Paid sick leave laws

Paid sick leave laws require employers in the affected jurisdiction to provide paid time off to employees for use when ill or injured. Sick employees may use the time to see a health care provider or stay home until they are healthy enough to work again, without concern for lost wages. As of 2017, the US Bureau of Labor Statistics estimates that 38% of employed adults in the US do not have paid sick leave (US DOL-PSL). Women, Hispanics, low-wage workers, and employees with low levels of education are less likely to have paid sick leave than their counterparts (Chen 2016*); individuals with paid sick leave also tend to have higher incomes (Cook 2011, Clemans-Cope 2008, CWF-Collins 2004). Some local governments cannot enact such measures due to state preemption legislation (Grassroots Change).

Expected Beneficial Outcomes (Rated)

  • Increased access to paid leave

  • Increased access to health care

Other Potential Beneficial Outcomes

  • Improved health outcomes

  • Increased job stability

  • Increased use of parental leave

Evidence of Effectiveness

There is some evidence that paid sick leave laws increase access to paid sick leave (Upjohn-Callison 2016, Romich 2017, Colla 2014), especially among women without a college education (Upjohn-Callison 2016). Paid sick leave can also increase use of health care services (Upjohn-Callison 2016, Cook 2011, Peipins 2012, DeRigne 2017*, DeRigne 2016*, Wilson 2014*). However, additional evidence is needed to confirm effects.

Following implementation of Seattle’s paid sick leave law, employer-offered leave increased for both full and part-time employees, particularly in the hospitality sector (Romich 2017). Access to paid sick leave appears to increase use of physician services (Peipins 2012, Cook 2011) including cancer screenings (Peipins 2012) and flu vaccinations (Asfaw 2017*, Wilson 2014*), and decrease emergency room use for children (Asfaw 2017*) and adults (Upjohn-Callison 2016, Bhuyan 2016*). Parental access to paid sick leave improves children’s access to health care (Asfaw 2017*). Lack of access to paid sick leave appears to lead to lower levels of preventive health care use (DeRigne 2017*) and delayed or forgone medical care, particularly among those with very low incomes (DeRigne 2016*).

Access to paid sick leave is associated with an increased likelihood that employees stay home when they are ill or injured, and to care for children who are ill or injured (Piper 2017), particularly among low income parents (Clemans-Cope 2008). When workers gain access to paid sick leave, flu rates decrease approximately 10%, likely due to fewer employees coming to work while contagious (Upjohn-Pichler 2015); lack of access to paid sick leave may increase the risk of illness for individuals and the spread of contagious illness among the wider population (Kumar 2012*).

Paid sick leave laws do not appear to affect employee’s job tenure or labor force participation, though early study suggests potential for reductions in average weekly hours worked among those most likely to gain paid sick leave (Upjohn-Callison 2016). An initial assessment of Connecticut’s paid sick leave law suggests potential for minimal decreases in employment (Ahn 2015*). Overall, evidence suggests access to paid sick leave can increase job stability (Hill 2013*, Clemans-Cope 2008).

Paid sick leave may lead to positive effects for employers such as decreased turnover, increased productivity, and increased employee loyalty and morale (Chen 2016*). Early assessments of San Francisco’s paid sick leave ordinance suggest variable effects on profits (Colla 2014, NPHL-Baker-White, Urban-Waters Boots 2009), and some adjustments to employee benefit packages among employers who had not previously offered paid sick leave, along with some initial challenges in implementation (Colla 2014).

A cost benefit analysis of Connecticut’s sick leave law estimates average costs of providing paid sick leave of $6.87 per employee, with $12.32 per worker in average benefits (e.g., increased productivity and reduced turnover) leading to overall savings (Chen 2016*). 

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of August 2017, Connecticut, California, Massachusetts, Oregon, Vermont, Washington, and Arizona have enacted statewide sick leave laws, and 33 municipalities including the District of Columbia also enacted local sick leave ordinances (FVW-Paid sick days). State legislation pre-empts laws related to leave in 16 states (Grassroots Change). The federal Healthy Families Act, which would allow all employed Americans to earn paid sick leave, has been proposed on multiple occasions but has not been enacted.

