In the spring of 2023, my husband was abruptly laid off from his job just before a long-planned surgery. While the surgery went well, he suffered from infections over several months that kept him in and out of hospitals and doctors’ offices. Overnight, I became the sole caregiver and breadwinner, without any familial support nearby.
During one of our many hospital visits, I reached out to my supervisor – at nearly 4 a.m. – to share that we were still at the hospital waiting on antibiotics. She quickly responded and suggested that I take the day off since we had been there for more than seven hours. Not only did having my supervisor’s support take a tremendous weight off my shoulders, but having paid time off to care for my recovering partner kept us from falling into a financially precarious situation. As a result of having paid sick days (also referred to as Earned Sick Leave), I could care for my husband without being forced into an impossible decision: supporting his recovery or having a paycheck to support us.
At some point, everyone gets sick – but no one chooses to get sick. And no one should have to decide between recovering or caring for their loved ones and being able to make ends meet. But as of 2024, nearly 27 million workers lacked paid sick days through their employer. While employers can and sometimes do voluntarily offer workers paid sick days, it’s not a guaranteed benefit for all.
A recent report from the National Partnership for Women and Families found that 18 states across the country – the majority of which are in the South – fail to guarantee that workers can earn paid sick days. What’s more, those states block local governments from setting their own standards through a practice known as preemption. In fact, nearly 73 million workers (43% of the U.S. labor force) live in states that preempt Earned Sick Leave. Black workers, as well as workers who live outside metropolitan areas, are particularly impacted by state-level preemption.
Currently, residents in 19 states, 17 cities, and four counties benefit from Earned Sick Leave laws. Workers with Earned Sick Leave are 1.5 times less likely than those without to report going to work with a contagious illness. Yet many public-facing workers, especially in food service and care industries, still lack this protection, potentially putting others at risk.
Without Earned Sick Leave, people are also more likely to delay or skip medical care altogether, turning minor illnesses into serious health or financial crises. Research suggests that paid sick days are associated with improved life expectancy, and that if all large U.S. metropolitan counties implemented such laws, mortality could decline by more than 5%.
Earned Sick Leave is especially critical for families. Seven in ten school-aged children miss at least one day of school each year due to illness or injury, but a census survey found that only about one in four parents can take paid time off to care for them. Parents without Earned Sick Leave are more than twice as likely to send a sick child to school or daycare, risking wider outbreaks. Many are also forced to rely on expensive emergency room visits for non-urgent care because they can’t miss work during regular clinic hours – straining already overburdened hospitals and jeopardizing care for those in greater need.
The need for Earned Sick Leave is abundantly clear. As jurisdictions continue to pass Earned Sick Leave laws, workers across the nation have also taken to the ballot box via referendums: last November, voters in three states, Alaska, Missouri and Nebraska overwhelmingly supported Earned Sick Leave measures.
Despite the tremendous victories, the recently passed laws have been under attack:
- Alaska: The state’s legislature attempted to modify Ballot Measure 1, which provides workers with earned sick and safe leave by limiting who is able to earn sick leave and more. As of July 1, 2025, Ballot Measure 1 went into effect without any change. Alaska workers may now earn one hour of earned sick and safe leave for every thirty hours worked.
- Missouri: Proposition A, which provides workers with the right to earn sick and safe leave and raises the minimum wage, has been repealed. Before its repeal, Missouri lawmakers filibustered legislative attempts to overturn the state’s Earned Sick Leave law. In April, the Missouri Supreme Court upheld the ballot initiative. In May, the Missouri legislature overturned the will of the people and passed HB 567, which repeals Proposition A. On July 10, Governor Kehoe signed HB 567 into law and the repeal went into effect on August 28, 2025. After August 28, 2025, Missouri workers will no longer be able to earn sick and safe leave and will lose any leave accrued since May 1, 2025.
- Nebraska: Lawmakers attempted to undo ballot measure Nebraska Initiative 436, which allows workers to earn paid sick leave. While lawmakers did not repeal Earned Sick Leave, the legislature did modify the ballot measure, excluding young teens aged 14 and 15, temporary, seasonal agricultural workers and workers at businesses with 10 or fewer employees. In June 2025, Governor Pillen signed LB 415 into law, barring thousands from the right to Earned Sick Leave.
- Michigan: In 2018, Michigan successfully passed an Earned Sick Leave ballot initiative. Shortly after its passage, the Michigan legislature passed a bill that greatly undermined the new law. Last July, the Michigan Supreme Court reinstated the 2018 Earned Sick Leave law. Earlier this year, the Michigan legislature made key changes to the law, including excluding certain employees, limiting carryover, and removing the private right of action.
While some state legislatures work to undo sick leave laws, others continue to work to provide more workers with Earned Sick Leave. For example, Oregon lawmakers introduced legislation to provide Uber and Lyft drivers with Earned Sick Leave. New York City and Seattle were the first cities to pass ordinances that allowed app-based workers to accrue Earned Sick Leave.
When my husband was recovering, having sick leave gave me something priceless: the ability to show up for him fully without fearing we would lose our financial footing. But millions of families aren’t given that chance. One day, all of us will need time to heal or to help someone else heal. Earned Sick Leave laws help make sure that when that day comes, workers are not forced into choosing between recovering or caring for their loved ones and being able to make ends meet.
Credits: The author would like to thank Gail Zuagar, Udochi Onwubiko, and Delesiya Davis for their contributions.
