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S. HRG. 110–296 

THE HEALTHY FAMILIES ACT: SAFEGUARDING 

AMERICANS’ LIVELIHOOD, FAMILIES AND 

HEALTH WITH PAID SICK DAYS 

HEARING 

OF THE

COMMITTEE ON HEALTH, EDUCATION, 

LABOR, AND PENSIONS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

ON

EXAMINING THE HEALTHY FAMILIES ACT, FOCUSING ON SAFEGUARDING AMERICANS’ LIVELIHOOD, FAMILIES, AND HEALTH WITH 

PAID SICK DAYS 

FEBRUARY 13, 2007 

Printed for the use of the Committee on Health, Education, Labor, and Pensions 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/senate 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS 

EDWARD M. KENNEDY, Massachusetts, Chairman 

CHRISTOPHER J. DODD, Connecticut 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

JEFF BINGAMAN, New Mexico 

PATTY MURRAY, Washington 

JACK REED, Rhode Island 

HILLARY RODHAM CLINTON, New York 

BARACK OBAMA, Illinois 

BERNARD SANDERS (I), Vermont 

SHERROD BROWN, Ohio 

MICHAEL B. ENZI, Wyoming, 

JUDD GREGG, New Hampshire 

LAMAR ALEXANDER, Tennessee 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LISA MURKOWSKI, Alaska 

ORRIN G. HATCH, Utah 

PAT ROBERTS, Kansas 

WAYNE ALLARD, Colorado 

TOM COBURN, M.D., Oklahoma 

J. MICHAEL MYERS, Staff Director and Chief Counsel 

KATHERINE BRUNETT MCGUIRE, Minority Staff Director 

(II) 

C O N T E N T S 

STATEMENTS 

TUESDAY, FEBRUARY 13, 2007 

Page 

Kennedy, Hon. Edward M., Chairman, Committee on Health, Education, 

Labor, and Pensions, opening statement ........................................................... 1 

Prepared statement .......................................................................................... 3 

Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming, opening 

statement .............................................................................................................. 4 

Prepared statement .......................................................................................... 6 

Ness, Debra, President, National Partnership for Women and Families, Washington, DC ............................................................................................................. 10 

Prepared statement .......................................................................................... 12 

Heymann, Jody, M.D., Ph.D., Professor at McGill University, Director, McGill 

Institute for Health and Social Policy and Project on Global Working Families, Montreal, Quebec ......................................................................................... 16 

Prepared statement .......................................................................................... 17 

Hartmann, Heidi, Ph.D., President, Institute for Women’s Policy Research, 

Washington, DC ................................................................................................... 23 

Prepared statement .......................................................................................... 25 

Bhatia, Rajiv, M.D., MPH, Director of Occupational and Environmental 

Health for the San Francisco Department of Public Health and Assistant 

Clinical Professor of Medicine at University of California at San Francisco, 

San Francisco, CA ................................................................................................ 34 

Prepared statement .......................................................................................... 36 

King, G. Roger, Partner, Jones Day, Columbus, OH ............................................ 38 

Prepared statement .......................................................................................... 41 

ADDITIONAL MATERIAL 

Statements, articles, publications, letters, etc.: 

Harkin, Hon. Tom, a U.S. Senator from the State of Iowa, prepared 

statement ....................................................................................................... 62 

Clinton, Hon. Hillary Rodham, a U.S. Senator from the State of New 

York, prepared statement ............................................................................ 63 

Brown, Hon. Sherrod, a U.S. Senator from the State of Ohio, prepared 

statement ....................................................................................................... 64 

Dancing Deer Baking Co. ................................................................................. 64 

Medical Legal Partnership for Children ......................................................... 65 

Children’s Hospital Boston .............................................................................. 66 

Jeff Levi, Ph.D., Executive Director, Trust for America’s Health (TFAH) .. 67 

Response to questions of Senator Kennedy by: 

Deborah Ness ............................................................................................. 67 

Jody Heymann, M.D., Ph.D. ..................................................................... 75 

Rajiv Bhatia, M.D., MPH .......................................................................... 82 

(III) 

Page

IV 

Response to questions of Senator Enzi by: 

Debra Ness ................................................................................................. 71 

Jody Heymann, M.D., Ph.D. ..................................................................... 80 

Rajiv Bhatia, M.D., MPH .......................................................................... 83 

G. Roger King ............................................................................................ 84 

Response to questions of Senator Coburn by: 

Jody Heymann, M.D., Ph.D. ..................................................................... 81 

Rajiv Bhatia, M.D., MPH .......................................................................... 84 

G. Roger King ............................................................................................ 85 

Questions of Senator Kennedy to Heidi Hartmann, Ph.D. ........................... 87 

(1) 

THE HEALTHY FAMILIES ACT: SAFEGUARDING AMERICANS’ LIVELIHOOD, FAMILIES AND HEALTH WITH PAID SICK DAYS 

TUESDAY, FEBRUARY 13, 2007 

U.S. SENATE, 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, 

Washington, DC. 

The committee met, pursuant to notice, at 10:07 a.m. in Room 

SD–430, Dirksen Senate Office Building, Hon. Edward M. Kennedy, chairman of the committee, presiding. 

Present: Senators Kennedy, Sanders, Brown, Enzi, Isakson, and 

Allard. 

OPENING STATEMENT OF SENATOR KENNEDY

The CHAIRMAN. We’ll get—this is off the record or you can put 

it on. We’ll get started in just a few minutes. We have—Senator 

Enzi and I had the report from the Aspen Commission. It was Governor Thompson and Governor Barnes on the No Child Left Behind 

and we had a conference with our House colleagues and a number 

of members of the press and they were somewhat slow arriving. 

They had all the members of the commissions. Many had traveled 

far distances so we were a few moments tardy but Senator Enzi 

will be here momentarily and we’ll get started. I’m very grateful for 

all of your presence here. 

We received good news that we’re not going to be interrupted by 

votes. We’ll have until 2:30 this afternoon. I think we can finish by 

then. You might not be able to get out of here with the snow. 

That’s something that New England does and people from Wyoming but we’ll get started in just a very few moments. I’m very appreciative. We’ve got an excellent panel here. 

We’ll come to order. Senator Enzi and Senator Isakson, I just reminded our panel that we were necessarily delayed to receive really excellent recommendations of the Aspen Commission on the No 

Child Left Behind. We welcome the opportunity now to move ahead 

on this very important issue. 

Each of us knows what it means to be sick. We all had to miss 

occasional days of work because of illness and every parent knows 

what it is like to care for a sick child. As a Member of Congress, 

we don’t lose our pay or risk our jobs if we stay home when illness 

strikes but millions of Americans aren’t so fortunate. Half of the 

private sector workers in the United States do not have paid sick 

days. Seventy percent don’t have paid sick days they can use to 

care for family members. You can’t take a day off to recover from 

2 

the flu. They can’t leave work to care for a child who is running 

a fever. 

This lack of protection is particularly difficult for women and 

children. Women have moved into the workforce in record numbers. 

They continue to take primary responsibility for their children’s 

health. Nearly 80 percent of mothers say they are solely responsible for their children’s medical care. 

We’re talking about hardworking people, like Stephanie Scott 

and Elnora Collins who are here today. Stephanie is a full-time 

teacher at a day care center. She and her colleagues, who have 

been at her workplace for years, have no sick days. Elnora is a 67- 

year-old home care worker who is caring for two granddaughters. 

She has no paid sick days. She tells us, one time I was sick, I 

threw up at a client’s house. She loves caring for older citizens but 

she needs time off to care for her own health. 

Children need their parents to have paid sick days. I have a letter from four pediatricians, the Boston Medical Center in the South 

End Community Health Center that I’ll include in the record. 

[The material referred to can be found in additional materials.] 

The CHAIRMAN. But briefly, they say, ‘‘We strongly support the 

Healthy Families Act because we believe it could be one of the most 

powerful treatments we have for children. By supporting the 

Healthy Families Act, you’re supporting minimizing expensive hospital stays for children and getting parents back to work more 

quickly.’’ If we truly care about families, we must change our policies. We need laws that let working men and women be responsible 

parents, too. 

The lack of paid sick days is not just a family issue. It’s also a 

public health issue. Sick people go to work or sick children go to 

school. They infect co-workers or fellow workers and the public. In 

fact, many workers who have constant contact with the public have 

no paid sick days. Eighty-five percent of food service workers and 

55 percent of workers in the retail industry are denied that benefit. 

Thirty percent of health care workers can’t take paid time off 

when they are ill. Paid sick days are the obvious solution to prevent the spread of illnesses and reduce medical costs. They would 

result in significant savings to our economy and our health care 

system. That’s why employers support paid sick days, too. 

Dancing Deer Bakery, a small business in my hometown of Boston says a national paid sick day law creates a level playing field 

for all businesses. We hope that a bill will move through the Chambers, beyond the President’s desk. Paid sick days should be a nonpartisan issue. A healthy nation is a productive nation. 

Paid sick days for workers is a vital step to address health needs. 

That’s why I’m re-introducing the Healthy Families Act to provide 

the seven paid sick days to workers each year. 

We are very mindful on our committee that this is the committee 

that had the Family Medical Leave bill. Leaders were my good 

friend, Senator Dodd. Five years of hearings before we finally 

passed that. And I know that has unpaid family medical leave and 

Senator Dodd is really leading in trying to make sure we make 

some progress in that area. Senator Murray on our committee as 

well, has a more modest approach, particularly to provide time off 

3 

for parents work with teachers, in terms of the educational kind of 

component. And she is enormously committed. Others have different ideas. We hope we’ll be able to find the common ground and 

get some work done in this area. 

[The prepared statement of Senator Kennedy follows:] 

PREPARED STATEMENT OF SENATOR KENNEDY

Each of us knows what it means to be sick. We’ve all had to miss 

occasional days of work because of illness. Every parent knows 

what it’s like to care for a sick child. 

As members of Congress, we don’t lose our pay or risk our jobs 

if we stay home when illness strikes. But millions of Americans 

aren’t so fortunate. 

Half of private-sector workers in the United States do not have 

paid sick days. Seventy percent don’t have paid sick days they can 

use to care for family members. They can’t take a day off to recover 

from the flu. They can’t leave work to care for a child who is running a fever. 

Among workers in the lowest income quarter, 80 percent do not 

have the ability to take time off for an illness without losing their 

pay or even their jobs. 

This lack of protection is particularly difficult for women and 

children. Women have moved into the workforce in record numbers, 

but they continue to take primary responsibility for their children’s 

health. Nearly 80 percent of mothers say they are solely responsible for their children’s medical care. 

We’re talking about hard-working people like Stephanie Scott 

and Elnora Collins, who are here today. Stephanie is a full-time 

teacher at a day-care center. She and colleagues who have been at 

her workplace for years have no sick days. Elnora is a 67-year-old 

home care worker who is caring for two granddaughters. She has 

no paid sick days. She tells us, ‘‘One time I was so sick, I threw 

up at a client’s house.’’ She loves caring for older citizens, but she 

needs time off to care for her own health. 

We’re talking about children like Jennetta Allen of Georgia. She 

says, 

‘‘Once when I was little I got real sick at school. I waited and 

waited but Mom never came. . . . When my Mom finally made 

it home she was crying more than I was. She told me her boss 

would not let her leave. My Mom was fired because her boss 

thought I might get sick again!’’ 

Children need their parents to have paid sick days. I have here 

a letter from four pediatricians who work at Boston Medical Center 

and the South End Community Health Center. I will include this 

letter in the record, but, briefly, they say: 

‘‘We strongly support the Healthy Families Act because we 

believe [it] could be one of the most powerful treatments we 

have for children. By supporting the Healthy Families Act, you 

support minimizing expensive hospital stays for children, and 

getting parents back to work more quickly.’’ 

If we truly care about families, we have to change our policies. 

We need workplace laws that let working men and women be responsible parents too. 

4 

The lack of paid sick days is not just a family issue—it’s also a 

public health issue. When sick people go to work or sick children 

go to school, they infect coworkers or fellow students and the public. 

In fact, a high proportion of workers who have constant contact 

with the public have no paid sick days—85 percent of food service 

workers and 55 percent of workers in the retail industry are denied 

that benefit. Thirty percent of health care workers can’t take paid 

time off when they’re ill. 

Paid sick days are the obvious solution to prevent the spread of 

illnesses and reduce medical costs. Every day we see stories in the 

paper of stomach illnesses breaking out in restaurants or on cruise 

ships. We learn of flu outbreaks leading to hospitalization of the elderly. These diseases are very contagious, but their spread can be 

minimized if sick people stay at home. 

Paid sick days also give people the opportunity to obtain medical 

treatment for illnesses or chronic medical conditions. We all know 

that preventive care helps reduce medical costs. 

For all these reasons, paid sick days would result in significant 

savings to our economy and our healthcare system. 

That’s why employers support paid sick days too. Dancing Deer 

Bakery, a small business in my hometown of Boston, Massachusetts, has written a statement that I will include in the record, saying that: 

‘‘A national paid-sick-days law creates a level playing field 

for all businesses. . . . We hope that a bill will move through 

both Chambers and be on the President’s desk. Paid sick days 

should be a non-partisan issue. A healthy nation is a productive nation.’’ 

Paid sick days for workers is a vital step to address health needs. 

That’s why I’ll be re-introducing the Healthy Families Act—to provide 7 paid sick days to workers each year. 

We must also move to take steps to deal with other family and 

work issues. We need to protect workers who seek greater flexibility in the workplace. We need to expand family and medical 

leave—an issue which Senator Dodd has led for many years. We 

need to provide affordable child care, such as Senator Murray’s bill 

to allow time off for parents to attend teacher conferences. 

The world and the workforce are changing, and our laws have to 

catch up. I look forward to hearing from our witnesses today about 

how we can move forward and make paid sick days our national 

law. 

The CHAIRMAN. I recognize Senator Enzi. 

OPENING STATEMENT OF SENATOR ENZI

Senator ENZI. Thank you, Mr. Chairman, I ask that my prepared 

statement be a part of the record and included. 

The CHAIRMAN. It will be so included. 

Senator ENZI. Normally I would begin by thanking the Chairman 

for holding this important hearing but I’ve been through a whole 

range of emotions on this and had a lot of difficulty with that statement until I read the testimony. I agree with the testimony that 

is to be presented. When paid sick leave is provided, it makes a treVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
5 

mendous mental impression on people and helps them out with 

their daily lives. 

One of my concerns is, if we make that a law, is it then the same 

category and the same incentive that it is when it’s done voluntarily? We’ve been holding roundtables and I know that from an informational standpoint and statistical standpoint that doing it this 

way is adequate. There are a lot of other opinions that I would 

have like to have had brought into the mix and we’re very limited 

in a hearing situation to do that. 

But I don’t want the public to think that business people just sit 

around and say, what do you think Congress would like us to do 

on paid sick leave or vacations or any of the other employee benefits that they have to wrestle with—and I say wrestle with because 

I’ve been one of those small businessmen. We do it to be sure that 

we have employees, as effective employees as possible, as consistent of employees as possible and we grapple with how to do it 

and how to beat the competition on it. You have to be a little better 

than the other guy in order to get the employee that you want. And 

consequently, across this nation, of those who do provide paid sick 

leave, there is a huge variety of ways of doing that and a huge variety in number of days of doing that. I’ve actually read the bill and 

I’ve made a lot of comments in the margin on it and this dictates 

a way that some, maybe even a majority of businessmen are providing paid sick leave but it isn’t the only ways that they’re doing 

it and isn’t the only amount of time and there is a variety between 

how many days a week people work and how many days sick leave 

there are and ease of calculation and ease of record keeping is very 

important, particularly to small businessmen. 

Now I noticed that this excludes businesses of 15 or smaller. I’m 

not sure why it doesn’t exclude businesses of 50 or smaller so that 

it complies with the Family Medical Leave Act. That seems to be 

the standard we’ve established for ultra-small businesses and ones 

that would have difficulty with processing it. I know when I was 

in the shoe business, we started with half a day per month for sick 

leave. Now that only comes to 6 days a year. We also found out 

that quite often what that was, as in addition to their paid vacation because a lot of times, they were sick when they needed to go 

somewhere. Some of my accounting practices, I found that was also 

helpful and recommended to a couple of people that most of the accidents that they had where people took workers comp, which was 

a paid time off, happened usually the day before hunting season 

and they ought to consider giving hunting season off as a paid vacation for their people and it would make a difference. You know 

and you run into the guy that just got back from an elk hunting 

trip and say, I thought you were off with an injury. Well, I was off 

from an injury. I said what did you do? And he said, well I went 

elk hunting. I said, how did you get into the backcountry? Well, I 

hiked. How did you get your elk out? I backpacked it. And he was 

out for a back injury. So there are different circumstances and the 

businessman has to deal with that and try to figure out how he can 

make his employees as comfortable as possible with the benefits 

that he is able to afford. 

Oh, yes. Afford. That does play a major role in it. There are a 

lot of things that small businessmen would do for their employees 

6 

if they could afford it. When we’re mandating paid days off, we’re 

mandating that they pay for it. It’s an unfunded mandate from the 

Federal Government. We’re not saying if you will give your people 

time off, we’re going to allow that as an additional tax credit because when you let somebody off, you have to fill that position in 

a small business. It isn’t like you had an extra position. If you had 

an extra position, you’d have fired the person. So it’s a necessary 

position and quite often, it’s not necessary all of the year but you 

pay them in the times that the work is really slow so that you have 

them during the times that it’s really busy, although that is time 

that often they get sick. 

But you have to pay the person and then you have to pay the 

person that replaces them or you fill in for them yourself. I’m 

aware of a guy in my home town that owns three restaurants and 

he keeps adding more people to his staff but if I want to find him, 

I can go to one of those three restaurants and he’ll be waiting tables because he didn’t have enough people that day. Now when he 

does that, he still has to spend the night doing the stuff that he 

would have done during the daytime, even though he tries to pay 

additional people to do it. So these things aren’t quite as easy as 

they sound. 

It would really be nice to give everybody the same amount of 

paid leave that the Federal Government gets. Affording it is the 

difficulty. It would be nice to do the paid vacation the same way. 

Do you know why we don’t just prescribe all of those things? I do 

know why we don’t prescribe all of those things. We haven’t figured 

a way for the small businessman to afford it. So I do look forward 

to the testimony. I appreciate the effort that went into it. I do have 

probably more questions than we can cover during the time that 

will be allotted on it and I hope all of you will respond to those 

questions as well because that information will be extremely helpful to us in whatever kind of a solution we can come up with. 

Thank you. 

[The prepared statement of Senator Enzi follows:] 

PREPARED STATEMENT OF SENATOR ENZI

I want to thank the chairman for holding this hearing and I also 

want to thank the panel for their willingness to participate in this 

important dialogue. 

Anyone who works for a living is keenly aware of the time demands that work imposes. The task of balancing work and family 

life is never easy, and when illness compounds the situation, the 

challenge becomes even greater. Most private sector employers are 

acutely aware of this reality and increasingly responsive to it. 

In the most recent member benefit survey conducted by the Society for Human Resource Management, 86 percent of the respondents reported that their companies provided paid sick leave either 

under a separate sick leave program, or as part of a general paid 

time off plan. More than 80 percent also indicated that they provide both short-term and long-term disability insurance coverage. 

In addition, an increasing number utilize even more creative approaches such as paid time off, and sick leave banks, or pools. 

7 

The more broadly-based National Compensation Survey reveals 

that on an overall national basis 68 percent of full-time employees 

have access to paid sick leave programs at work. 

Most employers make these provisions both because they know 

that a healthy workforce benefits their business; and, because they 

know that in a competitive labor market, such as the one we have 

right now, they must address this issue to attract and retain quality employees. 

Today, the average cost of employee benefits for all employers in the private sector is nearly $7.50 an hour. Average benefits now 

comprise nearly 30 percent of total payroll costs. That number has 

been increasing over the years, and such numbers support the importance that most employers attach to providing meaningful benefit packages, including provisions for illness-related absences, for 

their employees. 

Despite these facts, however, some employees do not have paid 

sick leave available to them at their place of work because many 

of these individuals are part-time employees and many work for 

smaller employers. Those small employers very often face the same 

cost squeeze and financial pressures that their own employees face. 

Many business owners view their employees as their own extended 

family. That is a fact that we need to always keep in mind as we 

discuss either wages or benefits and small business. We also must 

be aware that any additional requirements we place on small business may be the imposition of an unfunded employer mandate. 

Some estimates suggest that approximately 55 million private 

sector workers are without access to paid sick leave. The Health 

Families Act, as proposed, would extend paid sick leave benefits to 

all of those individuals except those that work for establishments 

with fewer than 15 employees which would cover roughly 45 million employees. The legislation requires up to 56 hours of paid sick 

time per employee. Currently, the average hourly wage is right around $17.00 per 

hour for non-supervisory, non-farm employees. Thus, the average 

cost exposure of the proposed legislation for each full-time employee is nearly $1,000. Even if we adjust the pool of the approximately 45 million workers to include part-time employees who have 

pro-rata entitlements, the cost exposure here is clearly in the tens 

of billions of dollars. 

To extend this type of leave requirement to businesses, as is contemplated by the Healthy Families Act, would be little more than 

an unfunded mandate on small businesses throughout the country. 

In addition, this legislation represents only direct labor cost, and 

does not account for a myriad of other indirect costs. The money 

necessary to pay those increased costs must come from somewhere. 

Proponents of this legislation argue that the huge cost of this legislation would be offset by productivity savings gained from eliminating ‘‘presenteeism’’ which is called by some individuals the practice of less than healthy individuals coming to work. Presenteeism 

‘‘losses’’ are, at best, highly speculative and subjective. Moreover, 

private sector human resource systems have traditionally shown 

the ability to adapt to economic reality. Put another way, businesses do not require Federal mandates to instruct them how to operate more efficiently, productively and profitably. 

8 

No matter how desirable a particular goal may be, one cannot 

simply dismiss the costs involved as unimportant or inconsequential. Here, the costs are decidedly not inconsequential, particularly 

for smaller businesses. The pool of available labor dollars is not infinite, and when we mandate their expenditure for a specific purpose, we always run the risk of unintended consequence. A dollar 

that must be spent here, often results in a dollar that will not be 

spent elsewhere. Imagine the irony for an employee who is granted 

sick leave under this bill, but whose employer decides to eliminate 

or reduce health plan benefits. 

If the end result this bill seeks is indeed healthier families, then 

I would also like to invite every member of this committee to work 

with me on small business health plan legislation. That initiative 

will make America’s working families healthier by allowing small 

businesses and associations to band together and buy into health 

plan coverage at better rates. Surely as we are rating the ‘‘To Do’’ 

list of the 110th Congress, increasing the number of insured Americans ranks higher than giving people days off who may not even 

have a health care provider to go to. I know if I were one of the 

46 million uninsured Americans, I would think so. 

Obviously, increased benefits, like increased wages, enjoys universal popularity. However, we cannot even contemplate mandating such benefits in an economic or policy vacuum. 

We also need to bear in mind that Washington does not always 

have a monopoly on good ideas; and that whenever we act prescriptively, we also decrease flexibility and creativity. What works in 

one place of business may not work in another; and, what we inflexibly mandate may not be best for all. 

I also believe that our consideration of this legislative proposal 

must be informed by our experience with similar legislative initiatives. As some of you may recall last Congress, the HELP Committee held a roundtable discussion on the Family and Medical 

Leave Act. During the course of that roundtable we learned about 

many of the practical issues and problems associated with implementing that legislation. I’d also note that the Department of 

Labor has recently solicited information from the public about 

many of these same issues. 

The Healthy Families Act—as it was introduced in the last Congress—while not an FMLA proposal, does import some of the practical problems associated with FMLA that have been repeatedly 

brought to our attention. Among those issues have been the practical problems associated with unanticipated, or intermittent leave; 

the issues associated with suspected abuse of leave entitlements, 

medical verification and privacy concerns, the existence of vague 

legislative terms and definitions, the issues related to the appropriate increments in which leave can be taken, and the incidence 

and costs of leave-related litigation. 

These are not isolated or minor concerns. These concerns have 

not been raised in support of any claim that FMLA should be repealed. Quite to the contrary, virtually all the employers that have 

raised these concerns support FMLA, however, they believe it must 

be clarified in several important, real-world respects. In a wide variety of instances this legislation borrows from FMLA, and imports, 

and even expands, many of these same real concerns to the proVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
9 

posed legislation. An appropriate first step would seem to be meaningfully addressing these very real issues in the context of our current laws before simply repeating them in new ones. 

Unfortunately, a review of this legislation replicates many of the 

practical problems we have witnessed with FMLA, and makes 

them even worse. The legislation lacks definitional precision, adequate safeguards against abuse, and due recognition of, or provisions to counter, its disruptive impact on affected businesses. The 

legislative language is extremely open-ended as to arguably create 

a Federal mandate of 56 hours of paid time off to be used as an 

employee wishes, and in such increments as the employee wishes. 

While I share the Chairman’s concern for working families I am 

also concerned for the businesses, particularly the small businesses, which employ them. I also appreciate that as both a policy 

matter and a personal matter the achievement of an appropriate 

balance between work and family is a matter of great importance. 

