Mapping Hospital Employment By State

Congress is considering substantial reductions in Medicaid spending as part of a budget reconciliation bill—the One Big Beautiful Bill Act—with the goal of offsetting part of the cost of tax cuts and other expenditures. While there are a number of Medicaid policy changes in the bill, three changes account for the vast majority of the savings according to estimates from the Congressional Budget Office: requiring states to implement work requirements for the expansion group, increasing barriers to enrolling in and renewing Medicaid coverage, and limiting states’ ability to raise the state share of Medicaid revenues through provider taxes. Any large cuts in Medicaid spending would likely have implications for hospitals, given that the program accounted for about one fifth (19%) of all spending on hospital care in 2023. Medicaid spending cuts, along with other policy changes under consideration, could lead to decreases in payments to hospitals and increases in the number of uninsured Americans, both of which would likely affect hospital finances, access to hospital services, and the quality of patient care. These changes could also impact local economies, given that hospitals are often major employers in their communities.

The interactive 50-state maps below show the number of hospital employees by state and how hospital employment ranks among industry subsectors based on 2023 data from the Quarterly Census of Employment and Wages (QCEW), which includes more than 95% of U.S. jobs. Most hospitals are part of a broader health system, but system employees working in other settings (such as in separate physician practices) are not included. (See Methods for additional information about the data). Key takeaways include the following:

• Hospitals employed 6.7 million individuals in 2023.
• Hospitals employed about 131,000 individuals on average across the 50 states and DC, with hospital employment ranging from about 13,000 in Wyoming to about 610,000 in California.
• Hospitals employed more than 100,000 individuals in 23 states and more than 400,000 individuals in four states: California, Florida, New York, and Texas.
• Hospitals are the sixth largest employer in the country, and among the top five largest employers in 22 states, when comparing industry subsectors. Nationwide, the hospital subsector follows educational services; food services and drinking places; professional, scientific, and technical services; administrative and support services; and ambulatory health care services in employment rankings. Some physicians and other employees in the ambulatory health care services subsector may in fact be part of the same health system as hospitals but are not included in hospital employment if they work in other settings.
• Hospitals ranked among the top eight employers in every state and were the ninth largest employer in DC.
• Hospitals were the second largest employer in West Virginia and the third largest employer in North Dakota, South Dakota, and Wyoming.