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Even though 21 jurisdictions in the United States have or will soon have a paid sick days law in place, millions of workers throughout the country don’t have access to paid sick days. That’s the key finding of a new analysis by the Institute for Women’s Policy Research (IWPR), in collaboration with the National Partnership for Women & Families. The analysis confirms that a national standard is critical.

According to the report, Workers’ Access to Paid Sick Days in the States*, which looked at the 42 states that have not adopted any state or municipal paid sick days laws, the percentage of workers without paid sick days varies from a high of 49.7 percent in New Mexico to a low of 38.9 percent in New Hampshire. Nationally, between 43 and 48 million workers – nearly 40 percent of the private sector workforce – lack access to paid sick time.

Some states do significantly worse than the nation overall. The five states with the highest percentages of workers without access to paid sick days (48 percent or more of each state’s private sector workforce) are New Mexico, Idaho, Nevada, Montana and South Dakota. In Texas alone, which has the largest private sector workforce included in the analysis, more than four million people do not have paid sick time.

A growing body of research shows clearly the harm a lack of paid sick days can do to workers, families, businesses and state and local economies. Workers without paid sick days are more likely to go to work sick or send a sick child to school or day care, risking the public’s health and increasing health care costs. If sick workers without paid sick time stay home, they lose pay and risk job loss and discipline, which can lead to reduced productivity and replacement costs for businesses. Analyses of existing laws show paid sick days make business and economic sense.

This new report and the marked disparities in access to paid sick days across states make clear that a federal paid sick days law like the Healthy Families Act is badly needed. No worker – no matter where she lives or works – should have to risk her health or financial security and ability to put food on the table when common illnesses arise. Progress will continue at the local and state levels, but it is past time for Congress to act.

* Workers’ Access to Paid Sick Days in the States relies on data from the 2012-2013 National Health Interview Survey and the 2013 1-year IPUMS American Community Survey.