However, these are complex problems and complex problems very 

often defy simple or universal solutions. I think we need to recognize this as we move forward, and also recognize that as simple 

and attractive as it may appear, we cannot solve all problems 

through legislative fiat without any regard to those that must pay 

the cost of the mandates we impose. 

Mr. Chairman, thank you for holding this hearing today. I look 

forward to hearing from all of our panelists and look to see how 

we can help employees and their families to be healthy while providing the flexibility and stability for our Nation’s small businesses 

to build and grow their businesses with the goal towards hiring 

more workers. 

The CHAIRMAN. Thank you very much, Senator Enzi. The panel. 

We have Debra Ness, who is the President of the National Partnership for Women and Families. Before assuming her current role, 

she served as the Executive Vice President of the National Partnership for 13 years. Ness has played a leading role in positioning the 

organization as a powerful, effective advocate for today’s women 

and families. 

Dr. Jody Heymann is a founding Director of the Institutes for 

Health and Social Policy at McGill, an institution dedicated to research of public policy. She is also a founding Director of the 

project of global working families at Harvard; first research program to comprehensively examine the condition of working families 

in the United States and around the world. She has recently published, Forgotten Families: Ending the Growing Crisis, confronting 

children and working parents in the global economy. 

Heidi Hartmann is President of the Institute of Women’s Policy 

Research, scientific research organization to meet the need for 

women-centered policy oriented research. She is also a Research 

Professor at the George Washington University and a recipient of 

the McCarthy Fellowship Award for her work in the field of women 

and economics. She is Vice Chair of the National Council of Women’s Organizations. 

Dr. Rajiv Bhatia is the Director of Occupational and Environmental Health, San Francisco Department of Public Health and Assistant Clinical Professor of Medicine at the University of California at San Francisco. He teaches public health at UC-Berkley. 

10 

Mr. G. Roger King, a Partner of Jones Day Law Firm, San Diego. 

He specialized in representing employers under Federal labor law. 

He was labor counsel for Senator Taft in 1971 to 1973, Senate 

Committee, 1973 to 1975, also a Captain in the U.S. Air Force, 

Judge Advocate, 1972 to 1973. And I had the chance to say hello 

and he remembered being a part of this committee working with 

Senator Javits and others, going back a long time. So welcome back 

to the committee. 

We’ll start. Debra Ness, please. 

STATEMENT OF DEBRA NESS, PRESIDENT, NATIONAL 

PARTNERSHIP FOR WOMEN AND FAMILIES, WASHINGTON, DC. 

Ms. NESS. Good morning. Good morning, Chairman Kennedy, 

Senator Enzi, Senator Isakson. Thank you very much for this opportunity to testify. 

I’m Debra Ness, President of the National Partnership for 

Women & Families. We are a non-profit, nonpartisan organization 

that for more than 35 years has been working on issues important 

to women and families. 

I am here to testify in support of the Healthy Families Act, a 

groundbreaking piece of legislation to guarantee workers 7 paid 

sick days annually to recover from their own illness or care for a 

sick family member. Congress should waste no time passing this 

bill. 

The reason is simple. Chances are, each of us will get sick or 

need to care for a sick family member some time this year. But not 

all of us have the option of taking time off to get better. In the 

United States today, nearly half of all private sector workers do not 

have a single paid sick day and the situation is even more grim for 

low-income workers, three quarters of whom have no paid sick 

days. 

In fact, 86 million hardworking Americans do not have a single 

paid sick day that they can use to care for a sick child or a sick 

family member. 

I’d like to put a face on some of those statistics. Let me tell the 

story of Robbie Bickerstaff. Her son was hit by a car but he didn’t 

want to call his mom because he was afraid she would lose her job. 

When Robbie found out, she of course left work to take her son to 

the emergency room where the doctors were able to treat him and 

set his broken arm. Fortunately, Robbie’s son was okay but unfortunately, he was right to worry about his mom’s job. Bickerstaff 

was fired for leaving her job that day. 

Let me tell you the story of Connie Smith, who worked for 3 

years at a fast-food restaurant without ever taking a single sick 

day until one day, she got the stomach flu. After vomiting at the 

restaurant, she told her boss that she simply had to go home. His 

response? He ordered her to finish her shift, which ended at 4 a.m. 

So she did. She continued to work, handling food and exposing 

every customer she served to her illness. 

Currently there is no State or Federal law that ensures that 

workers have paid sick days when they need them. Senators, you 

can change that by passing this bill. The National Partnership is 

leading a very broad coalition in support of the Healthy Families 

Act, a coalition that includes children’s, civil rights, women’s, disVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
11 

ability, faith-based, community groups as well as labor unions, 

health advocates, and leading researchers at top institutions. It includes organizations like 9to5, ACORN, the Leadership Conference 

on Civil Rights, AFL-CIO, and the U.S. Conference of Catholic 

Bishops. We are all very different organizations but we’ve come together to support this bill because millions of Americans are being 

forced to choose between taking care of a sick child or family member and losing a day’s pay or even losing their job. In a nation that 

values families, no worker should have to make this impossible 

choice. 

Paid sick days are particularly important to women, since 

women, for the most part, are still the primary caregivers for their 

families. Half of working moms report having to miss work when 

a child gets sick and half of those moms also lose pay, which can 

be a significant financial blow for families at any income level. 

Paid sick days are also critically important to the well being of 

children. Children recover from illness faster when their parents 

care for them and having access to paid sick days also increases 

the likelihood that working parents can take their children for preventive care and well child visits that can help keep them healthy. 

Paid sick days are also good for the public health. Our government, the CDC urges us to stay home from work, to keep our children out of school and daycare when they are sick but workers 

without paid sick days don’t have that option and we all suffer as 

a result. 

Paid sick days are also good for our economy. Studies show that 

presentism—employees’ practice of coming to work even though 

they are sick costs our national economy $180 billion in lost productivity annually. 

Cost-benefit analysis shows that if workers had just 7 paid sick 

days a year, our economy would experience a net annual savings 

of $8.2 billion due to reduced turnover, higher productivity and reduction in the spread of contagious illness in the workplace. 

I could go on. Paid sick days are good for low-wage workers, for 

older workers, for seniors, for caregivers. Paid sick days are important to all of us and poll and after poll has found tremendous public support for paid sick days and proposals like the Healthy Families Act. 

Momentum is building and the National Partnership is working 

with organizations across the country. Paid sick day bills have been 

or will soon be introduced in cities and State legislatures from 

coast to coast. These State and local initiatives are important but 

we need more. Americans need paid sick days and it shouldn’t matter what city or what State they live in. 

This debate is really about what we value as a nation. We’re very 

good at talking about family values but we need to do more than 

talk. If we truly care about the health, the well-being and the economic security of our families, then we must enact the Healthy 

Families Act. 

Thank you. 

[The prepared statement of Ms. Ness follows:] 

12 

1 Vicky Lovell, No Time to be Sick: Why Everyone Suffers When Workers Don’t Have Paid Sick 

Leave, Institute for Women’s Policy Research, May 2004. 2Lovell, No Time to be Sick. 3Lovell, No Time to be Sick. 

PREPARED STATEMENT OF DEBRA L. NESS

Good morning. Chairman Kennedy, Senator Enzi, and members of the committee, 

thank you for the opportunity to testify here today. I am Debra Ness, President of 

the National Partnership for Women & Families, a non-profit, nonpartisan advocacy 

organization with more than 35 years of experience promoting fairness in the workplace, access to quality health care, and policies that help women and men meet the 

competing demands of work and family. 

I am here to testify in support of the Healthy Families Act, a groundbreaking 

piece of legislation to guarantee workers 7 paid sick days annually to recover from 

their own illness or care for a sick family member. Congress should waste no time 

in passing this bill, which is tremendously important to people all across our country. 

The reason is simple. Chances are each of us will get sick or need to care for a 

sick family member this year. But not all of us have the option to take time off from 

work to get better. In the United States today, nearly half (48 percent) of private 

sector workers do not have a single paid sick day to use for themselves or to care 

for a family member.1 The situation is even more grim for low-income workers: 

three in four (76 percent) have no paid sick days at all.2 And 86 million hard-working Americans do not have a single paid sick day they can use to care for a sick 

child.3

Let’s put a face on some of those statistics: 

• Robbie Bickerstaff was fired after leaving work to take her son, who had been 

hit by a car, to the emergency room so doctors could set his broken arm. Her son 

understood the risk and refrained from calling her after the accident, because he 

did not want her to lose her job. It turns out that he was right to worry. 

• In 3 years working at a fast-food restaurant, Connie Smith never took a sick 

day—until she got the stomach flu. After vomiting at the restaurant, she told her 

supervisor that she simply had to go home. He ordered her to finish her shift, which 

ended at 4 a.m. She did, exposing every customer she served to the flu. 

• Donetta Renee Parish reported to work at a Washington, DC. grocery store with 

a severe ear infection because she could not afford to take unpaid leave. She was 

later written up for missing work when she stayed home to care for her 21⁄2-yearold son who had had a seizure. 

Currently, no State or Federal law ensures that workers have paid sick days 

when they need them. You can change that by passing this bill. The National Partnership is leading a coalition in support of the Healthy Families Act—a coalition 

that includes children’s, civil rights, women’s, disability, faith-based, community and 

anti-poverty groups as well as labor unions, health agencies and leading researchers 

at top academic institutions. It includes 9to5, ACORN, the Leadership Conference 

on Civil Rights, AFL–CIO, National Organization for Women, and numerous other 

large, well-respected organizations. We have come together in support of this bill because millions of Americans are being forced to choose between taking care of a sick 

child or family member and losing a day’s pay—or even losing a job. In a nation 

that values families, no worker should have to make this impossible choice. 

Americans want to be responsible workers and be able to care for their families. 

In 78 percent of today’s families, both parents work for pay—and the typical couple 

in America now works close to 90 hours per week. But our policies lag desperately 

behind—and families are struggling as a result. We can and must do better—and 

we will, if we truly value families. 

Coalitions are working in cities and States across this country to pass measures 

similar to the Healthy Families Act, and they are making progress. But we urgently 

need a national standard. America needs you to make passage of the Healthy Families Act a priority for this Congress. 

LACK OF PAID SICK DAYS HITS LOW-WAGE WORKERS HARDEST

When a low-wage worker gets sick, or needs to take care of a sick child or take 

an elderly parent to a medical appointment, he or she is faced with an impossible 

choice: lose a day of pay and possibly even your job, or take the time you need to 

take care of your family. Half of low-wage working parents report losing pay to stay 

13 

4 Jody Heymann, Forgotten Families, Oxford University Press, 2006. 5 Community Service Society and Lake Snell Perry & Associates, The Unheard Third 2005: 

Bringing the Voices of Low-Income New Yorkers to the Policy Debate, 2005. 6David Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler, Illness 

and Injury As Contributors to Bankruptcy, Health Affairs Market Watch, 2 February 2005. 7 Vicky Lovell, No Time to be Sick. 8S.J. Heymann, Alison Earle, and Brian Egleston, 1996, as cited in Lovell, Paid Sick Days 

Improve Public Health by Reducing the Spread of Disease, Institute for Women’s Policy Research, 2006. 9 Jody Heymann, The Widening Gap. 10Department of Health and Human Services, Administration on Aging, Statistics on the 

Aging Population, 2006. 11Families and Work Institute, Highlights of the 2002 National Study of the Changing Workforce, 2002. 12 Jody Heymann, The Widening Gap: Why America’s Working Families Are in Jeopardy—and 

What Can Be Done About It, Basic Books, 2000. 13Kaiser Family Foundation, Women Work and Family Health: A Balancing Act, Issue Brief, 

April 2003. 14Kaiser Family Foundation, Women, Work and Family Health: A Balancing Act. 

home and care for a sick child or being forced to leave children home alone.4 In the 

wealthiest Nation in the world, these are choices no parent should have to make. 

Low-wage workers typically have little or no savings to fall back on when they 

need time off but have no paid sick days. For example, a recent survey of New York 

residents found that 71 percent of low-income workers report having less than $500 

in savings, and 52 percent of those workers report having less than $100 in savings.5 When sick workers have little savings, they are especially vulnerable to extreme financial crises and even bankruptcy. One study found that nearly 2 million 

Americans experience medical bankruptcy annually, even though 75 percent of those 

surveyed had health insurance at the onset of illness. Respondents reported that illness and medical bills were the cause of 46.2 percent of their personal bankruptcies.6

PAID SICK DAYS ARE GOOD FOR CHILDREN

Children inevitably get sick. On average, school-age children miss at least 3 school 

days per year due to health issues, and younger children have even higher rates 

of illness.7 Providing workers with paid sick days that can be used to care for a sick 

child has a positive impact on children’s health. Studies show that children recover 

from illness faster when their parents care for them,8 and that having paid time 

off is a primary factor in a parent’s decision to stay home when a child is sick.9 Having access to paid sick days also increases the likelihood that working parents can 

take children for the preventive care and well-child visits that can help keep kids 

from getting sick or forestall more serious illness. 

PAID SICK DAYS HELP WORKERS CARE FOR OLDER RELATIVES

Many workers today care for an older relative, and many more will be caring for 

them in the near future as Baby Boomers age. In 2000, 12.6 percent of the population was over 65 years old; by 2030, Americans over age 65 will comprise 20 percent of the population.10 Studies have shown that more than a third of Americans 

(35 percent), both women and men, have significant eldercare responsibilities, and 

many are forced to reduce their work hours or take time off to provide care.11 Providing access to family-flexible sick leave is a critical strategy for helping working 

families deal with the needs of their aging relatives. 

WOMEN ARE DISPROPORTIONATELY IMPACTED BY THE LACK OF PAID SICK DAYS

The lack of paid sick days has a significant impact on working women, and is particularly threatening to women’s economic security. Women are still predominantly 

responsible for family caretaking. Many working women have children, and one in 

three has additional caretaking responsibilities for an elderly relative, a person with 

a disability, or a special need child.12

Staggering statistics demonstrate the hardship that can be associated with women’s caretaking responsibilities: half of working mothers miss work when a child 

comes down with a common illness.13 Many of these women—two-thirds of lowincome mothers and one-third of middle and upper income mothers14—lose pay to 

care for their sick children. That is a significant financial blow for many low- and 

moderate-income women and their families. 

Because women are more likely to work part-time (or full-time by cobbling together more than one part-time position), they are less likely to have paid sick days. 

Only 16 percent of part-time workers have paid sick days, compared to 60 percent 

14 

15 Vicky Lovell, No Time to be Sick. 16Lovell, No Time to be Sick. 17 Economic Policy Institute, Minimum Wage Issue Guide, http://www.epi.org/content.cfml/ 

issueguideslminwage, 2007. 18Spilerman and Schrank, Responses to the Intrusion of Family Responses in the Workplace, Research in Social Stratification and Mobility, 10, 27–61, 1991. 19 AARP Public Policy Institute, Update on the Aged 55+ Worker, 2005. 20 Centers for Disease Control and Prevention, http://www.cdc.gov/flu/symptoms.htm and 

http://www.cdc.gov/flu/professionals/infectioncontrol/childcaresettings.htm. 21Lovell, No Time to be Sick. 22 CCH Incorporated, 2006 CCH Unscheduled Absence Survey, October 2006. 23 Ron Goetzal et al., Health Absence, Disability, and Presenteeism Cost Estimates of Certain 

Physical and Mental Health Conditions Affecting U.S. Employers, Journal of Occupational and 

Environmental Medicine, April 2004. 

of full-time workers.15 Accommodation and food service industry workers, the majority of whom are women (53 percent) have almost no paid sick time.16 Women also 

are disproportionately represented among low-wage workers, the population least 

likely to have access to paid sick days: 59 percent of minimum wage workers are 

women.17

Further, women’s dual commitments to work and family can negatively affect 

their career paths and income stability if they lack paid sick days they can use to 

care for family members. One study found that being female doubles the chance of 

experiencing job loss because of family illness.18

OLDER WORKERS NEED PAID SICK DAYS, TOO

Roughly half of Americans 65 years or older participate in the labor force,19 and 

this number is expected to increase as the number of older Americans increases and 

more workers delay retirement for economic or other reasons. Many of these workers will require time away from work to care for their own health or to care for an 

older spouse or other family member. 

ESTABLISHING A MINIMUM STANDARD OF PAID SICK DAYS IS GOOD FOR PUBLIC HEALTH

Paid sick days are essential to ensuring that workers don’t have to risk their own 

or the public’s health because they can’t afford to take a sick day. The U.S. Centers 

for Disease Control and Prevention (CDC) strongly urges us to stay home from 

work, school, and social gatherings when we are sick and, not surprisingly, the CDC 

encourages parents to keep sick children home from school and daycare to avoid the 

spread of illness.20 But workers without paid sick days don’t have the option to do 

so, and we all suffer as a result. 

Workers in direct contact with the public every day are the least likely to have 

paid sick days. Eighty-six percent of food and public accommodation workers have 

no paid sick days, and most workers in child care centers, retail, and nursing homes 

also lack paid sick days.21 Nobody wants a sick worker sneezing in their food, passing illness at the store, or infecting children and seniors. We want sick children to 

recover at home and not infect other children at school or in daycare. We are all 

at risk when workers cannot stay home when they are sick or need to care for a 

sick child or family member. 

Giving workers paid sick days makes it possible for them to seek the medical help 

they or a family member needs. It also removes a key barrier to health care access, 

making it possible for them to seek preventive care. Preventive care is key to improving workers’ overall health and decreasing the number of avoidable hospitalizations, thus decreasing health care costs. Many people with chronic illnesses such as 

asthma or diabetes could avoid hospitalization if they were able to attend outpatient 

visits to manage their conditions. 

PAID SICK DAYS ARE GOOD FOR THE U.S. ECONOMY

Providing paid sick days for workers produces benefits beyond those that accrue 

to individual workers, children and seniors, or even our national public health. 

Healthy workers are critical to a productive and vibrant economy. Employers and 

our economy would benefit substantially if workers had 7 paid sick days annually. 

Sick workers in the workplace inevitably hurt more than they help. All workers 

who have no paid sick days go to work sick and spread illness to colleagues, lowering the overall productivity of the workplace. More than half (56 percent) of 

human resources executives report that ‘‘presenteeism’’—employees’ practice of coming to work even though they are sick—is a problem in their companies.22 Studies 

have shown that presenteeism costs our national economy $180 billion in lost productivity annually.23 When workers are guaranteed a minimum number of paid sick 

15 

24 Vicky Lovell, Valuing Good Health: An Estimate of Costs and Savings for the Healthy Families Act, Institute of Women’s Policy Research, 2005. 25 Jody Heymann, Alison Earle, and Jeffrey Hayes, Project on Global Working Families, The 

Work, Family, and Equity Index: How Does the United States Measure Up?, 2007. 26Steven Pearlstein, No Longer No. 1, and No Wonder, The Washington Post, Sept. 27, 2006, 

D10. 27 Jody Heymann, Alison Earle, and Jeffrey Hayes, Project on Global Working Families, The 

Work, Family, and Equity Index: How Does the United States Measure Up?, 2007. 28 Community Service Society and Lake Snell Perry & Associates, The Unheard Third 2005: 

Bringing the Voices of Low-Income New Yorkers to the Policy Debate, 2005. 29 Job Opportunities Task Force and Gonzales Research & Marketing Strategies, Statewide 

Survey, 2006. 30The National Council of Research on Women Poll, 2006. 

days, employers benefit as healthier workers are more productive and the spread 

of illness in the workplace is reduced. 

Employers reap the savings from reduced turnover as well. Turnover-related costs 

(which include advertising for, interviewing, and training replacements) are substantial, generally far greater than the cost of providing paid sick time to retain existing workers. A cost-benefit analysis of the Healthy Families Act demonstrates 

that if workers had just 7 paid sick days per year, our national economy would experience a net savings of $8.2 billion per year due to reduced turnover, higher productivity, and reduction in the spread of contagion in the workplace.24

The United States lags far behind the rest of the world in providing paid leave 

benefits. A recent study by Dr. Jody Heymann of Harvard and McGill Universities 

highlights just how far the United States lags behind other nations including those 

with some of the strongest economies in the world: at least 145 nations provide paid 

leave for short- or long-term illnesses, and 127 of those nations guarantee a week 

or more of paid sick days per year to their workforce. The benefits of paid leave are 

provided to workers in every one of the top 10 most economically competitive nations in the world, with the glaring exception of the United States.25

Also of note, just last fall the World Economic Forum announced its annual economic rankings, and the United States had fallen from first to sixth.26 The nations 

ranked above the United States all guarantee some paid sick time to their workers. 

We are familiar with the arguments against establishing minimum labor standards that provide workers paid sick days, because we heard them all in the fight 

to enact the FMLA. We are convinced that they are specious scare tactics; there are 

simply no objective studies that conclude that giving workers good working conditions leads to job loss or that these protections are in any way linked to higher unemployment rates.27 The statistics, and the experience of other economic powerhouse nations, clearly demonstrate that these arguments are not based in reality. 

THE PUBLIC OVERWHELMINGLY SUPPORTS PAID SICK DAYS

The likelihood of being sick—or of having a child who will get sick—does not depend on whether you live in a blue or a red or a purple State, so establishing a 

minimum standard of paid sick days deserves bipartisan support. Poll after poll has 

found tremendous support for paid sick days and proposals like the Healthy Families Act. For example, 7 in 10 New York City residents across income lines believe 

there should be a law that requires employers to provide full-time workers at least 

7 days of paid sick time annually.28 Nine out of ten Maryland voters believe that 

every full-time worker should have paid sick days. Similarly, 85 percent of respondents in a national poll support the use of paid sick days to care for children and 

parents who are ill.29 A recent poll by the National Council for Research on Women 

showed that women are five times more likely to vote for a candidate who favors 

guaranteed paid sick days.30

CONCLUSION

This debate is really about what we value in this Nation. If we want strong families and a strong economy, if we care about the health, well-being and economic security of our families, we will waste no time in passing the Healthy Families Act. 

Guaranteeing access to paid sick days is the next step in the effort to put our desperately outdated workplaces back in sync with the realities of families. Paid sick 

days are the next minimum labor standard the Nation needs. 

Momentum is building. The National Partnership for Women & Families is working with concerned citizens around the country who are pressing for paid sick days. 

San Francisco voters overwhelmingly approved the country’s first paid sick days ordinance in November. Thus far in 2007, paid sick days bills have been introduced 

in legislatures in Connecticut, Florida, Maine and Massachusetts and will be introVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
16 

duced in the District of Columbia, Maryland, Minnesota, Montana, Vermont, Wisconsin, and the city of Madison in coming months. These initiatives are important, 

but we need even more. Every American needs paid sick days. The time has come 

to enact a law that provides paid sick days for all workers: the Healthy Families 

Act. 

Mr. Chairman, members of the committee, I thank you for the opportunity to participate in this important discussion. 

The CHAIRMAN. Thank you. 

Dr. Heymann. 

STATEMENT OF JODY HEYMANN, M.D., Ph.D., PROFESSOR AT 

MCGILL UNIVERSITY, DIRECTOR, MCGILL INSTITUTE FOR 

HEALTH AND SOCIAL POLICY AND PROJECT ON GLOBAL 

WORKING FAMILIES, MONTREAL, QUEBEC 

Dr. HEYMANN. Good morning. There we go. That’s a little better. 

Good morning, Senator Enzi, Senator Isakson and Chairman Kennedy. Thank you for inviting me here to testify today. 

My name is Jody Heymann. I am the Director of the Institute for 

Health and Social Policy at McGill, Founding Director of the 

Project on Global Working Families at Harvard, and on the faculty 

of both universities. I am trained as a pediatrician and a policy analyst and for over a decade and a half, I have led systematic studies involving over 10,000 working Americans as well as studies involving over 55,000 families in the global economy. 

I am here today to say that the Healthy Families Act would 

make an enormous difference to working Americans. When we 

asked people across the country, in a representative sample from 

coast to coast, what was the single most important reason that 

they had to disrupt work to care for a family member, it was 

health. That was true for Americans from 25- to 75-years old, for 

men and women across every geographic region. Yet, nearly half of 

private sector workers currently have no paid sick days at all and 

an even larger percentage lack the ability to take days off to care 

for sick family members. 

Sick days matter to employees. They matter because they lead to 

faster recovery from illnesses and employees being less likely to 

spread their illnesses to those they work with. They also matter because people are more likely not to lose jobs. In fact, in the national 

study we did, having a health problem increased by 50 percent the 

likelihood of job loss among low-wage mothers. This matters to the 

middle class as well. The single factor that made the biggest difference in keeping your job if you got sick was paid sick days. 

Among nurses across the country, two and a half times as likely 

to keep your job if you had paid sick days once you got sick. So it 

matters to employees and it matters to their families. 

What are the basic facts about families? A majority of working 

Americans are caring for children, the elderly or disabled. Seventy 

percent of mothers with children under 18 are in the workforce. A 

third of working Americans are caring for somebody over 65 and 

two out of seven have at least one member in their family with disabilities. 

