by Kameron Dawson, Feroza Freeland, Jessica Mason, Katherine Gallagher Robbins and Brittany Williams
Every person gets sick, and no one should be forced to choose between their job and their health, or their family’s health. But lawmakers in 18 statesThis total includes Missouri, where voters decisively passed a ballot initiative in November 2024 that enacted a statewide paid sick days standard, but was subsequently overturned by the state legislature in May 2025. The governor signed the bill into law in July 2025. The paid sick days law that went into effect on May 1, 2025 will be in effect until August 28, 2025. As of August 28, 2025, Missourians will lose the statewide right to paid sick time that they approved and local governments in the state will remain preempted from passing their own protections. across the country – the majority of which are in the South – fail to guarantee that workers can earn paid sick days, and at the same time block local governments from setting their own standards for local workers, families and businesses. New analysis from the National Partnership for Women & Families and A Better Balance reveals that nearly 73 million workers live in these paid sick days preemption states – 43 percent of the U.S. labor forceThe labor force includes all individuals who are employed, or not currently employed but seeking work. Some of these workers have paid sick days through their employers, who are not legally required to provide paid sick days but do so voluntarily – sometimes with significant restrictions. – and that Black and Southern workers, as well as workers who live outside of metropolitan areas, are particularly impacted.
In recent years, thanks in large part to the efforts of organizers, many cities, counties and states have passed paid sick leave laws that support both workers and the economy. Voters across the nation have also taken to the ballot box and passed paid sick leave by large margins and with strong bipartisan support. But despite this growing momentum, policymakers in the 18 states highlighted in this report have put profits over people, preventing progress on paid sick leave at the local level while also failing to extend any statewide paid leave protections.
The effects of these roadblocks and rollbacks are tremendously harmful to workers, families and public health, preventing benefits of paid sick days laws like reduced spread of illness, improved parental health, employment and engagement in child care and better use of preventive health care. Meanwhile, state laws that block local paid sick days have contributed to higher working-age mortality.
For the 73 million workers living in preemption states, paid sick days laws are important both for those without any paid sick leave, and for those whose employers might choose to offer some leave. Currently 27 million workers nationwide cannot earn a single paid sick day, and these workers are disproportionately likely to be in low-wage and part-time jobs and to be women, young workers and people of color. Other workers may be offered paid sick leave on paper, but face punitive attendance policies or retaliation when they try to use it, be unable to take their time to care for a sick child or family member or lose access to paid sick leave simply for changing jobs. When cities and counties are able to enact paid sick days laws, they provide clarity and guaranteed protection for all workers.
New research from the National Partnership and A Better Balance reveals the widespread negative impacts of state actions that block local decision-making on worker protections like paid sick days. Our analysis finds that nearly 73 million people are part of the labor force in the 18 paid sick days preemption states that deny counties, cities and towns the ability to pass paid sick leave laws, representing 43 percent of the total U.S. labor force.
More than 71 percent of workers affected by these laws live in the South. In fact, due to a long history of racist policymaking and anti-Blackness, every state in the South denies local communities the autonomy to make their own decisions on paid sick leave.
While workers of all races and ethnicities are impacted by these laws, Black workers are dramatically overrepresented, with 56 percent of the Black labor force in the United States living in one of these 18 states.
More than 6 million workers who live in these 18 states live outside of metropolitan areas, accounting for more than half of the non-metropolitan labor force in the country. This finding underscores the outsized impact of these laws on small towns and rural communities. The lack of access to paid sick days in rural communities is troubling, as these residents often have to travel farther to access health care and are more likely to work in physically demanding jobs such as manufacturing and farming, in which workers often lack paid sick time.
More than 15 million economically insecure workers live in these paid sick days preemption states – roughly half of all economically insecure workers in the country. Workers who are not economically secure are least able to afford taking any leave without pay, or potentially losing their job altogether, when they or their loved ones become ill and lack access to paid sick leave.
Nearly 5.5 million disabled workers – 46 percent of the nation’s disabled labor force – live in the 18 paid sick days preemption states. Disabled people are a growing share of the workforce, and may need paid sick leave not only to manage their own health but also to support their caregiving responsibilities. Yet because they are more likely than nondisabled people to work in part-time jobs – which are less likely to offer paid sick days – laws that guarantee sick leave are an important employment support.
More than 23 million parents who are taking care of children live in these states. Without adequate paid sick leave, many parents are forced to choose between their paychecks and their own, or their children’s health. Meanwhile, paid sick days laws increase employment and wages, particularly for women without college degrees and those with child care responsibilities, and support parents’ ability to care for their children.
These laws impact workers across a range of industries and occupations, especially in the manufacturing sector.
More than 10.3 million workers ages 16-24 live in these 18 states. Young workers are less likely to work in jobs that provide paid sick leave and are particularly at risk in these states. While young workers of all racial and ethnic groups are impacted by the harmful laws in these 18 states, young Black workers are especially harmed. Nearly 1.8 million young Black workers live in these states, representing 59 percent of young Black workers nationwide – the largest share of any group of young workers.
Voters across states and party lines have made it clear they want access to paid sick leave. But at the behest of corporate interest groups like the Chamber of Commerce and the American Legislative Exchange Council (ALEC), state legislators have passed laws that deny local communities the opportunity to make progress. These actions not only harm people’s health and economic security, but also the overall health of our democracy. It is vitally important that all local communities – rural, suburban and urban – have the freedom and autonomy to enact policies that address the needs of working families. These laws are part of a growing and concerning trend of harmful state interference efforts that take away local decision-making power, particularly in the South. As the fight for paid sick leave continues, local communities are fighting back.
Methodology
Authors’ analysis of American Community Survey five-year data set 2019-2023 via IPUMS.org.
- “Workers” in this analysis include both employed workers and those seeking work and thus capture the entire labor force. Workers are recorded at their place of residence, rather than employment.
- Racial categories in this analysis include people who identify as Latino and/or Hispanic.
- People are identified as having a disability in this analysis if they responded that they have difficulty in one or more of the following six realms: vision, hearing, cognitive, ambulatory, self-care, and independent living. People may have multiple disabilities. This is a limited definition of disability that excludes a portion of disabled people. For more information on how disability is measured in the American Community Survey please see the U.S. Census Bureau’s report How Disability Data are Collected from The American Community Survey.
- While people across the income spectrum may have difficulty making ends meet, in this analysis we define “economically insecure” as living in a family below 200 percent of the federal poverty line.
- This analysis defines “parents” as having at least one own child (including step, adopted, or biological) under the age of 18 in the household. Due to data limitations, there are parents who are not included in this definition, including those who have non-resident or older children and those whose children have passed away.
- Due to data limitations, this analysis does not include people who identify as nonbinary people.
- For this analysis, the South includes Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.
- States that do not permit localities to make laws advancing paid sick leave come from the Economic Policy Institute. We do not include states that have statewide paid sick days. North Dakota’s law impacts only paid family and medical leave and is not part of this analysis. Missouri’s paid sick days law, which was passed by ballot initiative November 5, 2024, went into effect on May 1, 2025, but was overturned by HB 567 (passed May 14, 2025, signed into law July 10, 2025). While this is in effect as of the publication of this analysis, the repeal is set to go into effect August 28, 2025, and so Missouri is considered a paid sick days preemption state in this analysis.
This analysis has been updated to reflect the Governor of Missouri signing HB 567 into law.
The authors are grateful to Sharita Gruberg, Areeba Haider, Mettabel Law, Jared Make, Grace Nielson and Gail Zuagar for their review and thoughtful comments.
