janitors and food service workers, and for employees of hospitals, nursing facilities, dialysis centers and other organizations. Researchers from the University of California, Berkeley Labor Center predict the bill would affect 469,000 to 1.5 million workers.
This bill would make a significant impact on the ability of Black women and their families to afford the exorbitant costs of living in one of the country’s most expensive states. Research from The Maven Collective — a progressive think tank we both work for that centers race and gender in its pursuit of economic justice — shows that in Alameda, Contra Costa, Los Angeles, Riverside, San Francisco, and San Bernardino counties, the health care sector is the second most common field for households headed by Black women. Health care support jobs in the six counties have a median pay of approximately $3,000 per month (before taxes). This is far less than what the costs of covering basic needs are. In San Francisco, for example, our research shows that housing costs more than $3,000 monthly, and child care adds another $3,000. In fact, a family of two adults and two children (one preschooler and one school-age child) would need to earn more than $12,000 per month to keep up with living costs.
This single bill won’t cure the affordability crisis, but it’s an important step toward acknowledging the value and dignity of these workers who hold up our economy and our families. In addition to being the right thing to do, it’s also the smart thing to do. Research shows that higher wages reduce turnover, which results in better outcomes and experiences for patients. For instance, a 2018 study reported that a 10 percentage point increase in nurse turnover in nursing homes resulted in an 8.3% to 17.4% increase in deaths. And research done during the pandemic suggests that high turnover among nurses in nursing homes might have led to increased rates of mortality.
This bill is unique because it not only includes workers directly employed by health companies, but also “all paid work performed on the premises of any health care facility.” There is ample evidence that Black women working within the health care sector are relegated to the most physically demanding and dangerous jobs such as home health care workers and nurses’ aides. These jobs — which are among the lowest paying and offer little or even no benefits — take a toll on workers’ bodies. Research shows that home health care workers have some of the highest rates of occupational injury in the country.
The bill would increase costs for health care facilities, but those increased costs in wages would be offset by savings in other areas like staff turnover and declines in the reliance on safety net programs. The UC Berkeley Labor Center estimates the higher wages will result in a median 3.2% change in operating costs, with variations across different types of facilities. Hospitals — some of the most vocal opponents of the bill — would see an increase in operating costs of just 1.1%, while home health services will see a 11.6% increase in operating costs. That’s because home health workers are among the lowest paid workers in the state and therefore their increase in pay would be larger than that of many other workers.
By the policy’s third year, when hourly wages reach the full $25, it is estimated that the state budget would see anywhere from $467 million in net savings to $303 million in net costs. Where the state lands on this range depends on the level of state increases to Medi-Cal provider payments, along with the number of workers and dependents who move onto private insurance.
This bill — which passed the state Senate on May 31 and will be heard by the Assembly’s Labor and Employment Committee on July 12 — is an effort to prioritize people over profits. Yes, it will cost money. It should. It’s time we decide to reallocate profits to the workers holding up our health system. This would be precedent-setting for the rest of the country and potentially pressure other states to follow suit. Increasing wages increases in the health sector more broadly would be transformative. People of color represent 58% of nursing assistants, 63% of home health aides, and 52% of residential care aides. However, they only make up 39% of the labor force. In 2021 the median hourly wage for home health aides and personal care aides in California was just over $14; for certified nurse assistants the median hourly wage was $18. Among Black and Latina workers in these direct care positions, roughly half made less than $15 an hour. A $25 minimum wage would be a significant step in the right direction for these workers.
Black women have been the backbone of our health system since the earliest days of the country. For two centuries they have been un- or underpaid, undervalued, and disrespected despite the critical role they play in our economy, our communities and our families. This bill represents one step in a long journey to pay Black women — and, by extension, all workers in this sector — their worth.
Andrea Flynn is the senior fellow of health equity at the Maven Collaborative. She also teaches courses on reproductive and sexual health, public policy, and economic inequality at Columbia University’s Mailman School of Public Health. Yvonne Yen Liu is the director of research at the Maven Collaborative. She has more than 20 years of experience in applied research, including health care policy and labor market research.