Among the largest sectors in the two-county economy, none has grown as much over the past two decades as health care and social assistance.

In 2004, the average head count in this sector was 7,745; in 2024, 18,839. That’s a cumulative gain of 243%.

In Benton and Franklin counties, the overall labor force yielded a cumulative gain of 144% over the same period. Consequently, the share of the workforce claimed by health care and social assistance expanded from 8.4% to 14.1%.

Benton-Franklin Trends data shows this clearly. The site’s graph tracks the five largest sectors by head count. They currently are: government, health care and social assistance, retail trade, waste services and agriculture. Construction and manufacturing rank sixth and seventh, respectively.

Courtesy Benton-Franklin Trends

The accompanying graph homes in on the health care and social assistance sector for the two counties and for the state. It is currently the second largest sector in the two counties, by head count.

Government is still the area’s largest sector, but with a share of 14.7%, not by much. Its share of the total workforce has gone the other way, shrinking from 16.7% in 2004. Government as a sector includes federal, state and local agencies as well as school districts. The remaining three large sectors also have experienced relative downsizing over the past two decades.  

Further, the share of the workforce taken by health care and social assistance in the local economy is now larger than its share statewide (13.1% in 2024).

In a sense, one might describe the development of health care and social assistance here as “growing up,” as it accounted for a much smaller share than in the state 20 years ago. With its current size, it is hard to think of the greater Tri-Cities as a health care desert.

A word about social assistance. First, it is the smallest of the components of the sector, employing about 30% in the two counties in 2024. (Ambulatory care was the largest, with 40% of all workers in the sector, followed by a combined share of 30% for hospitals and skilled nursing facilities.)

What kind of firms populate social assistance industry? We don’t have access to local data, but we do know the statewide composition of the industry.

In 2024, the industry “services for the elderly and disabled” was by far the largest, followed by “other individual and family services,” followed by child care services.

Staff at these social assistance establishments do not wear blue uniforms or carry stethoscopes. Some provide health care services, but the bulk of their work is not clinical. To arrive at a more accurate representation of the size of health care here, let’s remove social assistance from the sector total. That step shrinks the total by about 5,500 (in 2024).

Nonetheless, a sector with over 13,000 employees is the third largest in the two counties.

This size is reflected in the dynamics of the local labor market. Every month, economists at Washington’s Employment Security Department (ESD) create a Top 20 list of occupations in demand for every county. For years on end, one occupation has been at the top of the local list: registered nurses. 

Present in the top 20 occupations list for the greater Tri-Cities so far for 2025 have been other health care professions, such as medical assistants, licensed practical nurses, nursing assistants, physical therapists and medical managers. In fact, the openings for registered nurses have been greater than the combined demand for all engineering disciplines.

It seems unlikely that the health care juggernaut in the greater Tri-Cities will slow down. First and foremost, the population is aging; in particular, the 65+ segment has increased its share from 12% to 15% in the past decade and will only grow over the next decade. Second, area residents are showing high and increasing incomes. Health care spending goes up with income. And the area’s population is projected to grow at the fastest pace among all Washington metro areas over the next few years.

Consequently, ESD economists are forecasting robust job growth for several health care occupations. For the period 2028-32, three health care occupations land in the top 20 of projected job openings. They are home health aides, nursing assistants and registered nurses. Three more health care occupations land in the top 50 occupations (out of 825) by openings: medical assistants, counselors and dental assistants.

A big unknown, of course, is the fate of Medicaid. This federal-state program currently insures nearly 30% of the population in the two counties. Were many residents to be dropped from the Medicaid roll, as might happen, growth in the area’s health care sector will likely be on pause.

D. Patrick Jones is the executive director for Eastern Washington University’s Institute for Public Policy & Economic Analysis. Benton-Franklin Trends, the institute’s project, uses local, state and federal data to measure the local economic, educational and civic life of Benton and Franklin counties.