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March 18, 2020
Blog Post
Adam Lustig
Marilyn Cabrera
Sep 16, 2026
Aug 28, 2026
Aug 18, 2026
Back to The States of Health
As the number of cases of the novel coronavirus (COVID-19) in the United States increases, Americans are acclimating to the new reality of school and business closures. Some of the recommendations from the Centers for Disease Control and Prevention include working from home, staying home from school and work if you are sick, taking leave if someone in your household gets sick, and limiting close contact with others. Yet service industry and low-wage workers often don’t have paid time off. According to the Bureau of Labor Statistics, just 45 percent of accommodation and food services workers have access to sick leave, compared with 90 percent of workers in professional or management positions. Coupling this lack of benefits with the fact that about three in 10 adults have no emergency savings, it is not realistic to expect these individuals to take time off work to quarantine themselves. The financial ramifications of taking unpaid sick leave from work poses a threat to these communities—and to the current public health response to the COVID-19 outbreak.
While the Families First Coronavirus Response Act, which was passed by the U.S. House of Representatives and is being considered by the Senate now, would expand access to temporary paid sick leave for a subset of workers, many individuals would still be unable to stay home and take sick leave if they become ill. There are some actions states and localities can take to protect their workers through paid sick and family leave to help fill in the gaps.
In its current form, the House’s bill requires employers to add or expand sick leave for two weeks, but exempts employers with more than 500 employees and provides hardship exemptions for employers with 50 or fewer employees, leaving upwards of 18.5 million workers without access to employer-provided or government-mandated sick leave. Additionally, the bill creates a temporary paid family and medical leave program that provides up to 12 weeks of job-protected leave for employees with children in schools and daycare facilities that have closed. However, as with the paid sick leave provisions, the bill exempts employers with 500 or more employees and provides hardship exemptions for small businesses with 50 or fewer employees. Many restaurants and local grocery stores, for example, may fall into this small-business category. While the Families First Coronavirus Response Act is a sign of the federal government recognizing the importance of paid sick and family leave in combating infectious diseases, it could fall short of providing this benefit for those that need it the most.
Over the past couple of decades, in the absence of federal action to create a permanent paid sick leave program, some states and localities have built upon the Family and Medical Leave Act of 1993 requirements and enacted their own paid leave and sick policies. Yet, an analysis by Trust for America’s Health found that only 11 states and the District of Columbia have passed a paid sick leave law and only eight states and the District of Columbia have paid family leave laws.
A total of 18 localities require employers to offer workers paid sick leave. However, progress at the local level has been hindered by preemption laws that restrict the ability of cities, counties, and municipalities to pass laws that require employers to provide paid sick days for employees because they are in conflict with, or explicitly prohibited by, existing state laws. There are currently 22 states that prevent localities from enacting paid sick leave policies. While these policies may have been crafted to preserve business interests within a state, they severely impact a locality’s ability to effectively protect its citizens when facing an outbreak. And, as the COVID-19 outbreak is beginning to demonstrate, an infectious disease outbreak isn’t just bad for the public’s health, it’s bad for business as well.
Now more than ever, it is imperative that lawmakers and employers work hand in hand to protect the nation’s health. Expanding access to permanent paid sick and family leave can strengthen our public health response while protecting workers from economic hardship. Rather than responding to infectious disease outbreaks in a piecemeal and temporary fashion, federal, state, and local policymakers should proactively consider permanent ways to support workers’ ability to take paid sick leave. These policies would not only improve our health and businesses but would also improve our country’s ability to handle diseases like COVID-19.
Adam Lustig is the Manager for Promoting Health and Cost Control in States Initiative at Trust for America’s Health.
Marilyn Cabrera the Policy Associate for the Promoting Health and Cost Control in States Initiative at Trust for America’s Health.