Americans are a sick people. Among their economic peers they expect to live shorter lives, experience higher rates of chronic disease, and spend more on their care and upkeep. The baseline necessities for maintaining a healthy human body over the course of a lifetime are often a luxury. Nevertheless, one in five Americans lack the ability to take a paid sick day from work if they fall ill. 

Health care — from ease of access to programs like Medicaid to a woman’s ability to access abortion care — is governed by a patchwork of increasingly complex state-level laws and policies. Sick leave is no different. 

Across the private sector and state and local governments, around 26.5 million employees do not have access to paid sick time, according to the Bureau of Labor Statistics released this year. The disparity is concentrated among low-income, part-time, and service industry workers, only about half of whom have access to paid sick days. Among the lowest 10 percent of earners, only 41 percent have paid sick leave, while 94 percent of the top 25 percent of earners have it. 

There is no federal law guaranteeing what, in most developed countries, is an uncontested, uncontroversial workers’ right. In fact, even as voters push to codify sick leave policies into local law, this year alone at least three Republican-controlled states are attempting to roll back leave provisions. 

In Missouri, voters overwhelmingly approved a referendum guaranteeing statewide paid sick leave, and an increase to the state’s minimum wage. Shortly after the mandate went into effect, Republicans in the legislature repealed it outright. In Nebraska, Republicans tacked on an amendment to a similar law — also passed by referendum — that significantly narrowed the pool of businesses covered, and which employees were entitled to the benefit. The amendment also stripped employees of the right to sue over the enforcement of the law. In Alaska, the state’s Republican administration worked to limit the scope of its own ballot-approved sick leave law via regulations instituted by the Alaska Department of Labor & Workforce Development. 

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“Fifty-seven percent of the people voted for it,” Missouri Senate Minority Leader Doug Beck, a Democrat, tells Rolling Stone of the state’s referendum. “One-hundred and nine out of 163 representative districts, which would be a super majority, voted for it. Twenty out of 34 Senate seats voted for it, and six out of eight congressional seats voted for — so it’s pretty much a mandate.. Republicans overturned that.” 

Beck says Democrats tried to negotiate a way to preserve coverage for as many Missourians as possible, even if it meant limiting what businesses would be subject to the law, only to have the rug pulled out from them at the last moment. 

“We got there and … they reneged on their deal in the middle of the middle of the night,” he adds. 

In an era where politics tend to split the American population down the middle, support for the right to paid sick leave, and other forms of paid medical leave, is an issue that has astronomically high support across the United States. The lawmakers and advocates who spoke to Rolling Stone agreed on one thing: It’s not voters who are pushing for the weakening of leave policies, but business interests and corporate lobbies. 

“The most vocal group against this was the restaurant industry, which, you know, relies on underpaying workers,” Beck said, adding that the Missouri Chamber of Commerce had also lobbied heavily against the legislation. 

Dawn Huckelbridge, founding director of the advocacy group Paid Leave for All, has been fighting for a federal law guaranteeing paid sick leave since 2019. “There’s been a bill around [in Congress] forever that has never gotten a vote,” she tells Rolling Stone. “I know in the case of paid leave, paid family medical leave, it was largely the Chamber of Commerce that was a big lobbying force against it.” The general argument — similarly to arguments against increases in the minimum wage and other basic guarantees for working class people — is that the cost of a few sick days a year would place undue burdens on employers and small businesses. 

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“In states that have passed it, the vast majority of employers do support it,” Huckelbridge adds, pointing to data indicating that paid sick leave policies actually save businesses billions of dollars in the long run, and improves health outcomes for individuals and families. “There’s piles of data that show this is good for business, this is good for public health, and yet in this country, we have refused to take action.” 

The U.S. had a brief moment of clarity during the Covid-19 pandemic, when the spread of a deadly, easily transmissible virus sent the national health apparatus into a crisis. During the pandemic, the federal government passed the nation’s first ever federal paid sick days and paid family leave policies — the Families First Coronavirus Response Act (FFCRA) — which was allowed to expire in 2023. 

Subsequent research found that the national policy prevented tens of thousands of daily coronavirus cases across states that previously lacked paid sick leave policies. 

“[Businesses] were fine with it. The sky didn’t fall down. Business was fine,” Huckelbridge says “I think that the inaction on common sense bipartisan things like paid leave goes hand in hand with the gutting and the undermining of the little social safety net that we have.” 

The state-level tug of war over the expansion of paid medical leave policies is taking place amid a federal bulldozing of the nation’s primary health systems. This summer, Republicans passed the largest cuts to Medicaid in the program’s history, with the knowledge that over 10 million people are expected to lose access to their insurance over the next few years. The cuts are expected to decimate rural hospitals and community health clinics — which often rely on Medicaid funding to stay afloat and may be the only connection individuals have to medical care. 

The federal government is currently shut down after Republicans refused to extend tax credits for Affordable Care Act subsidies, which if allowed to expire would skyrocket the health care premiums of millions of Americans who purchase health care through the public marketplace. 

Rep. Rosa DeLauro (D-Conn.) is the House sponsor of the Healthy Families Act, which would allow workers in businesses with 15 or more employees to earn up to seven job-protected paid sick days each year. The act has been languishing in Congress without any advancement. As the Capitol sits in tense silence amid negotiations to reopen the government, American’s health is at the forefront of her concerns. 

“Take House members, Senate members. If somebody in their family gets sick, if they get sick, they go get well. … You take as much time as you need. You don’t even ask. You just do it. Your kid is sick. You go home and you take care of your kids,” she tells Rolling Stone. “It’s just shortsightedness. It defies imagination that we would not think that people shouldn’t have to choose between caring for their families, for themselves, or keeping their jobs.” 

“Everything [Republicans] are doing in the health care realm is making people more sick and people will die,” she adds.

For health care advocates, the absence of paid leave policies are part of an intricate web of systemic failures that lead to worse outcomes for patients, and higher public expenditures for their care. Those without leave policies are less likely to seek prompt care for illnesses. Working sick gets coworkers sick. Couple that with a lack of reliable access to health insurance — or insurance that still bleeds the patients dry — and quality care facilities, and it’s not hard to see why the U.S. lags behind its peers in practically every health metric. 

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“The big context is that our health care system is broken, it is rigged against working people, and it has been that way for a long time,” Sen. Tina Smith (D-Minn.) tells Rolling Stone. “During the pandemic there was a moment of clarity, policymakers said, ‘We can’t let people just we can’t let people’s lives fall apart,’ and so we put into place sort of these pretty common-sense steps to help people. But of course, now we’re seeing a huge backsliding as the Republicans are trying to unwind all of that.” 

Smith adds: “No wonder people in this country are pissed off when we can’t do something that is so clearly in the best interest of the majority of Americans.”