Let’s just take the case of children which we began to hear about 

from Debra and look at it a little bit more. When there are no paid 

sick days available, we know what happens. Children are sent to 

daycare sick with contagious diseases that spread to other kids. 

17 

They are left home alone. They are often unable to see physicians 

for diagnosis or needed medications and end up with emergencies 

and conditions that worsen. 

When paid sick days are available and this is the important statistic to remember, families are five times as likely to be able to 

care for their children when they’re sick. 

Now it matters to adult care as well. When adults receive support from family members when they are sick, they have better 

health outcomes from major illnesses like heart attacks and strokes 

and those same working Americans that we asked across the country, who did you need to care for when they got sick? Well, 42 percent reported it was their children. The rest were reporting a wide 

range of family members, which is why I commend the fact that 

this act is written to incorporate the fact that you can be caring 

for aunts or uncles, grandchildren as well as your own children’s 

spouses who are in desperate need of help. 

Businesses benefit at the same time and that’s why I’m glad it’s 

been raised, the issue of what are the economic consequences? 

Businesses benefit from limiting the spread of infectious diseases 

in the workplace, from lowering job turnover rates, from lower recruitment and training costs, lower presentism costs and we base 

this on having spoken with businesses across the country. 

Importantly, we know the United States can compete while doing 

this. We’ve done a study of the countries around the world and who 

is offering paid sick days. One hundred and forty-five countries 

offer paid sick days. In at least 100 of these countries, it begins on 

the first day you are sick. Unless we think 7 days is too many, in 

100 of these countries, it’s for a month or more. 

Now, the world business leaders in the world economic forum 

have ranked the most competitive economies around the world and 

every single one of the 20 most competitive economies with the exception of the United States, guarantees paid sick days. In fact, 

guaranteeing paid sick days makes you more competitive and we 

have rigorous analyses showing that. 

As for unemployment, which is a question that has been raised, 

there is absolutely no relationship between national unemployment 

or employment levels and offering paid sick days. 

So in conclusion, can the United States afford to provide paid 

sick days and still compete in the global economy? Most of the 

world already has legislation guaranteeing paid sick days. All the 

competitive economies do. I have faith that U.S. companies are just 

as strong and compete as well with it. Will it make a difference to 

the health of American children and adults alike in need? Absolutely. It will make a great difference and particularly to those in 

greatest need, low-income families who are the most likely to lack 

it. Thank you for having me here. 

[The prepared statement of Dr. Heymann follows:] 

PREPARED STATEMENT OF JODY HEYMANN, M.D., PH.D. 

Good morning, Chairman Kennedy, Senator Enzi, and members of the committee. 

My name is Jody Heymann. I am the Director of the Institute for Health and Social 

Policy at McGill University, Founding Director of the Project on Global Working 

Families at Harvard University, and on the faculty at both McGill and Harvard 

Universities. For the past decade and a half, I have led a research team at Harvard 

and now at both McGill and Harvard, which focuses on understanding the condiVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00021 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
18 

tions working families face in America and in a globalized economy, and what can 

be done to improve the conditions of working adults, their children, their elderly 

parents, and other family members. 

Trained as a pediatrician and a policy analyst, I began this work when it became 

clear from individual families that the conditions parents faced in the workplace 

and in their communities in the United States were having a dramatic effect on the 

health of American children. Over the past decade and a half, I have led systematic 

studies involving over 10,000 Americans—from every State and across all income 

and demographic groups—as well as studies involving over 55,000 families in the 

global economy, and have examined public policies across the United States and 

across 180 other economies we interact and compete with. 

Thank you for inviting me here to testify today. I am here to urge you to support 

the Healthy Families Act. The Healthy Families Act will make a crucial difference 

to the health and livelihoods of American adults and their families. The provisions 

in the act are readily feasible and affordable while competing in the global economy. 

WORKING FAMILIES IN AMERICA

The clear majority of working Americans care for children, disabled, or elderly 

adults.1 According to the Bureau of Labor Statistics, 70 percent of mothers with 

children under 18 are in the workforce.2 At the same time, the National Study of 

the Changing Workforce found that between 25 percent and 35 percent of working 

Americans are currently providing care for someone over 65.3 According to the Census Bureau, 2 in every 7 families report having at least one member with disabilities.4 While both men and women provide important care, women are still much 

more likely than men to assume primary caregiving responsibilities for family members of all ages.567

While the majority of working Americans are caring for family members—children, spouses or partners, parents, grandchildren, and grandparents—the United 

States does not have most of the basic protections the rest of the world can count 

on. While the United States compares well to many other countries in having policies that ensure an equitable right to work for all racial and ethnic groups, regardless of gender, age or disability, the United States lags far behind the rest of the 

world when it comes to most policies protecting working families. Just to cite a few 

examples, 168 countries offer guaranteed leave with income to women in connection 

with childbirth; 66 countries ensure that fathers either receive paid paternity leave 

or have a right to paid parental leave; 107 countries protect working women’s right 

to breastfeed; 137 countries mandate paid annual leave; and 145 countries provide 

paid sick days or leave for short- or long-term illnesses. The United States does not 

guarantee any of these yet.8

And in the absence of legislation, the private sector has not filled the gap. Nearly 

half of private sector workers have no paid sick days at all. An even larger percentage lack the ability to take days off to care for sick family members.9 While many 

families cannot reliably count on paid sick days, working poor families are at the 

highest risk. Our research team found that 76 percent of low-income working parents did not consistently have paid sick days over a 5-year period.10

WHY SICK DAYS ARE SUCH AN IMPORTANT PLACE TO START

The research group I lead carried out an important study to learn from working 

Americans about their greatest needs when it comes to caring for family members. 

We interviewed a representative sample of Americans across the country every day 

for a week to learn about work disruptions they experienced in order to meet the 

needs of family members. The greatest needs were in two areas: caring for the 

health of family members and meeting school or child care needs. Meeting the 

health needs of family members was a top priority for working Americans from 25- 

to 75-years old in our study, for men and women, and for people across every geographic region. It is important to note that the need to care for children accounted 

for only 42 percent of work disruptions that were related to family. Fifteen percent 

were to care for parents, 12 percent to care for spouses or partners, 7 percent for 

grandchildren, and 24 percent for other family members.11 Because of the range of 

family needs, I fully support the definition of family coverage in the Healthy Families Act; it accurately reflects the needs and commitments of American families. 

SICK DAYS’ IMPACT ON THE HEALTH OF WORKING AMERICANS AND THEIR FAMILIES

When you look at the evidence on the importance to child and adult health of having family members involved in their care, then it should not be a surprise that this 

is a top priority for Americans. Parental availability is vital for ensuring children’s 

physical health. Children sent to daycare sick with contagious diseases exacerbate 

19 

the higher rate of observed infections in daycare centers,12 13 14 15 including higher 

rates of respiratory and gastrointestinal infections.16 17 18 Children left home alone 

may be unable to see physicians for diagnoses, needed medications, or emergency 

help if their conditions worsen. Furthermore, parental care may be important for 

children even when substitute sick child care is available. Studies of hospitalized 

children have shown that sick children have shorter recovery periods, better vital 

signs, and fewer symptoms when their parents share in their care.19 20 21 22 The 

presence of parents has also been found to shorten children’s hospital stays by 31 

percent.23 Without paid sick days, working parents have little choice but to send 

their sick children to day care or school, have young children stay home alone, or 

miss needed meetings with doctors with potentially serious health consequences. 

At the same time, the proportion of adults having to meet the needs of elderly 

and disabled adult family members while working is growing and will continue to 

do so as the American population ages. The percentage of the U.S. population made 

up of individuals aged 60 and older is estimated to increase more than 1.5 times 

and the percentage of the U.S. population made up of individuals aged 80 and older 

is estimated to double by 2050.24 A wealth of research has shown that when adults 

receive support from family members when sick, they have substantially better 

health outcomes from conditions such as heart attacks 25 26 and strokes.27 An extensive body of research also demonstrates that elderly individuals live longer when 

they have higher levels of social support from friends and family members.28 29

The ability of workers to address their own health needs is equally critical. Research has shown that taking the necessary time to rest and recuperate when sick 

encourages a faster recovery 30 and may prevent minor health conditions from progressing into more serious illnesses that require longer absences from work and 

more costly medical treatment.31 32 33 If working adults are able to stay home when 

they are sick, they are also less likely to spread their illness to those they work 

with.34

Workplace policies are essential to the ability of working adults to meet both their 

own health needs and the health needs of their family members. Our research found 

that the largest determinant of whether or not American parents can care for their 

children when they get sick is the availability of paid sick days. We have found that 

parents who have paid sick days are more than five times as likely to be able to 

care for their children themselves when they get sick as parents who do not have 

paid sick days.35 36

IMPACT ON THE ABILITY OF AMERICANS TO GET JOBS, KEEP JOBS, AND EARN

A DECENT LIVING

Without paid sick days, working families are placed at risk economically, experiencing wage and job loss when they take time off to provide care for family members.37 38 39 40 Alison Earle, a senior member of our research group, and I conducted 

the most comprehensive longitudinal study of working poor families and job loss in 

the United States. We found that the ability of working poor mothers to keep a job 

was dramatically affected by the health of the mother and the health of her child, 

even after taking into account the mother’s years of education, her skills, and the 

local environment in which she was looking for work. Having a health problem led 

to a 53 percent increase in job loss among low-wage mothers and having a child 

with health problems led to a 36 percent increase.41

We know paid sick days could make an enormous difference in the ability of 

adults to return to work and keep their jobs. In a subsequent study we carried out 

of nurses, most of whom were middle class, having sick days made all the difference 

in their ability to keep jobs after developing heart disease or having a heart attack. 

Of all the working conditions studied, paid sick days were the only benefit significantly associated with an increased likelihood of returning to work; nurses with paid 

sick days were 2.6 times more likely to return to work after a heart attack or angina.42

IMPACT ON BUSINESSES

Offering paid sick days has positive benefits for employers, including limiting the 

spread of infectious diseases in the workplace by letting employees stay home when 

sick.43 44 As just one example, the spread of infectious disease at the workplace is 

the reason that the U.S. Centers for Disease Control and Prevention recommended 

that Americans with influenza—a disease that leads to 200,000 hospitalizations and 

over 36,000 deaths in an average year 45—stay home when they are sick.46 In health 

care and service settings, providing sick days to employees also helps protect the 

health of patients and customers. For example, one study found a decreased risk 

20 

of respiratory and gastrointestinal outbreaks among residents in nursing homes 

that provide their employees with paid sick days.47

At the same time, workplaces with paid sick days experience lower job turnover 

rates, leading to lower recruitment and training costs and a higher level of productivity and decreased unnecessary absenteeism.48 49 In addition, a recent study found 

that customer satisfaction and commitment to service providers were lowest when 

consumers viewed the employer as having a high rate of turnover.50

SICK DAYS ARE FEASIBLE AND AFFORDABLE

While there are clear economic benefits to paid sick days, it’s a natural question 

to ask whether the United States can mandate paid sick days and still compete in 

the global economy. Having examined data on the public policies for working families in 177 countries around the world, we can answer this with a clear yes. One 

hundred and forty-five countries guarantee paid sick days. In at least 100 countries, 

paid sick days begin with the first day of illness.51

By global standards, the seven days proposed in the Healthy Families Act is quite 

modest. One hundred and two countries guarantee 1 month or more of paid sick 

days.52

The World Economic Forum, which brings together the top business leaders from 

around the world, has ranked the most competitive national economies.53 All of the 

20 most competitive countries, with the exception of the United States, guarantee 

paid sick days, and 18 of them provide 31 or more sick days with pay.54 In fact, 

we have examined the relationship between national economic competitiveness and 

paid sick days and leave. Those countries which are most economically competitive 

are consistently more likely to guarantee paid sick days and leave for employees’ 

own health, for the care of children’s health, and to meet the health needs of other 

adult family members.55 It makes sense. If you guarantee paid sick days, you have 

healthier workers and a healthier next generation—both essential to competition. 

Table 1.—Ten Most Competitive Economies and Their Sick Day Policies 

Country/Economy Ranking Any paid sick 

days? 

Provides more 

than 10 paid 

sick days 

Switzerland ................................................................................................................. 1 Yes .............. Yes 

Finland ........................................................................................................................ 2 Yes .............. Yes 

Sweden ....................................................................................................................... 3 Yes .............. Yes 

Denmark ..................................................................................................................... 4 Yes .............. Yes 

Singapore .................................................................................................................... 5 Yes .............. Yes 

United States .............................................................................................................. 6 No ............... No 

Japan .......................................................................................................................... 7 Yes .............. Yes 

Germany ...................................................................................................................... 8 Yes .............. Yes 

Netherlands ................................................................................................................ 9 Yes .............. Yes 

United Kingdom .......................................................................................................... 10 Yes .............. Yes 

* Rankings are from the World Economic Forum’s Global Competitiveness Report 2006–2007. Information on paid sick days is taken from 

the Work, Family, & Equity Index, 2007. 


33446-3.eps
21 

CONCLUSION

Finally, I’d like to speak for a moment on a personal note, as a doctor and as a 

mother. When I cared for children as a doctor, like other pediatricians, I relied entirely on the ability of parents to provide care for their children. When I discharged 

a child from the hospital after a serious asthma attack, the prescription and instructions for care went with the mother and father—and on the shoulders of parents 

rested whether the child would have a healthy recovery or return within days to 

the emergency room. For parents whose work let them take sick days to care for 

their children, whether after an asthma attack, to get a routine vaccination, or to 

check that the child met important developmental milestones, this was a fair responsibility to place on their shoulders. But for too many American parents, I’ve 

learned they have no chance to provide adequate care for their children—no matter 

how desperately they want to—because they are forced to choose between taking the 

needed hours to care for their children’s health and earning income that is essential 

to that care. 

As a young mother, I stood outside my son’s childcare center and listened sadly 

to the experience of another parent. The childcare center served medical school faculty and hospital workers from every kind of job. The mother I spoke to had succeeded in leaving welfare for work and had placed her children in childcare. Like 

many children during their first year in childcare, hers were sick often with respiratory infections and fevers high enough that they were not allowed to go to the 

center. My children had the same hurdles, but I could take leave from work. Her 

job offered no paid sick days. At the end of the year, she was dismissed, unemployed, and falling deeper into poverty because of the days she missed when her 

children were sick. 

After a decade and a half of our research, confirmed over and over again by the 

research of other groups, we know these experiences are not the exception. 

In short, the United States currently lags dramatically behind all high-income 

countries, as well as many middle- and low-income countries when it comes to paid 

sick days designed to protect the health of working Americans and their families. 

Can the United States afford to provide paid sick days and still compete in the global economy? The answer is clearly yes. Most of the world already has legislation 

guaranteeing paid sick days. All the most competitive economies do. Will it make 

a difference to the health of American children and adults alike in need of care? 

An enormous one, particularly for the health and well-being of those in greatest 

need—low-income families and families with a child or adult with frequent illnesses 

or a chronic health condition. 

The Healthy Families Act is superbly constructed to help meet the essential needs 

of working adults and their families and at the same time is readily achievable. 

Thank you again for holding these hearings and for taking the time to move forward 

on these critically important issues facing American working families. If I or my 

staff can be of further help to you as you continue to deliberate on these issues, 

please do not hesitate to contact us. 

ENDNOTES

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Jeopardy and What Can Be Done about It. New York: Basic Books. 2 U.S Bureau of Labor Statistics. (2006). Employment Characteristics of Families in 

2005. Washington, DC.: U.S. Dept. of Labor. Available online at: http:// 

www.bls.gov/news.release/pdf/famee.pdf. 3 Bond, J.T., C. Thompson, E. Galinksy & D. Prottas. (2002). The National Study 

of the Changing Workforce. New York: Families and Work Institute. 4Wang Q. (2005). Disability and American Families: 2000. Washington, D.C.: U.S. 

Census Bureau. Available online at: http://www.census.gov/prod/2005pubs/ 

censr–23.pdf. 5Dalenberg, D., J. Fitzgerald, & J. Wicks. (2004). Direct valuation of personal care 

by households. Population Research & Policy Review 23:73–89. 6 Bond, J.T., C. Thompson, E. Galinksy & D. Prottas. (2002). The National Study 

of the Changing Workforce. New York: Families and Work Institute. 7 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

Jeopardy and What Can Be Done about It. New York: Basic Books. 8 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: How 

Does the United States Measure Up? Boston/Montreal: Project on Global Working 

Families. Available online at: http://www.mcgill.ca/files/ihsp/WFEIFinal 

2007.pdf. 

22 

9Lovell V. (2004) No Time to Be Sick: Why Everyone Suffers When Workers Don’t 

Have Paid Sick Leave. Washington, DC.: Institute for Women’s Policy Research. 

Available online at: http://www.iwpr.org/pdf/B242.pdf. 10 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

Jeopardy and What Can Be Done about It. New York: Basic Books. 11 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

Jeopardy and What Can Be Done about It. New York: Basic Books. 12Loda F.A., W.P Glezen, & W.A. Clyde. (1972). Respiratory disease in group day 

care. Pediatrics 49:428–437. 13Sullivan P., W.E. Woodward, L.K. Pickering, & H.L. Dupont. (1984). Longitudinal 

study of occurrence of diarrheal disease in day care centres. Am J Public Health 

74:987. 14Dahl I.L., M. Grufman, C. Hellberg, & M. Krabbe. (1991). Absenteeism because 

of illness at daycare centers and in three-family systems. Acta Paediatr Scand. 

80:436. 15Mottonen M. & M. Uhari. (1992). Absences for sickness among children in day 

care. Acta Paediatr. 81:929. 16Loda F.A., W.P Glezen, & W.A. Clyde. (1972). Respiratory disease in group day 

care. Pediatrics 49:428–437. 17Strangert K. (1976). Respiratory illness in preschool children with different forms 

of day care. Pediatrics 57:191. 18Doyle A.B. (1976). Incidence of illness in early group and family day care. Pediatrics 58:607. 19 Robertson J. Young Children in Hospital. London, England: Tavistock. 20 Van der Schyff G. (1979). The role of parents during their child’s hospitalization. 

Aust Nurs J. 8:57–61. 21Mahaffy P. (1965). The effects of hospitalization on children admitted for tonsillectomy and adenoidectomy. Nurs Res. 14:12–19. 22Palmer S.J. (1993) Care of sick children by parents: A meaningful role. J Adv 

Nurs. 18:185. 23Taylor M. and P. O’Connor. (1989). Resident parents and shorter hospital stay. 

Archives of Disease in Childhood 64(2): 274–276. 24 United Nations Population Division. (2004). World Population Prospects: The 2004 

Revision Highlights. New York: Department of Economic and Social Affairs, UN. 

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2004Highlightslfinalrevised.pdf. 25 Bennet S.J. (1993). Relationships among selected antecedent variables and coping 

effectiveness in postmyocardial infarction patients. Research in Nursing and 

Health 16:131–139. 26Gorkin L., E.B. Schron, M.M. Brooks, I. Wiklund, J. Kellen, J. Verter, J.A. 

Schoenberger, Y. Pawitan, M. Morris, & S. Shumaker. (1993). Psychosocial predictors of mortality in the Cardiac Arrhythmia Suppression Trial–1 (CAST–1). American Journal of Cardiology 71:263–267. 27Tsouna-Hadjis E., K.N. Vemmos, N. Zakopoulos, & S. Stamatelopoulos. (2000). 

First-stroke recovery process: The role of family support. Archives of Physical 

Medicine and Rehabilitation 81:881–887. 28Seeman T.E. (2000). Health promoting effects of friends and family on health outcomes in older adults. American Journal of Health Promotion 14:362–370. 29 Berkman L.F. (1995). The role of social relations in health promotion. Psychosomatic Medicine 57:245–254. 30Gilleski D.B. (1998). A dynamic stochastic model of medical care use and work 

absence. Econometrica 66:1–45. 31 Aronsson G., K. Gustafsson, & M. Dallner. (2000). Sick but yet at work: An empirical study of sickness and presenteeism. Journal of Epidemiology and Community 

Health 54:502–509. 32Grinyer A. and V. Singleton. (2000). Sickness absence as risk-taking behaviour: 

A study of organizational and cultural factors in the public sector. Health, Risk, 

and Society 2:7–21. 33 Johannsson G. (2002). Work-life balance: The case of Sweden in the 1990s. Social 

Science Information 41:303–317. 34Skatun J.D. (2003) Take some days off, why don’t you? Endogenous sick leave and 

pay. Journal of Health Economics 22(3):379–402. 35 Heymann S.J., S. Toomey, & F. Furstenberg. (1999). Working parents: What factors are involved in their ability to take time off from work when their children 

are sick? Archives of Pediatrics & Adolescent Medicine 153:870–874. 36 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

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23 

37Murphy B., H. Schofield, J. Nankervis, S. Bloch, H. Herman, & B. Singh. (1997). 

Women with multiple roles: The emotional impact of caring for ageing parts. Ageing and Society 17:277–291. 38 Joshi H., P. Paci, & J. Waldfogel. (1999). The wages of motherhood: Better or 

worse? Cambridge Journal of Economics 23:543–564. 39 National Alliance for Caregiving and American Association of Retired People. 

(2004). Caregiving in the U.S. Available at http://www.caregiving.org/data/ 

04finalreport.pdf. 40 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

Jeopardy and What Can Be Done about It. New York: Basic Books. 41 Earle A. & S.J. Heymann. (2002). What causes job loss among former welfare recipients? The role of family health problems. Journal of the American Medical 

Women’s Association 57:5–10. 42 Earle A., J.Z. Ayanian, & S.J. Heymann. (2006). What predicts women’s ability 

to return to work after newly diagnosed coronary heart disease: Findings on the 

importance of paid leave. Journal of Women’s Health 15(4): 430–441. 43Lovell V. (2004) No Time to Be Sick: Why Everyone Suffers When Workers Don’t 

Have Paid Sick Leave. Washington, DC.: Institute for Women’s Policy Research. 

Available online at: http://www.iwpr.org/pdf/B242.pdf. 44Skatun J.D. (2003) Take some days off, why don’t you? Endogenous sick leave and 

pay. Journal of Health Economics 22(3):379–402. 45 Centers for Disease Control and Prevention. (2006). Key Facts about Influenza 

and the Influenza Vaccine. Available online at: http://www.cdc.gov/flu/ 

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size, staffing patterns, and infection control practices on communicable disease 

outbreaks in New York State nursing homes. American Journal of Epidemiology 

143(10):1042–9. 48Lovell V. (2005). Valuing Good Health: An Estimate of Costs and Savings for the 

Healthy Families Act. Washington, DC.: Institute for Women’s Policy Research. 

Available online at: http://www.iwpr.org/pdf/B248.pdf. 49Watkins M.P. (2004). The Case for Minimum Paid Leave for American Workers. 

Seattle: Economic Opportunity Institute. Available online at: http://www.eoi 

online.org/MinimumPaidLeave/Minimum%20LeaveBlueprint2004.pdf. 50 Casey T.F. & K. Warlin. (2001). Retention and customer satisfaction. Compensation Benefits Review 33:27–31. 51 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: 

How Does the United States Measure Up? Boston/Montreal: Project on Global 

Working Families. Available online at: http://www.mcgill.ca/files/ihsp/ 

WFEIFinal2007.pdf. 52 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: 

How Does the United States Measure Up? Boston/Montreal: Project on Global 

Working Families. Available online at: http://www.mcgill.ca/files/ihsp/ 

WFEIFinal2007.pdf. 53Lopez-Claros A., M.E. Porter, X. Sala-i-Martin, & K. Schwab. (2006). The Global 

Competitiveness Report 2006–2007. Hampshire, UK: Palgrave Macmillan. 54 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: 

How Does the United States Measure Up? Boston/Montreal: Project on Global 

Working Families. Available online at: http://www.mcgill.ca/files/ihsp/ 

WFEIFinal2007.pdf. 55 Earle A. & J. Heymann. (2006). A comparative analysis of paid leave for the 

health needs of workers and their families around the world. Journal of Comparative Policy Analysis 8(3):241–257. 

The CHAIRMAN. Heidi. 

STATEMENT OF HEIDI HARTMANN, PH.D., PRESIDENT, INSTITUTE FOR WOMEN’S POLICY RESEARCH, WASHINGTON, DC. 

Ms. HARTMANN. Good morning, Mr. Chairman. 

The CHAIRMAN. Good morning. 

Ms. HARTMANN. Senator Enzi, Senator Isakson. Thank you very 

much for the invitation to testify here this morning. I represent the 

Institute for Women’s Policy Research, which is a think tank focusing on issues of importance to women. I’d like to acknowledge the 

24 

work of Dr. Vicky Lovell on our staff, who has helped prepare the 

testimony today and who has conducted the research that I will be 

summarizing. 

And Mr. Chairman, before I begin, I’d like to thank you for your 

leadership, not only on the Healthy Families Act but on so many 

issues important to working women. I’d like to mention especially 

let us say your encouragement to the Bureau of Labor Statistics to 

reinstate the Women Workers Data series, a data set that we used 

today in presenting this research. So thank you very much. 

