The American economy cannot afford to forgo paid medical leave

As the Delta variant drives a new surge in COVID-19 cases and more Americans begin returning to in-person work, the need for paid sick and medical leave for all is clearly urgent.

We’ve already seen that when paid leave is available, COVID-19 transmission drops — and when it’s not, people go to work sick and spread accelerates. Lack of sick leave has also widened gaps in vaccine access: Nearly half of unvaccinated Americans — including 55 percent of unvaccinated Black adults and 64 percent of unvaccinated Latinx adults — report being concerned about missing work due to side effects.

This year the preventable tragedy centered around COVID-19. While devastating families from every background, the pandemic disproportionately harmed communities of color, leading to a three-year drop in life expectancy for Latinx and Black Americans and a 1.5-year decline overall. Millions of Latinx and Black essential workers were repeatedly asked to report to jobs where they would face high risks of exposure, even as the government failed to guarantee paid sick leave for all. Latinx communities were particularly hard hit, with 1.9 times as many cases as white Americans and 2.3 times as many deaths; similarly, Black adults’ COVID-19 mortality rates are twice those of white adults.

But the need for sick and medical leave is great every year. Nearly 2 million people in the U.S. are diagnosed each year with cancer, including over 700,000 who are in their prime working years. Far more each year have to cope with hospitalization or major illness such as heart disease, stroke or diabetes. For the tens of millions who lack paid sick and medical leave in the U.S., any serious illness threatens not only their health but the economic survival of their families.

These are unnatural disasters — that most countries do far more to prevent. Around the world, 181 countries provide paid medical leave at a national level. Only the U.S. and 10 other countries fail to do so. 

And if that weren’t bad enough, as our new study in Health Affairs shows, even the unpaid leave that the U.S. grants under the Family and Medical Leave Act (FMLA) builds in inequality. In particular, rules restricting leave based on employer size, minimum hours and minimum tenure — found in both the FMLA and a range of policies adopted since — sharply limit coverage overall and widen racial and gender disparities in access.

Latinx workers suffer some of the greatest consequences. For example, 42 percent of Latinx workers are ineligible for the FMLA because of their employer’s size, while 18.7 percent of Latina women don’t qualify due to the annual work hours requirement. But while the rules exacerbate inequalities, they leave all American workers behind: over a third of white workers are likewise excluded because they work for a small employer, while 16.2 percent of white women are ineligible because they work part-time.

Moreover, for most Americans, taking unpaid leave is only an option if they have savings to fall back on — and due to massive racial wealth gaps created by a long history of discriminatory policies, Black families have the least in the bank, with Latinx families not far behind. As of 2019, white households’ median net worth was eight times that of Black households and nearly five times that of Latinx households. But with nearly 40 percent of all Americans reporting they couldn’t cover an unexpected $400 expense, only providing unpaid leave has vast implications for broad swaths of the population.

And for serious illnesses, lack of income during leave can become catastrophic. For example, cancer treatment can easily take five months. If only one or two months of paid leave are available, workers without savings — disproportionately Black, Latinx and low-wage workers — face a devastating choice: discontinue care and go back to work, or face months without income during a personal health crisis. This cruel dilemma contributes to a vicious cycle of inequality, as the workers least able to afford unpaid leave fall further behind if they take it or sacrifice their health if they don’t. 

So why hasn’t Congress acted yet? It’s not because it’s too hard to do. As our new research shows, the vast majority of countries guarantee paid medical leave nationally. Almost all do so without broad restrictions based on employer size (100 percent), hours of work (93 percent), or tenure (96 percent cover workers with less than a year of tenure or contributions — over half cover workers regardless of employment history). Moreover, countries around the world have demonstrated that adopting three months of more paid medical leave is feasible. Altogether, 123 countries globally — including 74 percent of high-income countries — guarantee more than three months of paid medical leave, while 113 countries offer six months or more.

Ensuring every worker has access to paid medical for a long enough period to cover cancer as well as COVID-19 matters to all Americans and is essential to addressing inequalities. The question is not whether we can afford it — but whether American workers and our economy can afford the consequences if we don’t.

Jody Heymann is a distinguished professor in the Faculties of Public Affairs and Public Health at UCLA and founding director of the WORLD Policy Analysis Center.

Aleta Sprague is an attorney and senior legal analyst at WORLD.