Undervalued, Overworked, Underpaid: The Hidden Struggle of Healthcare Support Workers

Hospitals, nursing homes, and home care agencies rely on a workforce that is both essential and invisible: nursing assistants, home health aides, janitors, and dietary staff. These are the jobs that keep patients alive, rooms clean, and meals delivered—but the system systematically undervalues the people performing them.

Good Money for Citizens, But Hard to Reach

For working-class Americans, these roles offer comparatively good pay—$15–$20 per hour, or $30,000–$40,000 per year for full-time work—and often include benefits such as health insurance, paid leave, and retirement contributions. In economically depressed areas, these jobs can be among the best opportunities available, providing a path to stability that is otherwise scarce.

Yet despite the relative financial benefits, many positions are still filled by undocumented workers. The work is physically demanding, emotionally taxing, and often requires night shifts or rotating schedules. Certification and training requirements also create barriers for some citizens. Undocumented workers accept these challenges out of necessity, filling critical staffing gaps while enduring low pay and limited protections.

Systemic Problems: Labor Shortages and Wage Suppression

Hospitals and long-term care facilities are chronically understaffed. Reliance on undocumented labor has suppressed wages that could otherwise rise to attract more working-class citizens. Basic economic principles suggest that if undocumented workers were removed, employers would face critical shortages of staff, forcing them to raise wages and improve conditions to recruit citizens.

Currently, the system allows institutions to operate with a workforce that is stretched thin and undervalued, creating tension among citizens who see essential roles filled by workers with fewer rights, while wages remain constrained.

Struggling Despite Relative Stability

Even with pay above minimum wage, healthcare support workers face persistent challenges:

• Physically demanding work, long hours, and emotionally exhausting patient care

• Difficult schedules that interfere with childcare and family responsibilities

• Limited career advancement, despite the essential nature of their work

The workforce is essential to public health but chronically underpaid and underprotected, with both citizens and undocumented workers bearing the burden.

The Coming 2027 Medicaid Cuts

The looming Medicaid cuts scheduled for 2027 threaten to exacerbate these pressures dramatically. Analysts predict:

• Reduced funding for hospitals and long-term care facilities, particularly those serving low-income populations

• Staff layoffs or hiring freezes, putting further strain on remaining workers

• Worsening working conditions, as understaffed hospitals struggle to maintain essential care

• Greater reliance on undocumented labor, as facilities scramble to fill positions without raising wages

For working-class Americans, the cuts could turn good-paying, relatively stable jobs into high-risk, overworked positions with limited security. Citizens who currently see healthcare support roles as a viable path to stability may be pushed out entirely if conditions deteriorate.

Opportunity Lost and Tensions Exposed

These roles are genuinely desired by many working-class Americans, but systemic barriers and staffing gaps create tension. Undocumented workers fill roles that citizens could take if wages, schedules, and protections were improved. The looming Medicaid cuts threaten to make this tension worse, potentially lowering pay, worsening working conditions, and increasing turnover, even as the demand for essential labor rises.

Healthcare on Life Support

Healthcare support workers are the backbone of the U.S. healthcare system. They provide essential services that keep hospitals and care facilities running, yet the system consistently undervalues them. For working-class Americans, these jobs offer good pay and stability, but the combination of demanding work, systemic reliance on undocumented labor, and looming Medicaid cuts could push these positions to a breaking point by 2027.

Unless policymakers and institutions take action to raise wages, improve working conditions, and stabilize funding, the frontline workforce—citizens and undocumented workers alike—will continue to struggle, overworked and underappreciated, while the nation’s healthcare system faces growing instability.

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Sources:

• Migration Policy Institute, “Unauthorized Immigrants in the U.S. Workforce,” 2021

• Center for Migration Studies, “Undocumented Workers in Healthcare,” 2020

• Kaiser Family Foundation, Medicaid Policy Projections, 2025