I’d also like to acknowledge Holly Fechner’s contribution in 

crafting the Healthy Families Act. She took an idea, only an idea 

brought to her by some researchers back in 2000 and working with 

many other people along the way, including leaders of the business 

community and the health profession. She has drafted a well 

thought out law that we are able to hold hearings on today. 

Since the year 2000, when we first brought that idea to your 

staff, IWPR has conducted research on many aspects of the 

Healthy Families Act, working with other researchers, members of 

Congress, State and municipal legislators and advocates across the 

country. 

Today I want to just briefly summarize the most important findings and ask that the full testimony be included in the record. Our 

most recent research uses the brand new Confidential Data Set, 

the National Compensation Survey housed at the Bureau of Labor 

Statistics, which collects data from the nation’s employers about 

the benefits they provide their workers. 

The first and most important point is that millions of U.S. workers are without any paid sick days. Fifty-seven million workers in 

March of 2006, the most recent survey date, lack paid sick days. 

Forty-eight percent, nearly half of all private sector workers lack 

paid sick days. Twenty-two million women workers lack paid sick 

days. 

When Mr. King will testify in a few moments that 75 percent of 

employers provide some paid days off, he is correct. They do. But 

that includes vacation and holidays. Having July 4th is great but 

it won’t help you with an illness unless you happen to be sick on 

July 4th. 

Actually, it’s true that half of all workers have no paid sick days. 

I wanted to also stress that if any employer has the new style 

PTO—paid time off—the flexible leave that is becoming more common, those employers are counted in these data as providing paid 

sick days. If we can take a look for a moment at Figure 1 (see Ms. 

Hartmann’s prepared statement), it shows the industries that have 

coverage for their workers with paid sick days and it goes from a 

high of 80 percent of workers with paid sick days and utilities and 

finance and insurance to a low of only 22 percent in food service. 

If we look at only those in that industry who actually handle the 

food, it’s only 15 percent who have paid sick days and if we look 

further at a smaller group, waiters and waitresses, it’s only 8 percent who have paid sick days. So 92 percent of waiters and waitresses have no paid sick days. Childcare workers—80 percent have 

no paid sick days. Retail sales clerks—57 percent have no paid sick 

days. 

25 

Dr. Bhatia will testify that from a public health standpoint, food 

service jobs are among the most important jobs that should be protected with paid sick days. The very workers we come into contact 

with every day—food, childcare, retail services—they have among 

the worst coverage. 

Besides industry and occupation, who are the workers who most 

often lack paid sick days? Part-time workers, yes. Only 20 percent 

have paid sick days. Eighty percent don’t have any. But considering all full time workers, only 62 percent have some paid sick 

days. That means that nearly half—40 percent—don’t have any. 

Low pay, yes. If we take a look at Figure 2 (see Ms. Hartmann’s 

prepared statement), we see that only 20 percent in the bottom 

quarter have some paid sick days. Eighty percent don’t have any. 

The CHAIRMAN. Excuse me, do you have these charts in a smaller 

form? I have difficulty seeing—— 

Ms. HARTMANN. Yes, they should be in the testimony. 

The CHAIRMAN. I have them. Thank you. One of my wonderful 

staff has just placed it in front of me. Thank you. 

Ms. HARTMANN. Sorry. But I’d like to also call your attention not 

just to the bottom quartile where we can assume the lowest wage 

workers will have the least paid sick days but look at the second 

quartile from the bottom, where 40 percent don’t have paid sick 

days and in the third quartile, 46 percent don’t have paid sick days 

and even if you look in the highest paid quartile, 28 percent do not 

have paid sick days so that means nearly one-third of all workers, 

even in the top, don’t have paid sick days. The lack of paid sick 

days, therefore, goes throughout the economy in virtually every sector from the lowest to the highest paid. 

We also found in the new National Compensation Survey that 

the average worker has to wait more than two and a half months 

to use any sick days the employer may have on the books. 

Finally, we have looked at the cost to the economy from the turnover that exists because all of these people do not have paid sick 

leave and the cost is actually $31 billion a year. These are new 

2006 estimates but we’ll be—they are provisional. We’ll make new 

estimates when we have a new bill and the benefits to workers 

would be $22 million. So the benefit from the gain in productivity 

far outstrips the cost of $22 billion, $31 billion gain, $22 billion 

cost. So the economy as a whole gains. 

In conclusion, I would like to say that workers need expanded 

paid sick days policies. The change will be good for our economy. 

It will even save employers money, $9 billion and enacting the 

Healthy Families Act will therefore increase the total output in the 

economy and improve the operation of the U.S. economy. Thank 

you. If I or my staff can be of further help, please do not hesitate 

to contact us. 

[The prepared statement of Ms. Hartmann follows:] 

PREPARED STATEMENT OF HEIDI I. HARTMANN, PH.D. 

Mr. Chairman and members of the committee, I am Heidi Hartmann, President 

of the Institute for Women’s Policy Research, an independent, scientific research institute focusing on women’s economic issues. Trained as a labor economist, with the 

Ph.D. degree from Yale University, I have studied women’s employment issues for 

more than 30 years. I am also a Research Professor at George Washington University. I am pleased to have the opportunity to testify today on the impact of the 

26 

Healthy Families Act on workers, businesses, the general economy, and public 

health. 

RESEARCH DOCUMENTS THE NEED AND POINTS TOWARD EFFECTIVE POLICIES

The Institute for Women’s Policy Research (IWPR) has been conducting research 

on the adequacy of existing paid sick days policies since 2000. During this period, 

we have analyzed confidential data collected from employers by the U.S. Bureau of 

Labor Statistics to assess coverage provided voluntarily by employers; explored 

workers’ use of paid time off policies with data collected by the U.S. Department 

of Health and Human Services; completed scans of medical and economics literature 

for data on the likely effects of expanding paid sick days programs; and worked 

closely with other researchers to develop valid approaches to measuring consequences workers experience when they lack adequate paid sick days. IWPR has 

provided data and policy analysis on this topic to Members of Congress, State legislatures, municipal governing bodies, and stakeholder groups working on the issue. 

We have completed non-partisan analysis at critical junctures in several campaigns 

for expanded paid sick days policies, including the movement in San Francisco that 

led to voter endorsement of a paid sick days ballot initiative in November 2006. 

CURRENT PAID SICK DAYS POLICIES LEAVE TENS OF MILLIONS WITH NO COVERAGE 1

Only 58 percent of the non-agricultural wage-and-salary workforce is covered by 

a formal paid sick days policy for which they are actually eligible (Table 1). 2 This 

leaves 42 percent—more than 57 million workers—without paid sick days. Nearly 

23 million of these workers are women. Workers in the public sector have much better coverage than in the private sector. Considering the private sector alone, fully 

48 percent of employees, nearly half, lack eligibility for any paid sick days. 

Table 1.—Percent and Number of Workers With and Without Paid Sick Days, 2006 

Workers with paid sick days Workers without paid sick days Total number of 

workers 1

Percent Number Percent Number 

Private sector ............................................. 52 58,517,000 48 54,538,000 113,055,000 

State and local government ...................... 87 16,735,000 13 2,501,000 19,235,000 

Total, private and State/local 2 ............... 57 75,252,000 43 57,038,000 132,290,000 

Federal Government ................................... 100 2,709,000 0 0 2,709,000 

Total, private and public sectors ............ 58 77,960,000 42 57,038,000 134,999,000 

Notes: Excludes agricultural, military, private household, and self-employed workers. Rows and columns may not sum to totals due to rounding. 1Workforce numbers for 2006 use the Current Employment Statistics; IWPR’s report No Time To Be Sick: Why Everyone Suffers When Workers Don’t Have Paid Sick Days (Institute for Women’s Policy Research, 2004) used the Current Population Survey, for the 2003 workforce. 2 These numbers and percentages are comparable to those of Table 1 in the IWPR publication No Time To Be Sick: Why Everyone Suffers 

When Workers Don’t Have Paid Sick Days (Institute for Women’s Policy Research, 2004). 

Source: Institute for Women’s Policy Research analysis of the March 2006 National Compensation Survey, the November 2005 through October 2006 Current Employment Statistics, and the November 2005 through October 2006 Job Openings and Labor Turnover Survey. 

In some industries, coverage is notably worse than the overall average (Table 1 

and Figure 1). Fewer than one-quarter of workers in the accommodation and food 

service industry have paid sick days (22 percent); coverage in construction is nearly 

as bad, at 25 percent. Employers in administration and waste services (which includes many clerical workers) and in arts, entertainment, and recreation extend 

paid sick days to only about one-third of their workers (31 and 35 percent, respectively). Retail trade also trails the average, with 45 percent of workers covered. 

Many of these industries with below average coverage are those with workers that 

all of us come into contact with every day: food service workers, cashiers, sales 

clerks. At the other end of the scale, roughly three-fourths of workers in wholesale 

trade; health care and social assistance; information; and management have paid 

sick days (71, 71, 74, and 77 percent, respectively), and more than four of every five 

workers in finance and insurance and in utilities are covered (82 and 85 percent, 

respectively). 

27 

Coverage is best in larger establishments: 3 Three-fourths of workers in the largest establishments (those with 5,000 or more employees) have paid sick days, while 

only two-fifths of workers in the smallest establishments (with one to nine workers) 

do (77 percent vs. 42 percent; Table 2). For all establishments covered by the FMLA, 

58 percent of workers are eligible for paid sick days. For smaller establishments, 

with fewer than 50 employees, 42 percent are eligible for paid sick days. 

Table 2.—Worker Eligibility For Employer-Provided Paid Sick Days Policies in the Private Sector, 

By Establishment Characteristics, 2006 

Percent of workers with employer-provided 

paid sick days 

Industry: 

Accommodation and food service ................................................................................................................... 22 

Construction ..................................................................................................................................................... 25 

Administration and waste services ................................................................................................................. 31 

Arts, entertainment, and recreation ................................................................................................................ 35 

Retail trade ...................................................................................................................................................... 45 

Mining .............................................................................................................................................................. 49 

Other services .................................................................................................................................................. 49 

Manufacturing ................................................................................................................................................. 52 

Transportation and warehousing ..................................................................................................................... 56 

Real estate and rental .................................................................................................................................... 67 

Educational services ........................................................................................................................................ 68 

Professional and technical services ................................................................................................................ 69 

Wholesale trade ............................................................................................................................................... 71 

Health care and social assistance ................................................................................................................. 71 

Information ...................................................................................................................................................... 74 

Management .................................................................................................................................................... 77 

Finance and insurance .................................................................................................................................... 82 

Utilities ............................................................................................................................................................ 85 

All ..................................................................................................................................................................... 52 

Number of Employees: 

1 to 9 ............................................................................................................................................................... 42 

10 to 24 ........................................................................................................................................................... 40 

25 to 49 ........................................................................................................................................................... 44 


33446-1.eps
28 

Table 2.—Worker Eligibility For Employer-Provided Paid Sick Days Policies in the Private Sector, 

By Establishment Characteristics, 2006—Continued 

Percent of workers with employer-provided 

paid sick days 

50 to 99 ........................................................................................................................................................... 41 

100 to 499 ....................................................................................................................................................... 55 

500 to 4,999 .................................................................................................................................................... 71 

5,000 or more .................................................................................................................................................. 77 

1 to 49 workers ............................................................................................................................................... 42 

50 or more (FMLA covered) ............................................................................................................................. 58 

All ..................................................................................................................................................................... 52 

Region: 

New England .................................................................................................................................................... 61 

Mid-Atlantic ..................................................................................................................................................... 56 

East North Central ........................................................................................................................................... 48 

West North Central .......................................................................................................................................... 51 

South Atlantic .................................................................................................................................................. 49 

East South Central .......................................................................................................................................... 48 

West South Central .......................................................................................................................................... 49 

Mountain .......................................................................................................................................................... 52 

Pacific .............................................................................................................................................................. 55 

All ..................................................................................................................................................................... 52 

Note: Excludes agricultural, military, private household, and self-employed workers. Rows and columns may not sum to totals due to rounding. 

Source: Institute for Women’s Policy Research analysis of the March 2006 National Compensation Survey, the November 2005 through October 2006 Current Employment Statistics, and the November 2005 through October 2006 Job Openings and Labor Turnover Survey. 

By region, paid sick days coverage ranges from a low of 48 percent in the East 

North Central region (which includes the States of Illinois, Indiana, Michigan, Ohio, 

and Wisconsin) and the East South Central region (which includes the States of Alabama, Kentucky, Mississippi, and Tennessee) to a high of 61 percent in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and 

Vermont; Table 2). 

LOWER-WAGE WORKERS ARE SHUT OUT OF CURRENT POLICIES

The availability of paid sick days varies enormously along job characteristics such 

as occupation, work hours, and wage level (Table 3). In general, professional and 

other white-collar workers have the best paid sick days coverage, and those in 

lower-level service-sector jobs are the least likely to have any paid sick days. Among 

occupations, paid sick days rates are the highest for lawyers, managers, and computer, math, architecture, and engineering professionals, at 84 percent, 83 percent, 

and 81 percent, respectively. Three of every four workers in business and financial 

occupations, community and social services, and life, physical, and social sciences 

also have paid sick days (78 percent, 77 percent, and 75 percent, respectively). At 

the other end of the spectrum, only one in seven food service workers has paid sick 

days (15 percent). Protective services and construction workers also have very low 

coverage, at 22 percent and 18 percent, respectively. 

Table 3.—Worker Eligibility For Employer-Provided Paid Sick Days in the Private Sector 

By Job Characteristics, 2006 

Percent of workers with employer-provided 

paid sick days 

Occupation: 

Food Preparation and Services ........................................................................................................................ 15 

Construction and Extraction ............................................................................................................................ 18 

Protective Services ........................................................................................................................................... 22 

Personal Care and Service .............................................................................................................................. 37 

Transportation and Material Moving ............................................................................................................... 41 

Production ........................................................................................................................................................ 41 

Sales ................................................................................................................................................................ 46 

Building services, Grounds Cleaning, and Maintenance ................................................................................ 53 

29 

Table 3.—Worker Eligibility For Employer-Provided Paid Sick Days in the Private Sector 

By Job Characteristics, 2006—Continued 

Percent of workers with employer-provided 

paid sick days 

Installation, Maintenance, and Repair Services ............................................................................................. 58 

Arts, Entertainment, Sports ............................................................................................................................. 62 

Education and Training ................................................................................................................................... 62 

Healthcare Support .......................................................................................................................................... 65 

Office and Administrative Support .................................................................................................................. 68 

Healthcare Practice and Technical ................................................................................................................. 71 

Life, Physical, and Social Sciences ................................................................................................................. 75 

Community and Social Services ...................................................................................................................... 77 

Business and Financial ................................................................................................................................... 78 

Architecture and Engineering .......................................................................................................................... 81 

Computer and Math ........................................................................................................................................ 81 

Management .................................................................................................................................................... 83 

Legal ................................................................................................................................................................ 84 

All ..................................................................................................................................................................... 52 

Wage Level: 

Fourth (bottom) ................................................................................................................................................ 21 

Third ................................................................................................................................................................. 54 

Second ............................................................................................................................................................. 62 

First (top) ......................................................................................................................................................... 72 

All ..................................................................................................................................................................... 52 

Work Schedule: 

Full-time .......................................................................................................................................................... 62 

Part-time .......................................................................................................................................................... 20 

Full-year ........................................................................................................................................................... 53 

Part-year .......................................................................................................................................................... 26 

Full-year, full-time ........................................................................................................................................... 63 

Not full-year, full-time .................................................................................................................................... 21 

All ..................................................................................................................................................................... 52 

Notes: Excludes agricultural, military, private household, and self-employed workers. Rows and columns may not sum to totals due to 

rounding. Cutoffs for wage quartiles: first (top), $21.66 or more; second, $13.50 to $21.65; third, $9.23 to $13.49; and fourth (bottom), less 

than $9.23. 

Source: Institute for Women’s Policy Research analysis of the March 2006 National Compensation Survey, the November 2005 through October 2006 Current Employment Statistics, and the November 2005 through October 2006 Job Openings and Labor Turnover Survey. 

Full-time workers are more than three times as likely to have paid sick days as 

part-time workers (62 percent vs. 20 percent). While working a short week does provide some flexibility to respond to health needs, many part-timers have less than 

full-time hours involuntarily, and others work multiple part-time jobs in order to 

patch together a full-time income. (Despite the fact that 19 percent of women and 

24 percent of men would prefer to work more hours than they currently do,4 some 

firms deliberately limit workers’ hours in order to avoid having them become eligible 

for benefits such as paid sick days.) Thus, the lack of paid sick days for part-time 

workers is as serious an issue as the incomplete coverage of full-time workers. 

Workers on part-year schedules also have very restricted access to paid sick days, 

with only one-quarter covered (26 percent). 

Differences in paid sick days coverage by wage level are as extreme as those by 

occupation. At the top, nearly three-fourths of workers have access to paid sick days 

(72 percent; Figure 2 and Table 3).5 Coverage drops to three-fifths for workers in 

the second wage quartile (62 percent), and then to just over half for those in the 

third wage quartile (54 percent). Only about one-fifth of workers in the bottom wage 

quartile have paid sick days (21 percent). (The wage threshold for the bottom wage 

quartile is $9.23, approximately the same as the hourly wage which, if worked fulltime throughout the year, would provide a poverty-line income for a family of four.) 

30 

In addition to having differential access to paid sick days, workers at different 

wage levels are offered different numbers of paid sick days (Table 4). After 1 year 

on the job, workers in the top wage quartile average 10 paid sick days. Those in 

the second wage quartile have nearly 8 days; in the third, 7; and in the bottom, 6.5. 

With 10 years of job tenure, those at the top accrue nearly an additional 3 days, 

for a total of 12.7, while those in the bottom wage quartile have only one more paid 

sick day, giving them 7.5 days annually. The lowest-wage workers also have to wait 

longer to qualify for paid sick days than higher-wage workers: an average of 3.5 

months, or nearly twice the job tenure requirement of 1.9 months offered to workers 

in the top wage quartile. 

Table 4.—Number of Paid Sick Days By Years of Job Tenure, and Eligibility Periods, 

By Wage Quartile 

Wage quartile 

Number of paid 

sick days after: Number of 

months between hire 

1 year and eligibility 10 

years 

Top ............................................................................................................................................. 10.0 12.7 1.91 

Second ........................................................................................................................................ 7.8 9.1 2.33 

Third ........................................................................................................................................... 7.1 8.4 3.12 

Bottom ........................................................................................................................................ 6.5 7.5 3.48 

All ............................................................................................................................................... 8.1 9.8 2.59 

Notes: Excludes agricultural, military, private household, and self-employed workers. Rows and columns may not sum to totals due to 

rounding. 

Source: Institute for Women’s Policy Research analysis of the March 2006 National Compensation Survey, the November 2005 through October 2006 Current Employment Statistics, and the November 2005 through October 2006 Job Openings and Labor Turnover Survey. 

WORKERS WITH PAID SICK DAYS TAKE 3.9 DAYS PER YEAR FOR THEIR OWN ILLNESSES

AND 1.3 DAYS TO CARE FOR OTHER FAMILY MEMBERS

According to IWPR analysis of the 2004 National Health Interview Survey, workers who are covered by paid sick days policies miss an average of 3.9 days of work 

per year for their own illness and injury (excluding maternity leave).6 (Workers who 

lack this benefit take approximately one fewer day off for sickness per year, at an 

average of 3.0 days.) But, of course, individual workers vary enormously in their 

need for paid sick days. Zero is the most typical number of days taken off for illness: 

half (50 percent) of those with a paid sick days policy do not miss a single day of 

work because of illness in an entire year. Others—those with chronic illnesses, or 

medical emergencies—need more than 1 week in at least some years. 


33446-2.eps
31 

According to the U.S. Department of Labor’s 2000 Family and Medical Leave Act 

Survey of Employees, workers take 0.33 days of FMLA-type leave to care for ill children, spouses, and parents for every day of leave taken for their own health needs. 

Thus, on average, we estimate that workers need 1.3 days of paid sick time per year 

to care for family members.7 Again, this need will vary considerably by individual 

circumstances. For instance, parents of school-age children may need to attend to 

their children at home for approximately 4 days per year,8 and workers with responsibility for elderly parents or disabled adult children may need more time as well. 

The Healthy Families Act, as proposed in the last congressional session, would 

also provide time off work with pay for workers to obtain preventive and other care 

from doctors. This is likely to involve 3.5 hours for doctor visits per year, on average, for workers’ own health needs.9

THE HEALTHY FAMILIES ACT WOULD BRING BENEFITS TO WORKERS, BUSINESSES, 

AND THE OVERALL ECONOMY

Workers and their families. Establishing a minimum paid sick days standard 

through a bill such as the Healthy Families Act, proposed in the last session, would 

bring immediate benefits to workers who currently lack paid sick days. They would 

likely take an average of one additional day off work for their own health-care 

needs, and thus recuperate more completely and faster from illnesses, injuries, surgery, and other medical treatments.10 Their families would not suffer the lost income associated with staying home on unpaid leave when working is impossible. 

The preliminary 2006 estimated benefit to workers in new sick pay under a model 

program proposed to the 109th Congress as the 2004 Healthy Families Act would 

be $19.6 billion. This is the amount of new pay that workers who did not have sick 

pay before, or whose sick days were limited, would be expected to receive each year. 

Children recover their health faster with parents’ involvement,11 and having paid 

time off is the primary factor in parents’ decisions about staying home when their 

children are sick.12 Thus, workers who are granted new paid sick days will experience better health outcomes for their children and, likely, lower health-care expenditures. Parents who are allowed to take their children to the doctor during work 

hours without missing pay may also be better able to carry out recommended treatments and routine care, such as immunizations and well-child check-ups. And family care will not cause workers to lose as much income as they now do. Now, half 

of working mothers, and 75 percent of low-wage working mothers, lose pay when 

they stay home with a sick child.13 This is a costly, stressful burden to impose on 

families already struggling to shoulder the responsibilities of work and family. 

With better paid sick days programs, families may also be able to avoid some 

short-term nursing home stays for elderly relatives. Over 21 million full-time workers are caregivers for aging family members.14 It is not unusual for an older patient 

to be dismissed from a hospital as too healthy to need such a high level of medical 

care, but not being healthy enough to be home alone. If an adult child can take a 

couple days off work to provide needed care, the patient may be able to transition 

directly home. With nursing homes charging an average of $158 per day,15 and 

skilled in-home care also costly, families that can take care of their own relatives 

can enjoy substantial savings. 

Employers. With improved sickness absence programs, businesses will gain in at 

least three ways. First, and most significant in monetary terms: Rates of voluntary 

turnover will drop, as workers find their current compensation package more attractive and are, therefore, less inclined to search out another job. Research shows that 

turnover rates will drop by between 4 and 7 percentage points, for different demographic groups of workers.16 Replacing workers is very expensive: Even in the lowwage labor market, filling a vacant position and bringing a new worker up to full 

productivity can cost 43 percent of annual pay.17 A more general rubric is that an 

employer must pay 25 percent of a worker’s total yearly compensation (including the 

cost of benefits) to replace a worker.18

This benefit alone will save employers more than the total cost of additional 

wages, payroll taxes, and administrative expenses of the Healthy Families Act. 

A second major benefit for employers is that, when at work, their workers will 

be healthier. That is, those who are too sick to perform at full capacity will be at 

home, rather than receiving their full compensation for being at work but not being 

productive. Savings associated with better management of workers’ presenteeism 

will help offset new wage payments to workers who, appropriately, stay at home 

when they are sick. 

Finally, employers will reap benefits in lower overall sickness rates when workers 

with contagious diseases remove themselves from the workplace and avoid passing 

germs to their colleagues. Thirty percent of workers report having become sick from 

32 

someone in their office during the last flu season 19; many have experienced the phenomenon of a cold or flu spreading through a worksite, taking out one worker after 

another. This is much less likely to happen if workers can stay home when they 

are in a contagious phase of a disease. Employers know that presenteeism is not 

a good thing: More than half (56 percent) say it is a problem for them.20

The preliminary 2006 estimate of the total benefits of a bill such as the Healthy 

Families Act introduced in the last session of Congress is $31.2 billion, which far 

outstrips the estimated total cost of $22.3 billion.21

Public health. The issue of contagion has very important implications for public 

health, in addition to its impact on individual employers. Should a serious pandemic 

erupt—such as might occur if the bird flu mutated to be transmittable between humans—it will be critical that infected workers reduce their social contacts as much 

as possible while they are in a contagious phase. But even less serious flu outbreaks 

can be ameliorated by good paid sick days policies that allow workers to sensibly 

withdraw from worksites to avoid spreading disease. Research has shown that the 

incidence of disease within workplaces is lessened when workers have paid sick 

days.22 That also means that fewer individuals are bringing germs home to their 

own families and friends. And that is why the Centers for Disease Control and Prevention recommend that people who have the flu stay home.23

The economy at large. The productivity effects of expanded paid sick days will 

benefit not only individual employers—they will add to overall economic productivity. Reducing total sickness absence by keeping sick workers out of offices and 

reducing voluntary job turnover will help to maximize workers’ output. Job-protected paid sick days are especially important to women workers. Still today women 

workers bear the larger share of family care, and thus having the right to leave and 

return to their jobs, and not lose pay, is of far greater benefit to women. A bill to 

guarantee workers several paid sick days per year (that can also be used for family 

care) will lengthen and strengthen women’s attachment to their jobs, enabling them 

to gain job seniority and improve their long-term productivity. A paid sick days bill 

will help women’s average time on the job catch up with men’s, contributing ultimately to greater pay equity between women and men. 

