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October 31, 2023 HUMAN RIGHTS

Why Paid Leave Is the Path to Progress and Prosperity

by Molly Weston Williamson

In 2023, the United States of America does not guarantee any paid leave to its citizens—not a single day, not one dollar. That places us wildly out of line with our economic peers and far behind countries with considerably fewer resources. States and cities have stepped up to fill this gap while work continues to finally ensure paid leave for all federally. Yet, without a national guarantee of paid leave, Americans must hope for a generous boss or a supportive state—leaving too many people without the leave they need, living with the enduring ramifications of choosing between a paycheck, caregiving, or their own health.

Paid Sick Time

Nearly one in four private sector workers don’t have a single paid sick day. Those left out are disproportionately low-wage and part-time workers. Industries that are particularly important from a public health perspective are among the worst offenders. About half of all food service and accommodations workers have no paid sick time, making those who prepare and serve our food particularly likely to come to work sick, putting us all at risk. Similarly, fewer than one in five home care workers have any paid sick time, putting our most vulnerable at greater risk when those who care for them are forced by economic necessity to come to work while ill.

Fifteen states and the District of Columbia, along with nearly two dozen cities and counties, have passed paid sick time laws. These laws give employees the right to earn time off to use when they or their loved ones are sick, hurt, or receiving medical care or treatment. Most paid sick time laws also allow this time to be used for certain needs when employees or their loved ones are experiencing sexual or domestic violence, a protection known as safe leave. In addition, Illinois, Maine, and Nevada have passed more general paid time off laws, which follow a similar model but allow the time off to be used for other needs as well as for sick and safe leave purposes.

Nearly one in four private sector workers don’t have a single paid sick day. Those left out are disproportionately low-wage and part-time workers.

Nearly one in four private sector workers don’t have a single paid sick day. Those left out are disproportionately low-wage and part-time workers.


Paid sick time means a healthier population. Workers with paid sick time are more likely than those without it to receive regular medical care, access preventive care and screenings, and get invaluable vaccinations. Along with that earlier and better access to health care, paid sick time means reduced emergency room usage. Moreover, when workers have paid sick time, they are much more likely to stay home when sick and to keep sick children home from school or daycare, substantially reducing the spread of infection. For instance, one study found that in just the first year after states adopted paid sick time laws, infection rates for the flu and similar conditions dropped by 11 percent.

Paid sick time also means a healthier economy. When people must go to work sick, they are less productive, take longer to recover, and get their coworkers sick, dragging down productivity and the bottom line. That’s why research shows that state paid leave laws boost productivity and, with it, profits. At the same time, paid sick time reduces costly employee turnover, saving employers money by helping them retain employees.

There is no federal right to paid sick time. In 2020, an emergency federal paid sick time law for COVID-related needs was passed as part of the Families First Coronavirus Response Act (FFCRA), but this protection expired at the end of 2020. Despite limited awareness and significant carveouts, the FFCRA had a major impact in stopping the spread of COVID-19. When COVID was at its most dangerous, FFCRA paid leave was used by millions of Americans and prevented 15,000 cases per day. Recently, leaders in Congress reintroduced the Healthy Families Act. If passed, the Healthy Families Act would guarantee paid sick time for employees across the country, following the time-tested and data-backed approach of state and local laws.

Paid Family and Medical Leave

The second critical protection Americans need but, too often, don’t have is paid family and medical leave. Fifty-seven percent of private sector workers do not have access to short-term disability insurance through their employer—meaning that in the event of a serious illness or injury, they are out of luck when their limited paid sick days run out, if they have them at all. An even more dramatic 76 percent of private sector workers do not have access to paid family leave to bond with a new child or care for a seriously ill loved one.

This shocking situation is the result of a major gap in federal law, which does not guarantee paid family and medical leave. A federal law called the Family and Medical Leave Act (FMLA) ensures the right to take time for workers’ own or a family member’s serious health conditions, to bond with a new child, or to address the impact of military deployment without job loss, retaliation, or interference. However, due to restrictive eligibility requirements, the FMLA covers only about half the workforce, with low-wage workers especially likely to be excluded. Even for those who are covered, the FMLA guarantees only unpaid leave, making its promises illusory for those who cannot afford to go without a paycheck.

States have stepped up to do what the federal government has not. To date, 13 states and the District of Columbia have passed their own paid family and medical leave laws. Minnesota and Maine, the two most recent states to do so, joined the list in 2023. These laws replace a portion of lost wages when workers need time away to address their own serious health needs, bond with a new child, or care for a seriously ill loved one. Many of these state laws cover military family needs or safe leave, and most also guarantee workers the right to get their jobs back following leave. These laws create insurance systems, paid for by small contributions from employers, employees, or a combination of both to make benefits both affordable and sustainable. 

Paid leave means greater health, from better access to care for cancer parents, lower rates of postpartum depression, and reduced reliance on nursing home care. It also saves lives, from reduced on-the-job deaths to lower infant mortality. At the same time, paid leave means greater economic security for working families, reducing the risk of going hungry or struggling to keep the lights on in the short term while preserving employment, earnings, and retirement security for the long run.

Moreover, universal paid family and medical leave would be a powerful investment in our economy. With paid leave, workers can take the time they need for their health or their families and then return to work rather than being pushed out, increasing labor force participation and with it gross domestic product. Without paid leave, we are all paying the price to the tune of $22.2 billion in lost wages in our economy annually. For employers, paid leave is an essential recruiting tool, a powerful retention strategy, and a boost to the bottom line—and with state programs, paid leave is affordable and easy to administer.

In 2021, the United States came closer than ever before, when a comprehensive paid leave program passed the House of Representatives as part of the Build Back Better Act, but these provisions fell out of the reconciliation package as negotiated in the Senate. In 2023, congressional leaders introduced a new and improved version of the FAMILY Act, the marquee federal paid family and medical leave proposal, which is still awaiting action.


We all deserve the time to get well, to care, and to bond, but far too many of us don’t get it. Policymakers must act—at the city, state, and federal levels—to protect workers, provide for families, and promote productivity and profitability for businesses. It is past time to ensure that all workers have the paid leave they need when they need it most.

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Molly Weston Williamson

Senior Fellow at the Center for American Progress

Molly Weston Williamson is a senior fellow at the Center for American Progress and a nationally recognized expert on paid leave policy.