Implementation Resources

CDC-TWH - Centers for Disease Control and Prevention (CDC). Total worker health (TWH).

LAW-Resources - Legal Aid at Work (LAW). Work & family.

NCSL-PSL - National Conference of State Legislatures (NCSL). Paid sick leave.

SF-PSLO - City & County of San Francisco. Paid sick leave ordinance (PSLO).

Citations - Evidence

* Journal subscription may be required for access.

Upjohn-Callison 2016 - Callison K, Pesko MF. The effect of mandatory paid sick leave laws on labor market outcomes, health care utilization, and health behaviors. W.E. Upjohn Institute for Employment Research. 2016: Working Paper 16-265.

Romich 2017 - Romich JL. Local mandate improves equity of paid sick leave coverage: Seattle’s experience. BMC Public Health. 2017;17:60.

Colla 2014 - Colla CH, Dow WH, Dube A, Lovell V. Early effects of the San Francisco paid sick leave policy. American Journal of Public Health. 2014;104(12):2453-2460.

Cook 2011 - Cook WK. Paid sick days and health care use: An analysis of the 2007 National Health Interview Survey data. American Journal of Industrial Medicine. 2011;54(10):771-9.

Peipins 2012 - Peipins LA, Soman A, Berkowitz Z, White MC. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: Results from the National Health Interview Survey. BMC Public Health. 2012;12(1):520.

DeRigne 2017* - DeRigne L, Stoddard-Dare P, Collins C, Quinn L. Paid sick leave and preventive health care service use among US working adults. Preventive Medicine. 2017;99:58-62.

DeRigne 2016* - DeRigne L, Stoddard-Dare P, Quinn L. Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Affairs. 2016;35(3):520-527.

Wilson 2014* - Wilson FA, Wang Y, Stimpson JP. Universal paid leave increases influenza vaccinations among employees in the US. Vaccine. 2014;32(21):2441-2445.

Asfaw 2017* - Asfaw A, Colopy M. Association between parental access to paid sick leave and children’s access to and use of healthcare services. American Journal of Industrial Medicine. 2017;60(3):276-284.

Bhuyan 2016* - Bhuyan SS, Wang Y, Bhatt J, et al. Paid sick leave is associated with fewer ED visits among US private sector working adults. The American Journal of Emergency Medicine. 2016;34(5):784-789.

Piper 2017 - Piper K, Youk A, James AE, Kumar S. Paid sick days and stay-at-home behavior for influenza. PLOS ONE. 2017;12(2):e0170698.

Clemans-Cope 2008 - Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS. Access to and use of paid sick leave among low-income families with children. Pediatrics. 2008;122(2):e480-6.

Upjohn-Pichler 2015 - Pichler S, Ziebarth N. The pros and cons of sick pay schemes: Testing for contagious presenteeism and shirking behavior. W.E. Upjohn Institute for Employment Research. 2015: Working Paper 15-239.

Kumar 2012* - Kumar S, Quinn SC, Kim KH, Daniel LH, Freimuth VS. The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the 2009 H1N1 pandemic. American Journal of Public Health. 2012;102(1):134–40.

Ahn 2015* - Ahn T, Yelowitz A. The short-run impacts of Connecticut’s paid sick leave legislation. Applied Economics Letters. 2015;22(15):1267-1272.

Hill 2013* - Hill HD. Paid sick leave and job stability. Work & Occupations. 2013;40(2):143–73.

Chen 2016* - Chen ML. The growing costs and burden of family caregiving of older adults: A review of paid sick leave and family leave policies. The Gerontologist. 2016;56(3):391-396.

NPHL-Baker-White - Baker-White A. Calling in sick: Analyzing the legal, political and social feasibility of paid sick leave ordinances. Saint Paul: The Network for Public Health Law (NPHL).

Urban-Waters Boots 2009 - Waters Boots S, Martinson K, Danziger A. Employers' perspectives on San Francisco's paid sick leave policy. Washington, DC: Urban Institute; 2009.

Citations - Implementation Examples

* Journal subscription may be required for access.

FVW-Paid sick days - Paid sick days wins. Family Values at Work (FVW).

Grassroots Change - Grassroots Change. Connecting for better health.

Date Last Updated