Holding down involuntary job loss will also contribute to economic productivity. 

There is an ever-growing accumulation of anecdotal evidence about this effect, collected by worker rights organizations such as 9to5 24 as well as the Center for 

WorkLife Law at the Hastings School of Law.25 As no government surveys measure 

this phenomenon, it is difficult to estimate the dollar value of recovered productivity 

that would accrue from better paid sick days policies that keep workers from being 

fired for missing work when they, or members of their families, are sick. As a rough 

estimate, using known data on the share of the low-wage workforce that lacks paid 

sick days (79 percent), rates of hiring in low-wage industries, and the share of lowwage new hires that replaces workers (as opposed to filling new positions), IWPR 

calculates that involuntary turnover related to the lack of paid sick days for lowwage workers likely costs employers nearly $2 billion annually. This cost estimate 

is based on using a parameter of 3.3 percent of job loss in the low-wage labor market is involuntary due to the lack of paid sick days. The productivity impact of inadequate paid sick days policies is certainly very substantial. Productivity losses of 

this nature are a drain on the economy as a whole, in addition to their direct impacts on workers and employers. 

IWPR’s research clearly shows the need for expanded access to paid sick days and, 

further, that such access will bring benefits not only to workers but also to businesses and the economy overall. In fact the benefits substantially outweigh the 

costs, indicating that enactment of such a requirement would improve the operation 

of the U.S. economy. Our research also documents that workers make modest use 

of paid sick days policies—the most typical number of days taken off per year is 

zero, and workers who have paid sick days miss only one more day of work than 

those without. I urge the Congress to develop this legislation to address the needs 

of workers for paid sick days and improve overall productivity and economic growth. 

If I or my staff can be of further help to you as you continue to deliberate on these 

issues, please do not hesitate to contact us. Thank you for holding this hearing and 

for the opportunity to testify. 

METHODOLOGY

The IWPR analysis of paid sick days coverage rates begins with analysis of the 

March 2006 National Compensation Survey (NCS). Collected by the U.S. Bureau of 

Labor Statistics (BLS), this payroll survey includes more than 10,000 private-sector 

establishments of all sizes and 41,985 individual jobs. (Private household and military employers and the self-employed are not included.) IWPR staff conducted the 

33 

analysis of the confidential microdata set onsite at the BLS under contract with the 

BLS. Weighting variables calculated by the BLS allow generalization of findings to 

the entire U.S. private-sector workforce. The March 2006 NCS did not survey local 

and State governments, so participation rates for workers in those sectors are from 

IWPR’s previous analysis of the 1996–1998 Employee Benefits Survey, the precursor 

to the NCS. 

The NCS queries employers on numerous benefits provided to workers for which 

the employer incurred a cost. Regarding paid sick days benefits, it specifically collects data on whether jobs are covered by a policy allowing workers to stay home, 

with pay, when they are sick. (Thus, general paid-time-off policies that do allow this 

use are coded as being paid sick days programs.) Individual incumbents in those 

jobs may not yet have met employer-imposed eligibility thresholds related to job tenure. That is, the NCS provides data on ‘‘access’’ to paid sick days, but not on ‘‘participation.’’ To adjust for eligibility, data on the percent of workers who are new 

hires, taken from the BLS’ Job Openings and Labor Turnover Survey, by industry, 

were combined with data from the NCS on the average number of days between 

date of hire and eligibility for paid sick days policies (78 days). In the analysis presented here, ‘‘participation’’ refers to the share of the workforce that has ‘‘access’’ 

to paid sick days, according to the NCS, and has also met the average eligibility 

threshold. 

Workforce size estimates use the Current Employment Statistics payroll survey. 

In estimating the 2006 benefits of the Healthy Families Act, the 2003 estimates 

presented in Valuing Good Health: An Estimate of Cost and Savings for the Healthy 

Families Act (Washington, DC.: Institute for Women’s Policy Research, 2005) were 

used, with final dollar values for wages and other factors inflated to 2006 dollars 

using the CPI. 

To estimate the costs of involuntary job loss by low-wage workers, the most likely 

to lack paid sick days, IWPR combined information from several sources. The size 

of the low-wage workforce was estimated as the lowest paid quartile, using the 

sources described above; 79 percent of these lack paid sick days according to IWPR 

analysis of the 2006 National Compensation Survey. Monthly new hires from the 

Job Openings and Labor Turnover Survey for Accommodation and Food Service 

were used to proxy new hires for the low-wage labor force as a whole. IWPR then 

adjusted these numbers downward to obtain an estimate of the amount of job replacement, as opposed to job growth, based on data from the BLS for those with 

a high school degree or less.26 We estimate that 3.3 percent of all turnover in the 

low-wage labor market is involuntary job loss due to the lack of paid sick days. Finally, we estimate the annual compensation cost of the low-wage worker from Valuing Good Health (inflated to 2006 dollars) and, following that report, assume that 

turnover costs equal 25 percent of total annual compensation. 

ENDNOTES

1Data presented here are from Institute for Women’s Policy Research analysis of 

the March 2006 National Compensation Survey, which collected information on employment benefits from over 10,000 non-agricultural private-sector establishments. 

(Private households were not surveyed.) The survey’s data on workers’ ‘‘access’’ to 

paid sick days was adjusted to reflect actual participation in these programs using 

data on new hires from the Job Openings and Labor Turnover Survey, to account 

for workers who have not yet met job tenure eligibility criteria for participation in 

offered paid sick days programs. 2 Refers to the workforce excluding Federal, military, and private household employees and the self-employed. 3These data are for establishments—individual physical business locations; the 

National Compensation Survey does not collect data at the level of firms. (A firm 

may comprise a number of individual establishments.) 4 Jeremy Reynolds, ‘‘When Too Much Is Not Enough: Actual and Preferred Work 

Hours in the United States and Abroad,’’ Sociological Forum 19, 1 (2004): 89–120. 5The top wage quartile includes workers making $21.66 or more per hour; second, 

$13.50 to $21.65; third, $9.23 to $13.49; and fourth (bottom), less than $9.23. 6 Vicky Lovell, Valuing Good Health in San Francisco: The Costs and Benefits of 

a Proposed Paid Sick Days Policy (Washington, DC.: Institute for Women’s Policy 

Research, 2006). 7 Rutgers University Center for Women and Work analysis of data from U.S. Department of Labor, Family and Medical Leave Surveys, 2000 Update, April 12, 2005. 8 Vicky Lovell, No Time to be Sick: Why Everyone Suffers When Workers Don’t 

Have Paid Sick Leave (Washington, DC.: Institute for Women’s Policy Research, 

2004). 

34 

9Lovell 2006. 

10 Anne Grinyer and Vicky Singleton, ‘‘Sickness Absence as Risk-Taking Behavior: 

A Study of Organizational and Cultural Factors in the Public Sector,’’ Health, Risk 

and Society 2 (March 2000): 7–21. 11Sarah J. Palmer, ‘‘Care of Sick Children by Parents: A Meaningful Role,’’ Journal of Advanced Nursing 18 (February 1993): 185–191. 12 Jody S. Heymann, Alison Earle, and Brian Egleston, ‘‘Parental Availability for 

the Care of Sick Children,’’ Pediatrics 98 (August 1996): 226–230. 13 Roberta Wyn, Victoria Ojeda, Usha Ranji, and Alina Salganicoff, Women, Work, 

and Family Health: A Balancing Act (Washington, DC.: Henry J. Kaiser Family 

Foundation, 2003). <http://www.khpa.ks.gov/healthquest/pdfs/BalancinglActl IssuelBrief.pdf> 14 National Alliance for Caregiving and AARP, Caregiving in the U.S. (Bethesda, 

MD: National Alliance for Caregiving, 2004). 15MetLife, The MetLife Market Survey of Nursing Home & Home Care Costs 

(Westport, CT: MetLife Mature Market Institute, 2004). 16Philip F. Cooper and Alan C. Monheit, ‘‘Does Employment-Related Health Insurance Inhibit Job Mobility?’’ Inquiry 30 (Winter 1993): 400–416. 17Walter E. Johnson and Dan M. Tratensek, ‘‘Employee Turnover,’’ Do-It-Yourself 

Retailing 180 (June 2001). 18 Employment Policy Foundation, ‘‘Employee Turnover—A Critical Human Resource Benchmark,’’ HR Benchmarks (December 3, 2002): 1–5 <www.epf.org> (January 3, 2005). 19 National Foundation for Infectious Diseases, New National Survey Shows Employees Feel Pressured to Go to Work, Despite Being Sick with Flu <http:// 

www.nfid.org/pdf/docs/workplacelflulrelease.pdf> (February 8, 2007). 20 CCH Incorporated, ‘‘Findings from the 2006 Unscheduled Absence Survey’’ 

<http://hr.cch.com/thenews> (January 24, 2007). 21 Institute for Women’s Policy Research analysis updating the findings presented 

in Vicky Lovell, Valuing Good Health: An Estimate of Cost and Savings for the 

Healthy Families Act (Washington, DC.: Institute for Women’s Policy Research, 

2005) to account for inflation. 22 Jiehui Li, Guthrie S. Birkhead, David S. Strogatz, and F. Bruce Coles, ‘‘Impact 

of Institution Size, Staffing Patterns, and Infection Control Practices on Communicable Disease Outbreaks in New York State Nursing Homes,’’ American Journal 

of Epidemiology 143 (May 1996): 1042–1049. 23 U.S. Department of Health and Human Services, Influenza Symptoms, Protection, and What to Do If You Get Sick <http://www.cdc.gov/flu/pdf/symptoms.pdf> 

(February 8, 2007). 24 9 to 5: National Association of Working Women, 10 Things that Could Happen 

to You if You Didn’t Have Paid Sick Days <http://www.9to5.org/downloads/booklet.pdf> (February 9, 2007). 25 Joan C. Williams, One Sick Child Away From Being Fired: When ‘‘Opting Out’’ 

is Not an Option (San Francisco: UC Hastings College of Law, WorkLife Law, 2006). 26Daniel E. Hecker, ‘‘Occupational Employment Projections to 2014,’’ Monthly 

Labor Review (November 2005): 70–101. 

The CHAIRMAN. Thank you very much. 

Rajiv. 

STATEMENT OF RAJIV BHATIA, M.D., MPH, DIRECTOR OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH FOR THE SAN 

FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND ASSISTANT CLINICAL PROFESSOR OF MEDICINE AT UNIVERSITY 

OF CALIFORNIA AT SAN FRANCISCO 

Dr. BHATIA. Good morning, Mr. Chairman, Senator Isakson, Senator Enzi. My name is Rajiv Bhatia. I served as the Director of Occupational and Environmental Health for the City and County of 

San Francisco since 1998. I also teach at the University of California. My research focus is on methods to study the health impacts of social, economic and environmental policies. It has always 

been important to me that health is valued with economic concerns 

equally. In fact, health is the reason that we promote economic concerns in the first place. 

35 

In November 2006, San Francisco became the first place in the 

United States to require employers to provide sick days. Sixty-one 

percent of the voters approved this ballot initiative, in part because 

of the impacts on public health. In my testimony, I want to focus 

on three important issues that have already been, in part, mentioned by the other witnesses here today. 

First, I want to talk about the trade-offs that workers without 

paid sick days have to face. Second, the risk of infectious disease 

in the workplace and third, the economic and social costs of avoidable hospitalization. 

For the tens of millions of workers that don’t have paid sick 

days, you’re asking them to make a choice between two pretty unacceptable adverse health impacts—not taking care of themselves 

or their children or risking eviction or hunger or potentially a loss 

of future economic employment. About 14.1 million households pay 

50 percent of their income or more in rent. They are severely rent 

burdened. They have a few hundred dollars extra a month. 

Twelve percent of U.S. households are food insecure and 4 percent are hungry. When a worker without paid sick days has to 

make a choice, they are making a choice between two pretty unacceptable health consequences. 

The health impacts of these choices don’t stop just with the individuals who don’t have the sick days; they affect all of us. We’ve 

heard about the spread of infectious disease. Three of the most important infectious diseases that are really easily spread from person to person are influenza, stomach flu and meningitis. These diseases are spread just by touching or shaking hands or contact with 

the surface or sneezing—things that happen easily at workplaces 

or schools. 

Up to 20 percent of the population gets the flu. Thirty-six thousand people die from it. These viral gastroenteritis and viral meningitis affect tens of thousands of children a year. The Center for 

Disease Control recommends when you have influenza, stay home 

from work when you’re sick. Paid sick days lets Americans make 

a responsible choice. 

The third and I think very important reason for us to provide 

paid sick days has to do with food service workers. We go to restaurants every day. We go to catered parties and food service workers are working here without paid sick days. They know—we know 

food service workers are not supposed to go to work sick but food 

service workers may not recognize the symptoms of a food borne illness. They may defer it to earn some extra money and they are 

putting—in that short period of time, they can be spreading the 

disease, not only just to a few people through a restaurant but 

thousands of people if they are working in a food processing plant. 

As we know, only 15 percent of workers in the food service industry have paid sick days and this is among the lowest rate of occupations. 

Finally, I want to talk about hospitalizations. There are few hospitalizations for chronic diseases that are entirely preventable with 

appropriate and timely care. There are 14.7 million diabetics in 

this country. There are 600,000 hospitalizations for diabetes. There 

are 30 million asthmatics with 500,000 hospitalizations every year. 

36 

Early treatment can prevent these hospitalizations and save, for 

example, up to $13,000 for the hospitalization costs of asthma. 

In order to get this timely caring, you not only need health insurance but you need time off. You need transportation. Sick day benefits, in my experience, have been one that helps patients get to 

their doctor appointments and prevents these hospitalizations. This 

can have tremendous social costs. It can particularly prevent and 

help our public safety hospitals who are caring for the majority of 

low income—a lot of low-income workers without paid sick days. 

I want to conclude by just highlighting the significance of employment and social policies in general, on public health. The 

United States spends the most of the developed world on health: 

$6,000 per year—15 percent of our GDP. This is over twice the 

spending of every other western democratic market economy in the 

world and our health performance is the poorest. Canada and England—we live a full year less than people in Canada and England—3 years less than Spain, Sweden and Switzerland. The fact 

that our health performance is poor underscores what public health 

professionals know—that we don’t provide the social and economic 

and environmental conditions for good health for all Americans and 

that is why these other countries are outperforming us in health. 

I am very encouraged that you’re considering the public health consequences of this law. I sincerely hope that we can have paid sick 

days for all Americans, not only because it’s humane, because it’s 

in the interest of public health. Thank you. 

[The prepared statement of Dr. Bhatia follows:] 

PREPARED STATEMENT OF RAJIV BHATIA, M.D., MPH 

My name is Rajiv Bhatia. I have a Medical Doctorate from Stanford University 

and a Masters in Public Health from the University of California at Berkeley. I have 

practiced medicine since 1989 and environmental public health for the past 11 

years. Since 1998, I have served as the Director of Occupational and Environmental 

Health for the city and county of San Francisco’s Department of Public Health. I 

also hold the position of Assistant Clinical Professor of Medicine at the University 

of California at San Francisco. 

I want to thank the committee for recognizing that having paid sick days can 

have important public health consequences. In November 2006, San Francisco became the first place in the United States to require employers to provide paid sick 

days. Sixty-one percent of the voters approved this ballot initiative and the law took 

effect February 5, 2007. 

In part, San Franciscans passed this law understanding its importance to health. 

I believe that there are a number of important public health reasons to provide paid 

sick days. These include: 

1. Enabling workers to take the time off needed to manage and/or recover from 

an illness and care for ill family members. 

2. Protecting co-workers and the public from infectious disease. 

3. Reducing the social and economic costs of avoidable hospitalizations. 

When most people are ill, they need and want to take the time off to access health 

care or simply to recuperate. Sick children need to stay home from school and need 

their parents or caregivers to take care of them. While not all people who are sick 

would choose to stay away from work or school, paid sick days allow workers to 

make this important choice without sacrificing other equally important needs. 

For the 66 million workers without paid sick days benefits, an illness in the family means having to make an extremely difficult choice. Should they take unpaid 

time off from work to care for themselves or their children; or, should they go to 

work sick or send their children to school sick? For low-income workers, not going 

to work for even a few days may mean not having enough money to pay the rent 

or buy food. Some workers may also be insecure in their jobs, not knowing whether 

an absence from work may translate into the loss of a job. These workers must consider unemployment, hunger, and eviction when making a choice about staying 

37 

1 Heymann SJ, Toomey S, Furstenberg F. Working parents: what factors are involved in their 

ability to take time off from work when their children are sick? Arch Pediatr Adolesc Med. 

1999;153(8):870–4. 2 Viral gastroenteritis is caused by a variety of viruses including rotaviruses, noroviruses, 

adenoviruses, sapoviruses, and astroviruses. 3 Centers for Disease Control 2006. 

4Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Griffin PM, Tauxe RV. 

Food-Related Illness and Death in the United States. Emerging Infectious Diseases. Centers for 

Disease Control and Prevention, Atlanta, Georgia, USA Pathogens responsible for foodborne illnesses include the Norwalk viruses, the Hepatitis A virus, Salmonella typhi, Shigella species, 

Staphylococcus aureus, and Streptococcus pyogenes. 5Signs or symptoms in persons who handle food may include diarrhea, vomiting, open skin 

sores, boils, fever, dark urine, or jaundice. 6Fiore A. Hepatitis A transmitted by Food. Clinical Infectious Diseases 2004;38:705–15. 

home to take care of themselves or a family member. Such competing pressures 

mean that workers without paid sick days are more likely to go to work sick or let 

their children go to school sick. In fact, research tells us that parents who had paid 

sick days were 5.2 times as likely to care for their children when they were sick.1

The health impacts of these difficult choices are not limited to workers and their 

families. Going to work or school with an infectious disease can mean transmitting 

it to others. Several common infectious diseases are transmitted in workplaces, 

schools, and other public institutions through casual contact. For example, influenza 

virus is spread mainly from person to person through coughing or sneezing. Or people may become infected by touching something with flu viruses on it and then 

touching their mouth or nose. Every year in the United States, 5 percent to 20 percent of the population gets the flu; more than 200,000 people are hospitalized from 

flu complications; and, about 36,000 people die from flu. 

Viral gastroenteritis, often called the ‘‘stomach flu,’’ is contagious and spread 

through close contact with infected persons.2 Rotovirus, the most common cause of 

severe diarrhea among children, results in the hospitalization of approximately 

55,000 U.S. children each year.3

About 90 percent of cases of viral (‘‘aseptic’’) meningitis, which causes inflammation of the tissues that cover the brain and spinal cord, are caused by viruses known 

as enteroviruses which are also spread through casual contact. In the United States, 

there are between 25,000 and 50,000 hospitalizations due to viral meningitis each 

year. 

For all these common diseases—influenza, stomach flu, viral meningitis—infection 

can be prevented by allowing a sick worker to stay away from their workplace and 

by keeping sick children home from school. In fact, the U.S. Centers for Disease 

Control Web site provides the very common sense recommendation to people with 

influenza: ‘‘stay home from work and school when you are sick.’’ All things being 

equal, having paid sick days enables all Americans to follow our Federal public 

health recommendations. 

The public health importance of keeping sick employees out of the workplace is 

far more significant for some occupations. For occupations such as health care workers, child care providers, and people who handle food, there is the potential for a 

sick worker to transmit an infectious disease to many, many people. In the case of 

food handlers or food service workers, there is the potential for transmission to hundreds or thousands of others. The spread of foodborne illness by an infected worker 

can happen at a catered party or at a neighborhood restaurant, but it can also happen in food processing plants and result in outbreaks of illness nationally. Overall, 

foodborne diseases cause approximately 76,000,000 illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year.4

Of course, people with foodborne illnesses who work in the food industry should 

not be going to work. In reality, we rely on workers to recognize the illness and 

their employers to self-enforce requirements that protect the public. A worker may 

recognize a symptom but may not associate it with a foodborne illness.5 It takes 

time and often a visit to the doctor to find out that you have a foodborne illness. 

A food worker may not want to take unpaid time to obtain a diagnosis or may defer 

care until the symptom worsens, in the meantime, potentially infecting co-workers 

and patrons. A recent published review of foodborne Hepatitis A outbreaks in the 

United States demonstrated that in many cases the infected food handler either did 

not seek medical care or delayed getting medical care.6 Unfortunately, only 15 percent of workers in the food service industry have paid sick days—the lowest rate 

38 

7 Based on analysis of 2006 data by Vickie Lovell. Institute for Women’s Policy Research. 

Washington, DC. 8 Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. 

Health Affairs 1996 Fall;15(3):239–49. 9 Akinbami LJ. The State of Childhood Asthma, United States, 1980–2005. Advance Data 

Number 381 December 12, 2006. 10 California Office of Statewide Health Planning and Development 2006. Available at: http:// 

www.oshpd.cahwnet.gov/oshpdKEY/hospitalcharges.htm. 11Organization for Economic Cooperation and Development Health Data 2006. Available at: 

http://www.oecd.org/document/16/0,2340,enl2825l495642l2085200l1l1l1l1,00.html. 

among major groups of industries.7 Paid sick days would help a food service worker 

get a timely diagnosis and help them stay away from work until they recover. 

Providing paid sick days is also a strategy that can be employed to reduce the 

burden of chronic diseases, which are responsible for a growing share of national 

health care costs. Many of the admissions to our hospitals for chronic diseases such 

as asthma, hypertension, and diabetes are entirely preventable with timely and effective outpatient and primary care.8 Many of these hospitalizations occur in working age adults and among children. In 2004, there were almost 200,000 hospitalizations for childhood asthma alone.9 Early treatment of a flare-up of asthma in a doctor’s office or clinic can prevent deterioration to the point where hospital care is required. In California, a single hospitalization for asthma costs over $13,000.10 Getting timely primary care requires not only access to services and a way of paying 

for services, but also transportation, time, and the ability to leave work. A paid sick 

day benefit removes one of key barriers that people face in utilizing timely primary 

care. 

If we look at the patterns of hospitalizations in States and cities across the United 

States, we see that such preventable hospitalizations are more common in areas 

with a high proportion of low-income households. Lower-income workers are also the 

least likely to have paid sick days benefits. Providing paid sick days for all workers 

is a common-sense solution that addresses health disparities and reduces the strain 

on public hospitals that provide our safety net of services to low-income individuals. 

I would like to conclude my testimony by highlighting the significance of employment policies such as paid sick days for the health of all Americans. According to 

the Organization for Economic Cooperation and Development, the United States 

spends more on health care services than any other country in the world. We spend 

$6,102 per person, amounting to 15 percent of our GDP.11 Despite spending double 

that of countries we consider peers, life expectancy in the United States is a full 

year less than in Canada and England and 3 years less than Spain, Sweden, and 

Switzerland. These startling facts on our performance in health underscore what 

public health professionals are acknowledging more and more. Health is largely a 

function of our day-to-day living and working conditions. One of the most important 

roles our government can play is to help ensure that day-to-day living and working 

conditions support health. One reason these other countries may be outperforming 

with respect to health is that they have paid attention to ensuring a minimum set 

of healthy working conditions. 

I am proud that San Francisco has led the Nation in providing paid sick leave 

to workers. Paid sick leave is a humane policy; and it is also a practical and costeffective public health policy to reduce disease transmission, avoid unnecessary hospitalization, and help bring health care costs down. For these many reasons, I hope 

that you will consider providing a minimum number of paid sick days to workers 

throughout the country. 

The CHAIRMAN. Thank you. 

Mr. King. 

STATEMENT OF G. ROGER KING, PARTNER, JONES DAY, 

COLUMBUS, OH 

Mr. KING. Thank you, Mr. Chairman, Senator Enzi, Senator 

Isakson. I do want to note on a personal basis, it’s very, very heartfelt that I’m back here with this committee. I had an opportunity 

to work with Senator Kennedy and his staff in the 1970s, as he 

noted, with Senator Javits and Senator Taft and it was a great experience. Senator, thank you for your warm welcome. 

The CHAIRMAN. Thank you very much. 

39 

Mr. KING. There can be no question that paid leave is important. 

My practice, over 30 years, has been working with employers from 

all different phases of industry throughout this country. I don’t 

know of one employer that would come here today and argue many 

of the points that have been made except perhaps the economics. 

The employer community in this country is committed to paid 

leave. Seventy-five percent, as noted, of the employers in this country provide one form or another of paid leave and they do so on a 

voluntary basis. That’s something we should not lose sight of. 

There is a commitment and there will continue to be a commitment. It makes good business sense to recruit workers, retain 

workers, reduce turnover, to increase productivity, to prevent the 

spread of illness in the workplace—those are all very legitimate 

and I commend the panel here this morning for their intellectual 

and emotional commitment to this concept. 

