Earned sick leave alone is not enough for uninsured workers, study finds

Earned sick leave—short-term, paid time off for employees who are sick or injured or must care for sick or injured family members—has been found to reduce the spread of infectious diseases in the workplace and increase employee access to preventive care.

Since 2019, seven states have implemented laws requiring employers to offer earned sick leave, bringing the total to 18 (plus Washington, D.C.). Despite this growth, however, little has been known until now about the policy’s effects on worker well-being across various industries.

“This is important because both the short- and long-term benefits of earned sick leave might vary by industry,” said health policy expert Hannah I. Rochford, Ph.D. “For example, in industries that have higher injury rates, such as construction, earned sick leave may encourage injured workers to take time off for treatment and recuperation, which helps prevent more serious musculoskeletal disorders later on.”

For their study, published in Safety and Health at Work, Rochford and occupational health and safety researcher Aurora B. Le, Ph.D., both with the Texas A&M University School of Public Health, used natural policy variation, quasi-experimental methods and nationally representative datasets to causally explore how earned sick leave laws impact rates of reportable nonfatal illness or injury across major industry categories.

They obtained annual state rates of occupational nonfatal illness or injury reports from the Bureau of Labor Statistics for each North American Industry Classification and the earned sick leave policy data from Temple University Center for Public Health Law Research’s Law Atlas. They also excluded the 11 states that adopted earned sick leave policies after 2020 given the confounding impact of the COVID-19 pandemic on interpreting the policies’ impact.

“We found that states that implemented earned sick leave prior to 2019 saw a marginally significant increase in the rates of illness and injury reporting across industries after these policies were introduced,” Le said.

She said this uptick suggests that sick or injured employees were more likely to report their conditions since doing so would not result in retaliation or job loss.

On the other hand, employees who were uninsured or faced similar financial barriers to getting care and employees with social and/or legal barriers to getting care (such as undocumented workers) did not appear to benefit from earned sick policies.

“Male workers in high-risk industries like construction, agriculture and transportation face higher rates of illness or injury than their female counterparts, and this may desensitize them to frequent illnesses or injuries and the need to take time off,” Le said. “Similarly, undocumented workers could be disincentivized to use sick leave because they don’t want to draw attention to themselves or go against group norms.”

The study also identified other factors that affected the use of earned sick leave. Employees in unions, for example, were 10% more likely to have earned sick leave than their counterparts in non-union organizations.

Le said “union busting” by corporations and the passage of state right-to-work laws has led to a decline in union membership, which gives nonunionized employees even less bargaining power for earned sick leave policies.

“Earned sick leave policies alone are necessary but not sufficient to advance worker health,” Rochford said. “There is a need for strategies that increase insurance access and, for undocumented workers and others facing social and/or legal barriers, for training, education and resources on their rights using the appropriate language and literacy level.”