It’s one we all can agree on. There is no question about that. But 

as those of us that worked in the legislative arena know, it doesn’t 

stop there. It’s not that easy and I’d like to go through some concerns from the employer perspective, a very legitimate stakeholder 

in this discussion. 

We’ve heard from the worker perspective and that’s quite important, no question. But this is what I hear as I travel the country 

and talk to employers. First, we would respectfully submit on behalf of many in the business community that the legislative branch 

and executive branch need to fix FMLA and they need to do it now. 

You’ll get a much more receptive audience among employers in this 

country if you address that question. FMLA is a great statute. As 

Chairman Kennedy mentioned, many years were devoted to hearings and study on that particular legislation. Bipartisan support for 

it. Well accepted by the employer community, well accepted in this 

country but it needs attention now. It needs to be looked at. We 

have rules and regulations that are conflicting and many of those 

rules and regulations don’t work. In the intermittent leave area 

particularly, we have tremendous problems. So those need to be addressed. 

Again, I would submit, if we can get over that hurtle, we’ll have 

a much more receptive business audience or employer audience, if 

you will, for additional mandated leave. 

The second point I would note is on the metrics or the cost of this 

legislation. I note the testimony from the George Washington Institute of $22.3 billion. I would submit to this committee that’s a serious underestimate of the cost of this proposed legislation. If you do 

some sample or quick math, the statement has been made here this 

morning that there are 57 million workers in this country that do 

not have one form or another of paid leave. I question that because 

as noted, vacation leave is folded into PTO. It is available for people who do have illness. But put that aside for a moment. If you 

take the metric of 57 million workers times 56 hours in a given 

year times approximately $25 an hour and that’s what it costs 

when you’re fully loaded with all benefits and with all compliance 

costs, you’re talking somewhere in terms of $79.8 billion—or more. 

That’s a substantial cost. And the arguments that are being made 

here is that smaller employers don’t offer this. Well, that varies. 

But let’s assume that premise is correct. You’re putting a tremenVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00043 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
40 

dous financial burden on the employers in this country that have 

the least ability to pay for it. That’s something we need to talk 

about. The cost of this legislation is and would be considerable. 

The third point I would carry back to this committee from various employers of various sizes is that employers are overwhelmed 

with the cost of compliance with various Federal, State and local 

laws. Many of these laws are conflicting. Many of them overlap. 

They are hard to follow and the stealth cost, if you will, simply engaging in appropriate compliance, is very, very difficult. As I’ve 

noted in my prepared remarks and I would like those included in 

the record, if I might, we have situations under the present FMLA 

situation where we have FMLA, the Americans with Disabilities 

Act and State Workers Compensation statutes forming what I 

would deem and many of my colleagues have deemed the Bermuda 

Triangle of Compliance. It’s very difficult. If we were to have the 

HFA, the Healthy Families Act, the Fair Labor Standards Act and 

the FMLA Act, State Workers Compensation statutes and many 

now local and State regulations on top of that in the leave area, 

we’re in another Bermuda Triangle of Compliance. It’s exceedingly 

difficult. That’s something that needs to be thought about in some 

great detail. 

With respect to the legislation itself and having been a member 

of the staff of this committee and having drafted legislation, I understand how difficult it is draft legislation in this area or any 

other area—exceedingly difficult. But I must tell you that in reviewing the proposal, Mr. Chairman, that was put in the last Congress, there are many, many difficulties from just a sheer mechanics perspective, let alone a policy perspective. 

Let me share just a few of those. First, there is no minimum requirement for nexus with the workplace. As I read this statute, you 

could start on Monday and be entitled to paid leave on Tuesday. 

Under FMLA, you have to have at least a year of employment and 

1,250 hours. Senator Enzi mentioned the basic qualification situation. Under FMLA, we have at least 50 employees before coverage 

begins. Here, it’s 15. Further, this statute would permit, in theory, 

an employee to work for various employers throughout the year 

and qualify for paid leave for each of those employment situations. 

Further, paid time off as mentioned, a well now accepted concept 

in our Nation’s benefit structure but paid sick leave has really folded into that particular paid time off approach. You have traditional 

vacation, you have paid sick leave, you have personal leave, you 

have any number of different types of leave. Our employers that 

have paid time off like that in compliance with the equivalency requirements of the statute—I think it’s debatable. Further, many of 

those particular paid leave off time scenarios don’t pay the person 

that does not show up for work add-ons, like shift pay, differential 

pay, night shift pay. Are those to be added on? I don’t know. That 

would be in addition to the figure I shared with this committee. 

The definition of family. I agree in part, it’s quite broad but it 

goes way beyond that. It talks about someone that has an infinity 

with others living in a particular work and family environment. I 

don’t know what that means. Does it mean if people go to college 

that are friends and live in the same apartment or same dorm 

41 

room, that they’re covered? I would hope not. I think that goes well 

beyond what we’re talking about here. 

Further, we have questions about part-time and full-time. One of 

the problems with the basic figures that we’re talking about here 

are many part-time workers do not have this type of coverage. I 

would concede that. But those are entry-level positions. Often people working while they’re going to college, often working while they 

are in an educational environment and by definition, a part-time 

employee has time off during the week to address many of the 

needs that you’ve heard here today. 

I could go on but I’ve listed in great detail concerns about this 

legislation in my prepared testimony. Finally, I want to close 

with—one of my biggest frustrations when I worked on the Hill 

and also as a member of the business community and I do consider 

myself in that broad definition. Witnesses come here and just testify against things. That doesn’t really help. I think there are some 

definite areas here that we could reach an agreement on or at least 

ought to have that kind of dialogue. 

One, we ought to look at the Fair Labor Standards Act and again 

examine comp time. If we had some flexibility for workers, mothers 

and others, to have some time off on work week one and make it 

up in work week two, that would be of tremendous help. So far, 

we’ve not been able to have that dialogue on the Fair Labor Standards Act reform. We should. 

Second, tax credits for employers, particularly small employers 

that perhaps do not have the financial resources to address paid 

leave. We ought to look at that. 

Third, public health. I agree. Public health is exceedingly important. Perhaps we ought to look at additional funding for public 

health clinics, particularly that offer after hours or evening hours 

access. I have found in my experience working with employers that 

workers that can get to a public health clinic after they have left 

work can have tremendous treatment and health in preventive disease areas. 

Further, we should have more money, I would submit, in the elderly daycare and child daycare programs, tremendously important 

for employers in this country. 

Further, one concept I’d share with this committee that is catching on, relatively new, is the old office health nurse is back. This 

nurse or other health practitioner comes into the workplace, works 

with employees, works with workers to address their health needs. 

Tremendous cost benefit analysis. 

But in the end game, if you will, what we’re really talking about 

here is health insurance reform, health care reform in this country. 

The employer community cannot bear all of that cost. This committee is well aware of that. But that’s the dialogue we really need 

to have. 

Thank you very much. 

[The prepared statement of Mr. King follows:] 

42 

* Mr. King wishes to acknowledge the assistance of his associate Rebekah Bennett, a member 

of the Jones Day Labor & Employment Group in preparing this testimony. 1See, e.g., Chapman, Russell D., Garay, Joyce-Marie, Avoiding the ‘‘Bermuda Triangle′′: Navigating the ADA, FMLA and Workers’ Comp Void, Compensation & Benefits Review, Vol. 34, 

No. 3, 58–67 (2002); Bell, Christopher G., The ADA, FMLA, and Workers’ Compensation: The 

Bermuda Triangle of Employment Law, SHRM Legal Report (1997). 

PREPARED STATEMENT OF G. ROGER KING * 

Good morning Chairman Kennedy, Senator Enzi, and members of the Senate 

Health, Education, Labor, and Pensions Committee. My name is G. Roger King, and 

I am a partner in the Jones Day law firm. Jones Day is an international law firm 

with 2,200 lawyers practicing in 30 offices located both in the United States and 

throughout the world. We are fortunate to count more than 250 of the Fortune 500 

employers among our clients. I have been practicing labor and employment law for 

over 30 years and I work with employer clients located in various parts of the country with varying workforce numbers. I have been a member of various committees 

of The Society for Human Resource Management (SHRM) and The American Society 

of Healthcare Human Resources Association (ASHHRA) and I also participate in the 

work of other trade and professional associations that are active in labor and employment matters. My testimony today is based on my personal and professional experience. 

In the previous Congress, Chairman Kennedy with the co-sponsorship of other 

Members of this Body introduced two virtually identical bills the provisions of which 

I understand are the subject matter of today’s hearing—S. 932 and S. 1085. Both of 

these bills have been captioned the ‘‘Healthy Families Act’’ (‘‘HFA’’) and have as 

their fundamental objective the requirement that any private or public sector employer in the country with 15 or more employees provide at least 7 paid days (or 

56 hours) of sick leave annually to their employees. It is my further understanding 

that the committee’s objective today is to discuss the potential effects of the requirements of the HFA on workers, employers, the economy in general and on public 

health. 

Initially, I believe six fundamental policy and structure observations are appropriate to review regarding the HFA: 

• First, based on well-established data, employers in this country are not opposed 

to the concept of paid leave for their workers and have an excellent record in providing such leave on a voluntary basis. Indeed, numerous studies and analyses have 

conclusively established that 75 percent of the country’s employers provide, in one 

form or another, paid leave including paid sick leave. (U.S. Department of Labor, 

Bureau of Labor Statistics, the 2006 Employee Benefits Survey). This system of voluntary compliance, which includes collectively bargained policies and procedures, 

has worked exceptionally well and should not be disturbed. To the extent that positions or employers do not provide paid sick leave, such positions often are entry 

level in nature or constitute initial or part-time employment. Frequently, human 

capital market forces quickly respond to such situations with workers leaving or 

progressing out of such entry level positions to higher paid positions and jobs that 

do offer paid leave. 

• Second, given the above-noted employer commitment to the paid leave concept, 

and a high percentage of employers providing such leave—including paid leave for 

sick time—a fundamental question that should be asked by this committee is 

whether the HFA or a similar legislation is needed. I would submit the answer to 

such a question is in the negative. Employers in this country are already burdened 

by numerous Federal, State and local regulations which result in millions of dollars 

in compliance costs. These mandated, and largely unfunded, ‘‘cost of doing business’’ 

requirements in certain instances not only hinder and impede the creation of new 

jobs, but also inhibit our Nation’s employers from competing globally. Simply stated, 

a compelling case needs to be established before any additional regulations and statutes are imposed upon our Nation’s employers in this area. 

• Third, enactment of the HFA would create a second ‘‘Bermuda benefits triangle’’ 

for employers with FMLA, HFA and corresponding and often conflicting State laws 

forming such a triangle. Employers already face the difficult Bermuda compliance 

triangle composed of the American With Disabilities Act (ADA), FMLA and various 

State workers compensation statutes.1 The potential overlap of all of the above statutes will pose considerable practical/operational and legal burdens on the employment community in this country. Such additional administrative burdens, and the 

cost of same, including loss of productivity and ability to compete with offshore emVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00046 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
43 

ployers, must be addressed before the Congress proceeds with consideration of the 

HFA. 

• Fourth, the fundamental mechanics and metrics included in the HFA regarding 

‘‘equivalency’’ and the requirement that employers provide annually 7 paid days of 

sick leave, would appear to be fundamentally flawed and raise serious policy, practical and expense concerns. To begin with, the term or phrase ‘‘sick leave’’ is a term 

or concept that is no longer used by a substantial number of employers in this country. Paid sick leave has been replaced or folded into comprehensive leave programs 

such as paid time off (‘‘PTO’’) and other similar leave policies and procedures. This 

approach combines traditional paid sick leave days, vacation days and other paid 

leave time (e.g., personal days, attendance incentive pay, etc.) into a consolidated 

or comprehensive paid leave program. Under this approach, a worker is given the 

option of when to take such paid leave time and may choose to do so within general 

constraints for any reason for which he or she chooses, including taking leave for 

personal or family illness situations. The ‘‘equivalency’’ provision of the HFA raises 

serious questions as to how such PTO and analogous programs would deem to be 

‘‘equivalent’’ to the 

7-day paid sick leave requirement of the HFA. Indeed, the cost of regulatory staff 

and time associated with such ‘‘equivalency’’ reviews no doubt would be considerable 

as would be the cost of the inevitable litigation that will arise from such determinations. Consider the following hypotheticals: 

• An employer has a paid time-off program that provides employees with 20 

paid days off which an employee may use as he or she wishes (encompassing 

paid vacation leave, sick leave and personal days). The program has no separate ‘‘category’’ for sick leave. Does this program meet the ‘‘equivalency’’ test? 

• An employer has a paid time-off program that provides full-time employees 

(those who work 40 or more hours per week) with 20 paid days off, but does 

not provide a similar benefit for part-time employees (defined as those employees who work less than 40 hours per week). How will this program have 

to be adjusted to meet the ‘‘equivalency’’ test? 

• An employer has a paid time-off program that includes 20 paid days off, 

which includes vacation days, personal days, and attendance incentive days 

which can be used by an employee for illness situations. The employer also 

provides employees with 5 paid sick days per year. Does this employer have 

to add 2 paid sick days annually to meet the ‘‘equivalency’’ test? 

• An employer provides employees with 5 paid sick days per year along with 

other paid leave time and permits exempt employees to accrue compensation 

time for hours worked over 40 in a given work week. Does this employer have 

to add 2 paid sick days annually to meet the ‘‘equivalency’’ test? 

• An employer provides, at no cost to employees, a short term and/or a long 

term disability plan that provides paid sick leave time to employees. Is the 

employer in compliance with the HFA’s ‘‘equivalency’’ requirement? 

• Fifth, while employers in this country have embraced the spirit and the concept 

of the Family Medical Leave Act (FMLA) and are committed to its continuation, this 

statute and its implementing regulations need to be fixed before any other federally 

mandated leave requirements are enacted. Notwithstanding FMLA’s laudable policy 

objectives and the high degree of acceptance that it has achieved with employers 

it simply does not work well in a number of areas. Further, certain of the regulations implementing FMLA are in particular need of renewed scrutiny and redrafting. It has been well-documented in proceedings both in this committee and in committees of the Other Body that FMLA in its current regulatory enforcement state 

is confusing, subject to abuse and a source of considerable litigation. As this committee is well aware, The U.S. Department of Labor (DOL) has presently pending 

a request for information (RFI) regarding a number of issues with respect to the 

regulations that implement FMLA. I submit that this committee may be well informed by many of the comments that the DOL will receive in response to its RFI. 

Specifically, I would urge this committee to review the following issues that have 

arisen with respect to FMLA compliance: 

(1) Definition of what constitutes a ‘‘serious health condition’’; 

(2) The use (and abuse) of intermittent leave; 

(3) The inadequacy of notice and certification before a leave period begins; 

(4) The time period to measure eligibility for FMLA leave; 

(5) The time in which a worker is eligible to commence FMLA leave; 

(6) Employer communication with health care providers and verification of ‘‘serious health condition’’ claims; and 

(7) Impact on attendance incentive programs. 

44 

2Stewart, Walter F., Ricci, Judith A., Chee, Elsbeth, Morganstein, David, Lost Productive 

Work Time Costs from Health Conditions in the United States: Results from the American Productivity Audit, J. Occup. Environ. Med., vol. 45, no. 12, pp. 1234–1246 (2003). 

Intermittent leave is one area that particularly deserves this committee’s attention. Two different regulations, the regulation permitting intermittent leaves when 

there is no planned and scheduled medical treatment on the day of the absence and 

the regulation embracing chronic conditions as covered ‘‘serious health conditions,’’ 

intersect to create one of the biggest problems for employers in terms of day-to-day 

operations. Together, these regulations allow an employee to have unscheduled absences of up to 60 single work days per year or approximately 25 percent of all 

workdays for conditions that may not be a serious health condition. This means that 

an employee could be absent for 1.2 days every single week in a calendar year or 

a consecutive 12-month period. Additionally, intermittent leave could be taken in as 

little as 10- or 15-minute increments with the potential, therefore, for an employee 

to take off a portion of his or her workday everyday in the calendar year or in a 

consecutive 12-month period. Further, if the employee manages to work 1250 hours 

in the previous 12 months, the employee will be eligible to continue this cycle. 

Problems arising from other FMLA compliance issues as noted above have also 

resulted in considerable litigation. One example of such litigation is the recent case 

Rucker v. Lee Holding Co., d/b/a Lee’s Auto Mall, 471 F.3d 6 (1st Cir. 2006). In 

this case, the Court of Appeals for the First Judicial Circuit ruled that an employee 

could meet the 12-month FMLA eligibility requirement by combining separate periods of employment, including the employee’s current employment period together 

with a prior period of employment with such employer that was separated by a period of 5 years. The underlying regulation that is applicable to such issues—29 

C.F.R. 825.110—lacks clarity and has provided the result noted above which from 

any perspective is neither practical nor workable. 

• Sixth, to the extent that the HFA is premised on the concept of ‘‘presenteeism’’ 

[a relatively new term used to describe workers who remain on the job, or come to 

work, but who are not as productive as usual due to stress, depression, injury, or 

illness], I would submit that additional analysis and research needs to be undertaken regarding this workplace issue. For example, the most frequently cited illnesses on which the presenteeism studies’ cost estimates are based are depression 

(approximately $36 billion), and other chronic conditions such as back problems, arthritis, headaches, and stress (approximately $47 billion). An employee’s inability to 

work productively because of depression or arthritis is unlikely to be resolved by 7 

days of paid sick leave. Further, the Journal of Occupational and Environmental 

Medicine reports that family health-related work absence accounted for only 6 percent of all health-related productivity loss.2 The same article also states that because costs vary significantly by worker characteristics, intervention needs vary by 

specific subgroups. Additionally, if lost productivity is a true cost of presenteeism, 

employers will no doubt conduct their own cost-benefit analysis and will, if appropriate, adjust their leave policies to correct for lost productivity. This will ensure 

that employers receive the full benefit of enacting such a program (without offsetting such a benefit with compliance and recordkeeping costs associated with the 

HFA). Finally, to the extent presenteeism is a problem in the work place there are 

other solutions. For example, many employers already provide employees with alternatives to working 5-day weeks and 9-to-5 schedules. Specifically, many employers 

permit employees to telecommute, provide flexible work arrangements, and compensation time. These alternatives are more likely to effectively address the chronic 

conditions (headaches, arthritis, etc.) that impact presenteeism issues. 

In addition to the above outlined concerns and issues, HFA as drafted in the last 

Congress presents numerous ambiguities and questionable policy and legal conclusions. Certain of these policy and legislative drafting issues include the following: 

SECTION 2: FINDINGS

Discrimination 

• Subsections 13 through 15 discuss the gender stereotypes associated with family caretaking responsibilities. It is debatable that the HFA would assist in any 

meaningful manner the present regulatory scheme and related statutes that prohibit gender stereotyping. For example, employers are already subject to civil rights 

laws, such as Title VII of the Civil Rights Act of 1964, that effectively address these 

issues. For example, an employer that penalizes men who take leave for caretaking 

purposes, or denies men such leave while granting women a similar accommodation 

45 

3See Price Waterhouse v. Hopkins, 490 U.S. 228, 251 (1989) (‘‘As for the legal relevance of 

sex stereotyping, we are beyond the day when an employer could evaluate employees by assuming or insisting that they matched the stereotype associated with their group, for ‘[i]n forbidding 

employers to discriminate against individuals because of their sex, Congress intended to strike 

at the entire spectrum of disparate treatment of men and women resulting from sex stereotypes.’’) (internal citations omitted). 4 It is not clear under section 5(b)(1) how much ‘‘accrual’’ an employee is required to receive 

in a given calendar quarter. 

are in violation of Title VII, which specifically prohibits evaluating employees by assuming or insisting that they match a certain gender stereotype.3

SECTION 4: DEFINITIONS

‘‘Applicant’’ 

• Why is an applicant contained in the definition of ‘‘employee’’ in section 4? Are 

applicants for employment to be covered by this legislation? If so, on what basis? 

How would an applicant for employment qualify for HFA leave and how much paid 

leave time would an applicant be entitled to receive? 

‘‘Covered Employee’’ 

• How long does an employee have to be employed to be covered by this legislation? If applicants are covered, presumably there is no minimal employment period. 

Seemingly, an employee or applicant could start work on Monday and be eligible 

for some number of paid leave days on Tuesday.4 In contrast, under FMLA an employee is required to be employed by an employer for 12 months and have at least 

1,250 hours of service with such employer before the employee is eligible for the 

act’s benefits and coverage. 29 U.S.C. § 2611(2)(A). The FMLA approach would appear to be a more appropriate eligibility requirement. 

‘‘Employer’’ 

• The definition of ‘‘employer’’ under the HFA includes entities that employ 15 

or more employees for each working day during each of 20 or more calendar work 

weeks in the preceding calendar year. By contrast, before FMLA is applicable, an 

employer must employ at least 50 employees within 75 miles of a worksite. 29 

U.S.C. § 2611(2)(B)(ii). Why should the HFA be applicable to business entities that 

are quite small and may have difficulty in being compliant? The FMLA definition 

of ‘‘employer’’ would appear to be more appropriate. 

SECTION 5: PROVISION OF PAID SICK LEAVE

• This section mandates that 7 days of sick leave with pay shall be annually provided for employees working 30 or more hours per week and that a pro rata number 

of days of paid sick leave be available with pay on an annual basis for employees 

working less than 30 hours per week or 1,500 hours throughout the year involved. 

The financial impact of such an unfunded mandate on employers should be carefully 

and thoroughly researched. Although, as noted above, many employers in this country provide paid leave in excess of such 7-day requirement, employers with 

workforces in the 15–50 category may experience financial difficulty in complying 

with such requirement. Further, even those employers that have the resources to 

be compliant may experience considerable additional costs of compliance if the HFA 

is enacted, especially depending on how the HFA ‘‘equivalency’’ test is applied. 

Full-Time Employee Definition 

• Why is the definition of full-time employees under the HFA at 30 hours per 

week when the traditional work week in this country is 40 hours? Indeed, this is 

the definition generally utilized under the Fair Labor Standards Act. Further, the 

HFA’s requirement of providing paid sick leave for employees working less than 30 

hours per week, even on a pro rata basis, is inconsistent with many employer leave 

plans and would appear to be unreasonable in many employment settings. For example, is there a minimum number of hours that an employee must work to qualify 

for HFA coverage? Presumably, an employee could work only 1 hour a week and 

still qualify for fractional paid leave benefit. Would an employee working for multiple employers be entitled to more than 7 paid sick leave days annually? How 

would employees working multiple part-time jobs be treated under the HFA? 

Definition of Pay 

• The HFA does not define the word ‘‘pay’’ in either section 4 or section 5. Does 

this term include all types of compensation associated with a given work day even 

though the employee would not be present and working? For example, would it inVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
46 

clude such compensation as incentive pay, differential pay, specialty pay, weekend 

bonus pay, night shift differential, bonus pay, and other similar compensation arrangements that generally only result in an employee receiving such additional compensation if and when such a employee appears for and completes a work day? Does 

the term ‘‘pay’’ include all benefits that would otherwise be applicable from working 

such day? For example, would the employee receive accrual credit for pension and 

other like benefits when a mandated paid sick leave day situation arises and the 

employee does not work on such day? Stated alternatively, many employer paid sick 

leave and PTO plans only pay an employee on leave their straight time hourly rate 

without payment of differentials or other compensation tied directly to the employee 

working his or her shift. Arguably, under the HFA this approach may not meet the 

equivalency requirement and such employers, therefore, would be required to increase the amount of compensation an employee would receive while on paid sick 

leave. There is obviously considerable ambiguity in this area and there is mandated 

in this section of HFA alone the potential to place millions of dollars of additional 

paid leave expenses on our Nation’s employers. 

Intermittent Use 

• The calculation of how the paid sick leave system would work is particularly 

troubling. Section 5(c), the calculation section, would permit paid leave to be on an 

hourly basis or in the smallest ‘‘increment that the employer’s payroll system uses 

to account for absences or use of leave.’’ This literally could be in minute increments 

as many employers track absences in such minute incremental amounts. Indeed, as 

discussed above, this concept is already a tremendous problem area under FMLA. 

Use Standards 

• Section 5(d) is extremely broad in defining when a worker could qualify for sick 

leave and would no doubt result in considerable disagreement and potential litigation. For example, an absence resulting from obtaining medical diagnoses or care, 

or preventive medical care is very broad and is in need of considerable additional 

specificity. Again, this is a problem area under FMLA which has an analogous openended definition of ‘‘serious health condition.’’ 29 CFR § 825.114. 

Definition of Family 

• Equally troubling under section 5(d) is the potential for use of the mandated 

paid sick leave for an individual that has an ‘‘affinity whose close association with 

the employee is the equivalent of a family relationship.’’ What does this mean? This 

phrase is obviously susceptible to a very broad inclusion of a variety of individuals. 

Does it include frequent visitors to a household? Does it include domestic partners? 

Does it include ‘‘friends’’ living together, for example, while away at college? 

Scheduling 

• Section 5(e) would only require an employee to make a ‘‘reasonable effort to 

schedule leave.’’ This open-ended and minimal requirement of notice to an employer 

for unscheduled leave will pose significant practical and operational problems. 

Foreseeability 

• Section 5(f) regarding notification procedures is similarly deficient as it only requires oral and written notice 7 days in advance of any leave that is foreseeable. 

This period is too short and will pose considerable problems for many employers. 

By contrast, FMLA requires in most instances 30 days advance notice for qualified 

foreseeable leave. 29 U.S.C. § 2612(e)(1). 

No Dispute Resolution Mechanism 

• The HFA contains no mechanism for an employer to question or challenge a certification that an employee may receive to qualify for the required paid leave. By 

contrast, under FMLA, employers may require the employee to obtain a second medical certification from a health care provider selected by the employer. 29 U.S.C. 

§ 2613. 

Certification 

• Section 5(f) requires certification only if the employee takes leave for more than 

3 consecutive work days. This very ‘‘loose’’ standard will no doubt impede the employer’s ability to curb abuse. Further, under section 5(f)(2) an employee is given 

up to 30 days before a certification would need to be provided to an employer. This 

period is too long. Finally, section 5(f)(2)(B)(ii) states that: 

‘‘A health care provider shall make reasonable efforts to limit the medical 

facts described in clause (i)(III) that are disclosed in the certification to the minimum necessary to establish a need for the employee to utilize paid sick leave.’’ 

47 

What does this mean? It would appear to severely limit an employer’s ability to 

use the certification requirements (such as they are) to prevent abuses of paid sick 

leave. 

Equivalency 

• The section 5(g) ‘‘equivalency requirement’’ in addition to the problems noted 

above, also contains a mandate that ‘‘an employer may not eliminate or reduce leave 

in existence on the date of enactment’’ of the HFA. This edict would appear to contradict other sections of the HFA that will require employers to substantially modify 

their leave policies to become compliant with the HFA. • Further, section 5(g)(2) is troubling as it states: 

‘‘An employer may not eliminate or reduce leave in existence on the date of 

enactment of this Act, regardless of the type of such leave, in order to comply 

with the provisions of this Act.’’ 

As noted above, does this subsection prohibit even minor adjustments to an employer’s current leave programs? For example, would an employer that has a paid 

time-off program that does not specifically identify sick leave be prevented from 

changing in any manner how this paid time-off system works, including the eligibility and accrual levels associated with such plan? 

Enforcement Authority 

• Section 8 of the HFA provides the Department of Labor with broad investigative 

and enforcement authority. What will be the cost of such enforcement and oversight? Does the Department have the resources to carry out these new obligations? 

• This section also provides for private lawsuits for lost wages and benefits, reinstatement and other equitable relief, and attorney fees for a prevailing employee. 

Given the numerous ambiguities in the HFA, this section would appear to be an 

open invitation for considerable litigation, including class action lawsuits that already are causing our Nation’s employers to pay millions of dollars in unnecessary 

legal fees and costs. 

Effect on Other Laws (No Preemption) 

• Section 10 of the HFA is an ‘‘anti-preemption’’ provision and would permit State 

and local laws to co-exist with, or supersede, the provisions of the HFA. If the Congress does proceed to enact further mandated leave legislation, either paid or unpaid, considerable attention must be directed to the question of whether there 

should be uniform national standards. The varying and often conflicting State statutes and regulations regarding leave pose significant administrative costs for employers and can result in confusion and potential error. Neither employers nor workers are well-served with such a difficult regulatory scheme. The approach taken 

with respect to ERISA preemption should be given serious consideration. 

Effect on Existing Employment Benefits 

• Section 11(a) of HFA states that its provisions shall not be read to diminish the 

‘‘obligation of an employer to comply with any contract, collective bargaining agreement, or any employment benefit program or plan that provides greater paid sick 

leave rights to employees in the rights established under this right.’’ Subsection B 

states ‘‘the rights established for employees under this Act shall not be diminished 

by any contract, collective bargaining agreement or any employment benefit program or plan.’’ The above subsections read together with section 5(g)(2)—the 

Equivalency Section—would appear to unduly ‘‘lock in’’ current employer leave program provisions and make any change of same unlawful, including in collective bargaining settings. This approach is too rigid and will restrict both employers and 

unions in collective bargaining from having any flexibility in making even minor adjustments in benefit plan provisions. 

Encouraging More Generous Leave Policies 

• Section 12 of the HFA makes the following interesting policy statement: 

Nothing in this Act shall be construed to discourage employers from adopting 

or retaining leave policies more generous than policies that comply with the requirements of this Act. 

• Unfortunately, if the HFA is enacted based on the experience of many employers under FMLA, and the problems outlined above that can be anticipated with the 

enactment of the HFA, employers of all sizes may be discouraged from implementing any additional improvements in their paid leave programs—assuming after 

paying for their additional paid leave costs, administrative expenses, and litigation 

costs associated with the HFA that they would even have any resources left to make 

such improvements. Indeed, in many instances it may be that the added administraVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
48 

5 Ironically, the testimony in a number of congressional hearings has documented how, as a 

result of the FMLA, some employers are moving toward eliminating their more generous preFMLA programs and other companies are being urged by consultants not to adopt programs 

more generous than the FMLA. See Senate Testimony of Deanna R. Gelak, SPHR on behalf of 

the FMLA Technical Corrections Coalition and the Society for Human Resource Management, 

July 14, 1999, p. 22. For example, Thomas E. Burns, corporate director of compensation and 

benefits, NYNEX Corporation, New York, N.Y., testified before the U.S. House Subcommittee 

on Oversight and Investigations, at the June 10, 1997 hearing, (page 14) that ‘‘NYNEX Corporation’s sickness disability benefit plan provides up to 52 weeks of paid salary continuation for 

each illness. Since the FMLA was enacted, NYNEX has experienced a 42 percent increase in 

the percentage of incidental absences from 1992 to 1995, despite a reduction in the workforce 

of 7,000 employees. Incidental absences are those of 7 days or less for an employee’s own illness.’’ 

tive and litigation costs and other compliance expenses associated with the HFA will 

drain any resources that otherwise would have been available for paid leave benefit 

improvements.5

Mr. Chairman, Senator Enzi, and other members of the committee, thank you for 

permitting me to share my views with you this morning. I would be happy to answer any questions that you might have. 

The CHAIRMAN. Very good. Thank you for your suggestions and 

ideas. I’m always—this is always a subject matter that I find enormously compelling because I—shortly after I entered the Senate, I 

found out that my son had osteosarcoma in this leg and he had to 

have it amputated and he had to get a treatment up in Boston and 

he had to go two and a half days every 3 weeks for 2 years. I never 

showed up for work here in the United States Senate. Never 

showed up. Talked to Mike Mansfield and said, I’m outta here on 

these Fridays. You have an important vote and need my vote, this 

is it but I’m gone. 

I think if I hadn’t gone, the people of Massachusetts would generally have thrown me out and they probably should have. But I 

never had to worry about missing a paycheck all during that time. 

And yet, I always remember these parents being in those rooms 

where other children who were getting treatment and what they 

were facing every time, every few weeks, they were going to miss 

a day or two being with their children. 

We ought to be able to work this out. I mean, this is about—I 

don’t buy into this. Maybe there are abuses in certain areas— 

abuses in a lot of areas around here about the exploitation on this. 

It’s difficult for me to buy those arguments easily. 

I’m interested in these health—we’re doing a good deal of talk on 

our committee about how we’re going to try and save resources and 

how we’re going to find common ground and the preventative aspect stands out as one of the ones that everyone sort of agrees on 

and you talk about a preventive aspect of this kind of thing. We 

can all get into all of our various parts of things which we think 

can be done in terms of preventive care, boy, this is certainly one 

of them, if you’re talking about education. You’re talking about 

schools, you talked about teachers and what’s happening in schools 

all over this country, particularly my part of the country and colder 

areas. New England, what happens to a number of children that 

are missing each day from these kinds of health challenges that Dr. 

Bhatia has mentioned. 

Let me just—I’d like to ask, on the public health, the Center for 

Disease Control. I’d like to try and keep it this on what they say, 

what the real type public health, what the Center for Disease Control say about children. I mean, we know that children recover a 

49 

lot faster. I remember 40 percent, I don’t what it is but it’s a lot 

faster when they are with a parent. We all know that. We know 

there are going to be a certain number of children that are going 

to get sick over the course of this year. We know that—pretty predictable in terms of the flu and the rest of these. What is the Center for Disease Control and our State agencies say about the public 

health implications of this, Doctor? I’ll ask Dr. Bhatia first. 

Dr. BHATIA. The public health implications—— 

The CHAIRMAN. Well, take first of all, the CDC. You quoted some 

studies in the CDC and then if you can, tell us about the various 

public health. Another area I’m very interested in is the pediatricians’ talk about this. Jody, you might talk about that a little afterwards about what the doctors—so we try and keep this, to the extent that we can—on what those that are the trained medical professionals feel about this issue as a public health issue, as a preventative issue. What’s in the best interests of children? They have 

a pretty good—we’ve got to worry about our employers certainly 

but we also have children and family members that are important 

to give consideration to as well. 

Dr. BHATIA. So I don’t think it’s just the CDC. I think there is 

a pretty wide consensus that when there is a contagious disease, 

you try to avoid contact. In an adult situation, perhaps you can 

say, okay, adults shouldn’t be shaking hands—but with kids, you 

can’t control that situation. So it’s not—the CDC is pretty clear 

with certain infectious diseases, don’t go to school. Don’t go to 

work. That is their official recommendation. It’s on their Web site, 

it’s on their fact sheets. These recommendations are also made by 

physicians. They are so commonly made—I don’t think that they 

are published anywhere as recommendations. They are codified in 

our school districts. Our school districts tell parents, if you have a 

child with a fever, don’t bring that child to school. Stay home 24 

hours after the last time the child has fever and I think that most 

parents would like to follow these recommendations but as I was 

saying, I think that there is a number of competing pressures— 

work pressures, economic pressures that are also health issues that 

are making many people have to make tradeoffs between one adverse public health consequence, not following those public 

health—their doctor’s recommendations and risking hunger or risking eviction. These are diseases that affect tens of millions of people every year, several times a year and these are fairly clear recommendations. 

I want to mention one other thing about the tradeoffs. The tradeoffs cause stress and I think research has shown increasingly that 

stress is, in itself, is a factor that operates biochemically to affect 

diseases, ranging from obesity to infectious disease. So not only are 

these kids not getting—having the time to get better from their infectious diseases, not only are they spreading them, they are being 

put—their families and them are being put at greater risk of infectious diseases and other illnesses because of the stress that is ensuing. 

The CHAIRMAN. And finally, if Jody could talk about the pediatricians, not only on the stress but it’s the stress on the employer, too. 

They are worried about their child at home that’s sick, in terms of 

productivity and where they’re going. 

50 

Dr. HEYMANN. Thank you, Mr. Chairman. Let me give a series 

of numbers here, both about adults and children. I think one very 

striking one about adults is influenza. So these are Center for Disease Control numbers. Influenza leads to 200,000 hospitalizations 

a year, over 36,000 deaths in an average year and we know very 

clearly what the recommendations are. You get sick, you should 

stay home. 

We also know that it’s infectious after people have symptoms, 

that they are coughing and sneezing on people, they’re spreading 

it at the workplace and what happens commonly, if people don’t 

have paid sick days, is they go to work sick. This is an enormous 

dollar cost, by the way. They spread it to others at work. Those 

folks are home some of the time. When they’re not home, they’re 

at work. Presentism—not at full capacity but the health costs are 

enormous. 

When it comes to children, there are several things we should be 

aware of. When children are sent to childcare sick, which they are 

and they are so commonly that if you ask daycare teachers, they’ll 

tell you about the Tylenol sign. That’s when the children have a 

little pink collar because the parents have given the child Tylenol 

to mask the fever before sending them to the childcare center and 

the little child dribbles out the pink Tylenol onto their shirt but 

then they go there and what happens is, at noon, the fever goes 

up. The Tylenol has worn off. The child has diarrhea, vomiting, 

spreads it to the other kids and we know this leads to three and 

four times the rate of infections among children in these centers. 

When parents are present, in contrast, even in serious illnesses 

like hospitalizations, the hospital stays are decreased by 31 percent. That’s an enormous amount of cost savings. 

I guess the last thing I want to mention on these health numbers, which is included in my prepared remarks and I hope that 

will also be included in the written testimony, is thinking about 

these other countries that are doing it. Why? Because I think it 

does go to this core issue of can we afford to do it? For sure, if 19 

out of 20, all but us in the most competitive economies are providing paid sick days. Our companies are as good. We can make 

this work, too. It is noteworthy that those top economies are also 

higher ranked in terms of their health outcomes. 

Thank you. 

The CHAIRMAN. Debra, I’ll come back. My time is 2 minutes over 

here. I’ll come to you in just a minute. Don’t forget what you were 

going to say. 

Senator Enzi. 

Senator ENZI. Thank you. You know, we talk about the stress of 

the employee who has these problems. I don’t want you to think 

that the employer isn’t under any stress. Everything that we’ve 

talked about here are things that most of the businessmen that I 

know would love to be able to give to their employees. They think 

it is essential. They just haven’t figured out how to pay for it. The 

hearing is extremely helpful. There will be some people out there 

that will be introduced to this concept that haven’t been before and 

they’ll make some adjustments. And it will make a difference. 

Now as far as the legislation itself, there are a lot of unintended 

consequences that I think would happen if we were to go ahead 

51 

and pass this because I don’t think we have any concept of what 

those businessmen, the ones between 50 and 500 employees are 

going through with their decisions and this affects all of them but 

a lot of them above that, 75 percent of them above that provide this 

benefit already. I was kind of surprised that 25 percent of big businesses don’t. But I’m more worried about the small businesses and 

how they get along and I know that some people in small business, 

to try and figure out the dilemma of how to handle this, have said, 

I’m going to go ahead and pay my people sick leave and I’m going 

to pay it on every paycheck. I’m going to show it on that paycheck 

as paid sick leave. They don’t have to have any excuses for taking 

sick leave off. Hopefully they take that money, they save it for 

when they do have something but it’s a way that they can have the 

money for it but it’s also a way that when they think maybe they’re 

sick—they know they got paid for it so maybe they’ll determine 

whether they really need to come to work or not. 

Now, of course, we all hope that nobody comes to work really sick 

but I can tell you that the employers do because they don’t have 

anybody to fill in for them. 

I’m an accountant and I had a little trouble with some of the 

numbers in this bill. We usually talk about 40 hours but this drops 

down to 30 hours for qualification and then 20 hours for pro-ration 

and I was trying to figure out—20 hours is two-thirds of 30 hours 

but when you multiply that by 7 days the employer has to come 

up with some minutes that he has to work out there, I also noticed 

that you could take this in 1-hour increments or smaller increments if people keep track of their time on that basis and I think 

a lot of people keep track of it in 6-minute increments. So I guess 

we’re giving people permission to have 6 minutes worth of being 

sick. That’s the way it will work out and somebody will have to do 

all the record keeping on it. 

Mr. King, you mentioned some of the lack of clarity in the bill’s 

equivalency provisions coupled with the requirement that existing 

leave policies be frozen. Do you have any opinion as to what employers would be advised to do with their existing leave problems 

and entitlements were this bill likely to be enacted? 

Mr. KING. Senator Enzi, I can refer the committee to the experience in employer area after FMLA was enacted. Many employers, 

including very large Fortune 500 employers, said the cost of compliance is such that we will not increase or add on to our current benefit package. And that has been the experience with many. The 

costs on the margin here to comply can be considerable so I think 

that what you will see if legislation such as this were enacted, 

would be less resources (a) available for paid leave and (b) a great 

reluctance on many employers’ part to put more money in this 

area, which is counterproductive. 

I might note in reference to the public health discussion also, certainly employers agree with virtually everything that has been said 

here regarding the CDC. We don’t want sick workers coming to our 

place of business. That’s not good for productivity. It’s not good for 

clients or customers. Many employers have flex time situations 

where they permit a different hour for the person to come in or a 

different day. Many of our employers in this e-age we live in, this 

electronic age we live in, permit employees, workers to work from 

52 

their home. They telecommute. There are many things that can 

and should be done in this area. 

This legislation, Senator, has a lot of areas that just from a pure 

mechanical legislative drafting perspective, as I mentioned, needs 

attention. 

Senator ENZI. Thank you. Actually I think you were very kind on 

that. I think there are a lot of attorneys across this country that 

would say to the small businessmen, cancel your paid time off. 

You’re going to have to make it up for sick leave and we don’t know 

where the sick leave is going to go after this. Those who are providing more than 7 days sick leave will be encouraged to cut back 

to 7 days of sick leave and the advice they will be given is, blame 

Congress. They said that was adequate sick leave, so cut it back. 

Mr. KING. Senator, if I may, I hear that all the time and what 

you also may see is vacation banks or other paid leave time being 

decreased to meet the mandate of the statute. So I think you are 

correct in your analysis. 

Senator ENZI. I think maybe some attorneys would worry about 

their liability if they didn’t give some advice like that but I guess 

they don’t worry about liability or they’d be doctors. 

I have questions for all of you and most of them have some more 

levels of detail in them that I’d like to have so I’ll provide those 

in writing because I am interested in whether it is your intention 

that we cover cosmetic things, like Botox and teeth whitening and 

there were some comments about nursing home costs in there and 

I’m wondering if you think we ought to shift the cost of nursing 

homes over to employers, also the cost of friends? I don’t know why 

we picked 7 days. It could be 14 days. In the presentism study that 

was cited, flex time among Federal workers increases morale. On 

the presentism study—I’ve got a lot of questions on how those 

numbers were derived. I’ve got some questions on these other countries that have the lower rates, what their employee compensation 

is to begin with and what their rate of unemployment is. I’ve got 

some questions about flex time, of course, because we allow Federal 

employees to do that because it increases morale and we know that 

it does but we deny private employers from doing that same thing. 

I have whole lists of questions here that I’d like to have answered 

and so I hope that you’ll respond in writing to these as you get 

them. Thank you. 

The CHAIRMAN. Senator Sanders. 

Senator SANDERS. Thank you very much, Mr. Chairman and 

thank you for holding this important hearing. My apologies for not 

being here earlier. I was over at a Veterans Committee meeting 

and what was interesting and one of the aspects of the discussion 

at the Veterans Committee meeting was the pride that everybody, 

including the Bush Administration, took in the quality of care that 

our veterans are receiving at the VA and I found it rather amusing, 

Mr. Chairman, after all the attacks on big government, how government can’t do anything, we have everybody saying that the Veterans Administration is providing cost effective, high quality care 

to our veterans. Maybe that’s a lesson that we might want to think 

about when we keep attacking the government and how it can’t do 

anything. The importance of this hearing, I think, and I’m going to 

53 

ask Dr. Heymann a question in a moment and I think we have to 

do this a lot, Mr. Chairman. 

You know, I hear people saying, America, we’re No. 1. We’re No. 

1. Well, if you look around the world in terms of how we treat our 

children and how we treat our working families, we’re not No. 1. 

We’re way, way, way on the bottom and I think we need more discussion to ask why countries in Scandinavia, in Europe can virtually eliminate childhood poverty while we have the highest rate 

of children poverty in the world. 

I think, Mr. Chairman, we should be asking why, in this country, 

millions of workers go to work today and you know what? They 

have zero—zero vacation time or 1-week vacation time when all 

over the world, people are guaranteed 3, 4, 5 weeks of paid vacation. So when people talk about us being No. 1, yeah, we have the 

most unfair distribution of wealth and income of any major country 

on earth. We’re No. 1 there. 

[Applause.] 

Senator SANDERS. We have the highest rate of childhood poverty 

of any country on earth, we’re No. 1 there. But maybe—maybe the 

Chairman is going to quiet you down, so let’s—I’ll save him the—— 

The CHAIRMAN. Gently, gently. 

[Laughter.] 

Senator SANDERS. But the real issue is how we can be No. 1 in 

protecting the needs of working families and our kids and I would 

hope—I would hope that that is where we strive to be No. 1. 

Senator Enzi has very appropriately pointed out the problems 

facing small businesses. He’s absolutely right, certainly in the case 

of the State of Vermont. We know that. But we also know that in 

the tax bill that the President has just presented to the Congress, 

guess what? The Walton family that owns Wal-Mart is going to get 

$32 billion in tax relief. While we have the highest rate of childhood poverty in the industrialized world. Maybe we should start 

changing those priorities. 

What I wanted to ask Dr. Heymann is—and I think you’ve already gone over this—is the United States No. 1 in paid sick leave? 

Dr. HEYMANN. Unfortunately, the United States is very far down 

the list on paid sick leave and you mentioned other family priorities. In fact, it’s very far down the list overall. We’ve heard a lot 

about the FMLA today but it’s unpaid leave. I’ll mention that that 

leaves us near the bottom. We have data on 173 countries—168 of 

these provide for paid leave for women at childbirth. Who doesn’t? 

The Sudu, Liberia, Swaziland, Papa New Guinea and the United 

States of America. That’s it. 

Now when it comes to the paid sick days, 145 provide paid sick 

days and as I mentioned, 100 of these—it’s from day one, for over 

100 of these, it’s at least a month. Seven days is quite few by those 

measures. 

In terms of Senator Enzi’s question about unemployment, which 

is an important one, the answer is that many of these countries 

have lower rates of unemployment and when you look at the relationship between the duration of their paid sick days and unemployment, which we have, for all countries, there is absolutely no 

relationship there. The only relationship is the competitiveness. 

When we do this against the Competitive Index from the World 

54 

Economic Forum, the top quarter of competitive countries offer the 

most paid sick days. The bottom quarter offers the least paid sick 

days. We don’t think that’s a coincidence. It’s because having a 

healthier workforce is a competitive advantage, as is having better 

educated children. 

Thank you. 

Senator SANDERS. You raised the Family and Medical Leave Act 

and I remember how hard we had to struggle to pass that and yet, 

if you don’t have money, it doesn’t do you any good because you’ve 

got to go work to pay the bills. How many countries in the world— 

well, you just told us. In that regard and I would hope that everybody recognizes that when your child becomes ill, your parents become ill, you want to be able to spend time with them. That’s kind 

of pretty basic. And yet, we provide zero guarantee, zero pay for 

low-income workers, many of whom can’t even take advantage of 

that Leave Act, is that correct? 

Where do we rank internationally in terms of providing health 

care to all of our people? 

Dr. Heymann. 

Dr. HEYMANN. Why, I think we know unfortunately again, compared to most industrialized countries, we’re very far down that 

list. 

Senator SANDERS. What about maternity leave? 

Dr. HEYMANN. Maternity leave, we’re basically at the bottom. 

Senator SANDERS. What about vacation time for American workers? 

Dr. HEYMANN. Vacation time—137 countries around the world 

guarantee paid annual leave. We don’t guarantee any. 

Senator SANDERS. Mr. Chairman, we’ve got a lot of work to do. 

The United States should not be at the bottom of the international 

community in terms of benefiting its workers. 

[Applause.] 

The CHAIRMAN. [Pounding gavel to restore order.] Thank you, 

thank you. Please. 

Senator Isakson. 

Senator ISAKSON. Thank you, Mr. Chairman. Dr. Heymann, I 

want to make sure I heard what you said a minute ago. You said 

the—you talked about the top quarter of the most competitive and 

the bottom quarter and the correlation was, the bottom quarter 

didn’t have paid sick leave and the top quarter did. Is that correct? 

Dr. HEYMANN. So what I said is, we looked at duration of sick 

leave and quality of sick days and the most competitive countries 

are the ones providing it and you can look at it both across the 

countries. The other way we looked at it, is we took this World Economic Forum list—the list put together by top business leaders and 

we said, what about the top 20 countries? And I’ll just give you 

some of the top 10: Switzerland, Finland, Sweden, Denmark, Singapore, United States, Japan, Germany, Netherlands, UK. That’s the 

top 10 in rank order. Everybody but the United States guarantees 

paid sick days in that list and the United States is falling in competitiveness. We’re now ranked No. 6. We used to be ranked No. 

1 and I think that’s about a chronic under investment. 

Senator ISAKSON. Doctor, thank you. The reason, before I lose my 

train of thought here. 

55 

Dr. HEYMANN. I’m sorry. 

Senator ISAKSON. The reason I asked that question is—and you 

sort of noted it at the end of your answer. The people that are at 

the bottom don’t have required annual sick leave, except, in the top 

10 is the United States that doesn’t have any required sick leave, 

which is the point I want to get to, is something that Mr. King alluded to. While the United States does not have mandatory, minimum number of paid sick leave days, it is true that a significant 

portion of the United States of America’s employers voluntarily 

have benefit programs for sick leave for their employees, I think. 

I know Ms. Ness said that 57 percent had paid sick leave and 43 

percent don’t or something like that and then Mr. King said 75 percent had it. I think the difference is formal policy versus informal 

policy, is that not correct? 

Dr. HEYMANN. That’s—if I could answer—is it okay if I answer 

that? 

Senator SANDERS. Sure. 

Dr. HEYMANN. Senator, I think it is important and valid question 

and in fact, again, of those top ten, just to take as an example, they 

all, except for the United States, have higher rates of paid sick 

days, even when you include informal policy as well as formal policy. While there is informal policy in the United States, it covers 

half of the private sector and importantly, I’ve heard from many 

employers that among those employers who do provide it, they’re 

having a hard time because they are competing against other companies down the street that aren’t. Among those who would like to 

provide it, many of them feel that putting it in the law would give 

them a level playing field. 

But in direct answer to your question about those other top competitive economies, they all have higher percentages of employees 

receiving paid sick days than we do. 

Senator ISAKSON. My point is that I respect all the things that 

Senator Sanders said but this is a great country and America does 

a lot of things voluntarily that it doesn’t get a lot of credit for and 

so does American business and the point of my whole statement is, 

Mr. King makes a very valid point. And that is, we need to look 

at—no one is opposed to what is being talked about today. That’s 

the first thing but it’s how you—the devil is in the details and 

every time you deal with these issues and isolated mandates based 

on circumstance, they accumulate. And to some pretty unbelievable 

mandates on business and the question about re-looking at the 

Family Medical Leave Act as you address this area of sick leave 

is tremendously important. Second, the reason—in a positive sense, 

not a negative sense and I think Mr. Sanders’ recognition of the 

importance of small business is critical—I ran a small business for 

22 years before I came here and many times, Federal mandates for 

minimums become maximums and ceilings because you don’t have 

the flexibility as an employer to do what’s right for the employee. 

And as bad as many employers are categorized and castigated by 

statements that really are taken out of context and inappropriate. 

The fact of the matter is that any good business person that runs 

a business and owns it is very compassionate about their employees because they have no business without their employees. And 

I’m making a speech here rather than a statement but—I want evVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
56 

erybody to understand—it really bothers me a lot when we take out 

after this country as being so bad about everything when we’re so 

great about everything, much of it voluntarily and on our volition 

and not because some government mandated that it happens so as 

we—and I appreciate all your testimony. I think this is a great 

thing for us to look at and improve because I care about the plight 

of every worker but let’s look at it in the context and the perspective of all the—and this is not a question for you, necessarily, Doctor. It’s a speech I’m making right now and I apologize for that but 

we need to look at these things in the context of all of them and 

not let them stack and accumulate. 

Last point—— 

Dr. HEYMANN. Would it be all right to mention one thing from 

a small business perspective in response to this? 

Senator ISAKSON. As long as you don’t take all the rest of my 

time. 

Dr. HEYMANN. Okay, I’ll be very brief. Senator Kennedy mentioned Dancing Deer. They are a small business. We did a case 

study of them because they treat their employees well. They right 

now don’t have paid sick days. They’d like to have them very much 

because this kind of law will mean that they can compete with 

other bakeries while offering it. So I think there really is an important perspective. In no way does the fact that some companies don’t 

offer it now means they are not good companies. It means that the 

public policy can help them as well, as we’ve heard. 

Senator ISAKSON. Well, Chairman Kennedy, if you would or have 

your staff, I want to ask you a point of information later on, on the 

accumulation provision in the bill. It appears to me—it says it allows accrual of sick leave days but no more than 7, which leads me 

to believe that you can accumulate 7 in 1 year and roll those forward and add them to the 7 in the next year, so it could go as high 

as 14, the way it’s worded. And I think we need to take a look at 

that because that would have an unintended consequence that I 

don’t think the Senator intends to do. 

The CHAIRMAN. That’s right. Thank you. 

Senator Brown. 

Senator BROWN. Thank you very much, Mr. Chairman. Last 

month, Senator Kennedy led the fight here in this Senate for a 

higher minimum wage. Opponents to the minimize wage said that 

it will make business—it will put some people out of work, it might 

even put some businesses out of business. It will put minimum 

wage workers, low-income workers out of work, that it will overall 

hurt the economy all over the country. 

Our answer to that and Senator Kennedy’s answer and the answer of many of us was that to look at those States which had 

higher minimum wages, state-imposed minimum wages and found 

that in fact, those States, by and large, are more prosperous States 

than those without higher minimum wages. We’re hearing the 

same kind of argument and opposition to this proposal—that this 

will make America less competitive as a nation. Both Ms. Hartmann and Dr. Heymann, if you would, answer to that with a little 

more specificity. Ms. Hartmann mentioned in her testimony and I 

apologize for being late and having to leave. I have other hearings 

I have to do today but replacing workers is very expensive. Even 

57 

in the low-wage labor market, filling a vacant position and bringing 

a new worker up to full productivity can cause 43 percent of annual 

pay. I would like Ms. Hartmann to expand on that a bit and Dr. 

Heymann, if you would expand on the competitiveness, why, in 

fact, the United States—you’ve made clear we stand out as a country that doesn’t do this while others do—but why, in fact, this 

would make us, if you would, delineate in this global economy, why 

this will make us more productive, faster growing and a better, 

stronger economy and Ms. Hartmann, if you start. 

Ms. HARTMANN. Thank you very much for the question. Basically, what we found in doing this research is that turnover rates 

differ between companies where workers do have paid leave and 

where they don’t and that differential and turnover means that 

when a company puts in paid leave, they can expect their turnover 

to fall. We value that turnover with a number that comes from the 

Employment Policies Foundation, which is a business think tank. 

So we used their number of 25 percent rather than the 45 percent 

that we mentioned in the testimony. So we low-balled, if anything, 

the estimates, which are savings from reducing turnover and what 

we found was that the savings from reducing turnover outweigh 

what you would actually pay the workers for leave. The reason my 

numbers differ from Mr. King’s is that we look at the amount of 

leave that people would actually use so in the economy as a whole, 

again, if you have paid sick leave now, you use only one more day 

of sick leave per year than if you have unpaid leave. So the amount 

of increase that you would get is small and we measured that increase as a cost and the cost of providing that money to workers 

is substantial—it’s $20 billion but the cost of the reduced turnover 

and adding to it, the reduced spread of flu in the workplace, we get 

a savings of $32 billion. So on that, there is about a $9 billion difference. So anything that economists can say, where the gainers 

can pay the losers and then have a surplus—that’s considered 

Fredo optimal. It’s considered that you are increasing total output 

in the economy so it’s basically a net gain for the society because 

we can actually gain more than we lose. So all the points that Mr. 

Enzi and others have made are very valid but you also have to look 

at it from the point of view of society as a whole and if you can 

do any change, which saves the economy more money than it would 

spend, then all economists would say, do it. 

[Applause.] 

Senator BROWN. Dr. Heymann, if you would address the issue of 

making us more competitive. 

Dr. HEYMANN. Sure. On a national level, there are really three 

things that make an enormous difference in making us—any country competitive, including us. One, is the education of the population. Second, is the health of the population and the third is the 

training and skills that are specific to the job. And in that last one, 

I want to mention, we’ve done a study of very successful companies 

across the country and around the world from Alabama to Connecticut, from China to Ireland to Norway to South Africa. Our 

competitors, as well as our local companies, including manufacturers of clothing to bricks to call centers and all of the CEOs, human 

resource people at every level talk about the same thing. If you can 

keep your employees on the job, active, there a long time, there is 

58 

so much job specific knowledge that the productivity goes up markedly. So this gets back to what I think Heidi was saying in terms 

of turnover rates and what we know from our own work, paid sick 

days reduce turnover dramatically among those who have been 

sick. So that kind of training retention—big impact on a company 

by company basis and long-term impact for the country. The other 

areas—health—the population health numbers are just striking. 

What makes the biggest difference in health long term are the prevention measures. We know this from really countless studies and 

the countries that have this kind of policy in place have much better health outcomes. 

Finally, development of children. Paid sick days makes parents 

five times as likely to care for their kid’s health. When their kids 

are healthy, their development is better, their education is better. 

That really is a tremendous long-term investment and we know the 

statistics bear this out on the countries. Thank you. 

Senator BROWN. Thank you. Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Allard. 

Senator ALLARD. Thank you, Mr. Chairman. I guess—from my 

own background, I come from a small business person’s attitude 

but in addition to that, many of us represent small businesses that 

are in rural areas. One of the problems that you have, as a small 

businessman, is you have an employee who is trained to do one 

specific function for that business. If they don’t show up for work, 

the business can’t take care of its clients or its customers or whoever is utilizing that and it creates a hardship for the business 

owner, who by the way, is a hardworking American. Many times, 

small business people put in more hours than anybody on the payroll because they know that when they’re not there, the business 

doesn’t function. 

So I have a concern about those particular types of businesses 

and I guess I look at it from a total compensation package. I think 

the comment that says that well, if you’re looking at the total compensation, some types of employees prefer different types of benefits from the business than other types of employees. It depends on 

where they are in their work cycle. It depends on what type of community they are in and those types of things and it seems to me 

that when we have mandates, we take away that flexibility. 

I have a question for Mr. King. Has any effort been made to analyze on a local basis, how this may impact small communities, for 

example. If you have a business that provides one particular type 

of service to a small community, I guess if the person who wants 

the service has to drive 60 miles, that’s not anything that’s going 

to help that local community. So has any study been done on that? 

Mr. KING. Senator, not to my knowledge and that’s a real problem. This legislation, as introduced in the last Congress, covers 

small businesses with 15 employees, which is a dramatic difference 

from FMLA that goes to 50. So that’s a very real concern and one 

other point I would just make in the attack on the business community to a certain extent here. We don’t disagree with turnover 

data. We don’t disagree with all of the things that have been said. 

Paid leave is very desirable. The flexibility question is a very real 

one. This country, by the way, Senator Sanders, and the business 

community has billions of dollars of benefits—billions of dollars. If 

59 

someone did an economic analysis, a true economic analysis, the 

amount of money that the business community in this country voluntarily provides—I’d like to see where we rank. I would say we’re 

probably No. 1 by far in pure dollars. But Senator, you’re absolutely right. The practical impact on the small business person is 

very real and to my knowledge, it’s not been thought out. 

Senator ALLARD. Doctor—how do you pronounce your—— 

Dr. BHATIA. Dr. Bhatia. 

Senator ALLARD. Bhatia. 

Dr. BHATIA. If I may and I know that San Francisco is just one 

place but we’ve passed a number of mandates in the past few 

years. They include a living wage, a minimum wage and now sick 

days and soon to be universal health care requirement. One of my 

responsibilities is ensuring food safety for the 6,000 restaurants 

and we track the openings and closings of the restaurants, their 

size, their employees and we’ve been asked by the local business 

association, restaurant association, what effect is this having on 

openings and closings and over the past 8 years that I’ve been 

doing this and in the course of these mandates, there has been no 

change in the openings and closings of these restaurants. These 

restaurants—6,000 small business—mostly small businesses appear to be running about the same that they always have. So that’s 

just one anecdotal experience from one place. 

Senator ALLARD. I wonder if that explains why more California 

businesses are moving to Colorado. 

[Laughter.] 

Dr. BHATIA. Well, I don’t think our 6,000 restaurants, the small 

businesses of San Francisco, the small markets, are moving to Colorado. 

Senator ALLARD. That’s right. Thank you, Mr. Chairman. 

The CHAIRMAN. Just thank you all very much. We’ll have other 

questions. Debra—and I wanted to just finally and I just have a 

question of you on the implementation of this legislation and your 

reaction to your own kind of studies about having supported other 

kinds of protections for workers, whether you feel that this a zero 

sum game, that if they advance this, they’re going to get cut back 

on some of the other benefits. What’s your own kind of experience? 

But on the implementation, how complex do you think this would 

be? 

Ms. NESS. Well, I don’t think there is any evidence that this is 

a zero sum game or that providing paid sick days, a minimum 

number of paid sick days, has proven to be economically challenging to countries that do it or businesses in this country that 

do it. There are many who do and do it because it makes a lot of 

sense and they have managed to do it without a great deal of administrative difficulty. 

I hate for us to think about the ability to take time when you’re 

sick or to get preventive health care as a privilege or a benefit. It 

seems to me that we should be thinking of this as a minimum labor 

standard. 

Earlier on we were talking about the public health benefits and 

we focused primarily on children. I would say we also urge adults 

to get preventive health care all the time. We tell them to get 

mammograms. We tell them to get colonoscopies. But yet if they 

60 

don’t have the days off to do that, I don’t know any place you can 

do that on weekends or evening hours. We know that there are 

people in this country now that have not just one but two and increasingly three chronic conditions and that’s going to get worse 

and the costs of that are huge to our healthcare system. Five percent of the population is responsible for 50 percent of our health 

care costs yet we know people being able to take a little bit of time 

out to get the preventive care they need can keep them from reaching the point where they need extensive hospitalizations or more 

expensive healthcare down the road and from a personal point of 

view, people who don’t get that care—they spiral downward very 

fast. It’s not just they miss a day or two of work. They get sicker. 

They potentially lose their job. They potentially lose their health 

insurance if they were lucky enough to have it. And for those people, the costs are enormous. We now know that about 50 percent 

of all bankruptcies are probably a result of medical bills triggered 

by illness. So I hope we can get a place where we think of this as 

a minimum labor standard. Thank you. 

The CHAIRMAN. Thank you. 

[Applause.] 

Ms. HARTMANN. Senator Enzi, I’d like to congratulate you for 

your leadership with the Work for Us Investment Act and one of 

the things you did in that act was highlight the importance of pay 

and equity between women and men and one of the things that 

paid sick leave would do, would actually improve pay equity between women and men because it would reduce turnover on the job 

and women still bear the brunt of leaving work because of illness. 

When you look at the unemployed, something like 40 percent of 

women say that they left their last job and now can’t find work for 

family reasons. So if you have a paid sick day or two to tide you 

over so you don’t have to lose your job, you will be able to increase 

your seniority on the job. You’ll increase your productivity on the 

job and that will raise your wage. So I think that this minimum 

labor standard should really be seen as something that will help 

redress the imbalance between men and women in the labor market and really raise women’s pay and I’d just like you to be aware 

of that because I know this is a very important issue for you. 

[Applause.] 

Senator ENZI. If we really want to increase or decrease that gap, 

we’re going to have get more women to do non-traditional jobs and 

we’re going to have to get more people to move out to Wyoming, 

where we have a lot of those jobs that are very good jobs that they 

could do and they’d get paid $60,000 to $80,000 a year for them 

and get paid medical leave and get—I’m told, vacation. 

The CHAIRMAN. Where is this magnificent place? 

[Laughter.] 

Senator ENZI. This is in Gillette, Wyoming and every time I 

make this kind of announcement, we get one or two more people 

that come out there and take advantage of it. But most people don’t 

want to leave whatever kind of a job with whatever kind of a benefit because they are afraid of change. I’m a little disappointed that 

today we haven’t talked about the pressing issue of getting health 

insurance for more employees. Of course, when we do the paid 

medical leave, that will drive up some of the business costs and 

61 

every time the costs go up by 1 percent, 100,000 people get dropped 

out of the insurance market because small business can’t afford it. 

And that’s from some very good studies. So I don’t know whether 

they would consider this part of the cost, if they’d say, okay, you 

can get off to go take care of it but we’re not going to pay for it 

anymore. That would be a huge disadvantage. So somehow, we’ve 

got to figure out how to solve all of these problems and I don’t 

think we’re going to be able to do it with a big government onesize-fits-all mandate when we’re talking about such a diverse economy. I do know that when we were talking about the economy that 

we talk about how it goes up when the minimum wage goes up and 

it will go up when this happens and I don’t necessarily doubt those 

statistics. But it doesn’t go up in every business and when a business goes out of business, the people that own the business and the 

people that work for that business really feel like the economy has 

gone to hell. That’s the economy that they’re interested in, where 

they work, the job that they have, the job they understand, the job 

that they like going to every day. When that disappears, the economy is bad. So I hope we’ll do some more discussion on small business and health insurance and of course, I have the small business 

health plan proposal that would have allowed businessmen to 

group together to get some lower prices, largely reducing administrative costs. Hopefully some of those ideas will move along yet and 

solve some problems for small business and their employees. 

The CHAIRMAN. You can see we have a full agenda here and not 

uniformity of agreement on most of these issues. If there is any further, we’ll leave this open. You’ve been very, very helpful. We’ll 

leave the record open for additional questions. We’re very thankful 

to our witnesses. It’s been very informative and valuable and we’re 

grateful to you. 

The committee stands in recess. 

[Additional material follows.] 

62 

ADDITIONAL MATERIAL 

PREPARED STATEMENT OF SENATOR HARKIN

For the past few decades, people have been throwing around the 

term ‘‘family values’’ here in Washington. But the policies that 

have been passed in that name often reflect anything but valuing 

families. I am proud to cosponsor this bill because it represents two 

of my highest priorities: respect for workers and their families, and 

workplace wellness. 

First, I think it is time for us to take a whole new view of labor 

policy. For the last several years, we have been moving in the direction of concession. We have been told that in the name of profit, 

in the name of competitiveness, that we have to force workers to 

give up the rights that past generations have fought and died for. 

We’ve seen overtime rights eroding. We have seen pensions 

evaporating out from under workers—while the executives keep 

their deferred compensation. We’re rewarding record workplace 

productivity with more mandatory overtime and lower wages. Yet, 

CEOs are getting paid a record 400 times the wages of the average 

worker. We keep moving in the wrong direction. 

This bill is a step in the right direction. This bill says parents 

should have the right to take their sick child to the doctor. Workers 

should have the right to take care of their own health and wellbeing without worrying about losing pay or losing their job. I hope 

that we can begin to think again about the working men and 

women of this country as human beings with basic needs and basic 

rights, like the right to take a day off when they are sick. 

Unfortunately, a whopping 50 percent of private sector workers, 

and 76 percent of low-income workers don’t have paid sick leave. 

These are people who have to work long hours, increasingly during 

nights and weekends, just to survive. 

As witness Jody Heymann has found, the United States is behind the curve in providing sick leave. She found that 139 countries provide paid leave for short- or long-term illness—with 117 of 

those providing a week or more annually. 

I know some of the witnesses have talked about this, but I really 

want to underscore the cruel irony that low-wage workers, who are 

least likely to have paid sick leave—and their kids are sick more 

often. It isn’t surprising that kids health outcomes are better when 

a parent can spend time helping them to get better. If we value 

families, we shouldn’t force parents to choose between job responsibilities and taking care of their sick children. 

As I said earlier, this is also a public health issue. I find it amazing that companies don’t see their own interest in encouraging sick 

employees to stay home, and avoid infecting coworkers or customers. But amazingly, 78 percent of food service workers do not 

have paid sick days. In one hotel in Nevada, a worker who didn’t 

have paid sick time went to work with a stomach virus and infected 600 customers and 300 employees. 

As you know, wellness and illness prevention have been a top 

priority for me for many years. Americans spend an unbelievable 

$1 trillion every year on health care. Three quarters of that cost 

is accounted for by chronic diseases like heart disease, cancer, and 

diabetes that, in many cases, are preventable. We can save hunVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00066 Fmt 6633 Sfmt 6601 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
63 

dreds of billions of dollars on unnecessary hospitalization, treatment, and disability, but only if we make the up-front investment 

in prevention and allow our workers to take time off to get essential preventative screenings and assessments. We also know that 

one of the best, most common sense measures to preventing illness 

is keeping people with communicable illness at home until they are 

well again. 

Mr. Chairman, families are feeling more pressure every day to 

try to make ends meet with more responsibilities heaped on them. 

Rosa Pederson, from Fort Dodge, Iowa is working and raising a 

toddler. She writes, ‘‘We’re all supposed to be supermen. We’re supposed to price compare health services and know which practices 

are proven most effective. We’re supposed to actively manage our 

funds in a way that consistently beats the market. We’re supposed 

to work our way through school and get through in 4 years. We’re 

supposed to . . . save more and spend more while making less.’’ 

Add to that having to show up to work even when you’re sick, or 

to find a way to manage your child’s sickness while still working 

full-time or more—or worse—you or your child is sick because 

someone else at work couldn’t take a sick day. It is easy to see how 

families suffer. 

PREPARED STATEMENT OF SENATOR CLINTON

I would like to thank Chairman Kennedy and Ranking Member 

Enzi for holding this important hearing on the Healthy Families 

Act. I am a proud cosponsor of this legislation that would provide 

workers with 7 paid days of sick-leave, giving parents time off from 

work to go to the doctors’ office with their child, aging relative, or 

to address their own health needs. 

Throughout my career as a lawyer, mother, First Lady and Senator, I have sought solutions to the difficult challenges that working parents face. 

That is why I am looking forward to re-introducing my ‘‘Choices 

in Child Care Act of 2007’’ to meet the child care needs of working 

families. My bill provides a modest and important option for families who have none; it gives them the chance to stay at home with 

their infants when there is no childcare available to them. This is 

the critical next step to ensure low-income families welcoming children in their lives are afforded more economic security than they 

would have otherwise. 

I am also looking forward to re-introducing my ‘‘Paycheck Fairness Act’’ in March. This bill would prevent, regulate, and reduce 

pay discrimination for women across the country by taking critical 

steps to empower women to negotiate for equal pay, to create 

strong incentives for employers to obey the laws that are in place, 

and to strengthen Federal outreach and enforcement efforts. 

With this month marking the 14th anniversary of the Family 

and Medical Leave Act, we can celebrate how far we have come in 

terms of providing benefits for the hardest working families in this 

country. But we must also recognize the challenges Americans face 

in balancing work and family life today. The time has come, with 

the new 110th Congress, to give parents additional resources and 

options in helping them address these challenges. 

Thank you. 

64 

PREPARED STATEMENT OF SENATOR BROWN

We are here today to discuss a very simple piece of legislation. 

The Healthy Families Act will guarantee millions of Americans the 

basic right to care for a family member or recuperate from an illness without worrying if they will be able to pay the rent that 

month. In my State of Ohio, 42 percent of workers—2,232,125 

workers in total—have no paid sick days. These people are forced 

to choose every day between their jobs and the health of themselves or a family member. This is a decision no American should 

have to make. A single parent should not have to worry about losing their job simply because they need to take their ailing child to 

the doctor. 

Paid sick leave improves overall health, lowers healthcare costs 

and makes good business sense. Experts agree that the ability to 

take time off and go to the doctor lowers the likelihood of chronic 

illness and ultimately the cost of healthcare. This benefits productivity and prevents ill workers from spreading their sickness to coworkers. The ability to stay home when you are sick is critical. 

This legislation would provide paid sick days for an employee’s 

medical condition, doctor’s appointment or other preventative treatment. It would also provide prorated leave for part-time employees 

and require employers to post notice of the availability of sick 

leave. This is crucial to thousands of Ohioans and middle class 

Americans who are just trying to work hard and take care of their 

families. I thank the Chairman for holding this hearing and drawing attention to the plight of so many Americans. I fully support 

this bill and encourage my colleagues to do the same. The time for 

mandatory paid sick leave is long overdue and millions of working 

Americans deserve better. 

STATEMENT OF DANCING DEER BAKING CO. 

Employers, families and our economy depend on the existence of a healthy workforce. I commend Senator Kennedy for his leadership in seeking paid sick days for 

employees around the Nation. 

At Dancing Deer Baking Company we have always sought to ensure that our employees can have the time to address their own and their families’ health needs. We 

also provide all employees with short- and long-term disability insurance as a secondary safety net. Full time non-exempt employees at our company receive a minimum of 15 days per year in their first year of employment as paid time off (which 

can be used for any reason, including not coming to work because of the flu) which 

they start accruing immediately upon employment with us. It makes good business 

sense and good people sense to put structures in place to help people live more balanced, healthier lives. 

A national paid sick days law that sets a minimum standard is important because 

it means that employees do not have to choose between coming to work sick or staying home and losing a day’s wages—or a job. National data indicates about half of 

private sector employees do not have paid sick days. That’s an incomprehensible statistic, until you break it down and look at the granular, person-by-person implications. What you find is that health issues and family care issues are often the final 

straw that throws families into crisis. We see this in our work in the community 

targeted at ending family homelessness; Our ‘‘Sweet Home Project’’ provides funds 

that help homeless families (the majority of whom are the working poor) move to 

healthy, economically stable lives. 

A national paid sick days law creates a level playing field for all businesses. Personally, I believe that we have a competitive advantage from our benefits policies, 

but many small businesses struggle with this issue. I believe that creating a level 

playing field with respect to incentives and requirements for ‘‘doing the right thing’’ 

is a good idea for all. 

65 

1 Jody Heymann, The Widening Gap: Why America’s Working Families Are In Jeopardy & 

What Can Be Done About It, Perseus Book Groups, p. 115 fig. 61. New York, NY. 2000. 2 Vicky Lovell, No Time to be Sick: Why Everyone Suffers When Workers Don’t Have Paid Sick 

Leave, Institute for Women’s Public Policy Research, May 2004, p. 3. 3 Virginia Fried, Diane Makuc, and Ronica Rooks, Ambulatory Health Visits by Children: Principal Diagnosis and Place of Visit, U.S. Department of Public Health and Human Services, 

DHHS Pub. No. 98–1798, Hyattsville, MD, 1998. 

It is encouraging that the committee is holding hearings on paid sick days. We 

hope that a bill will move through both Chambers and be on the President’s desk. 

Paid sick days should be a non-partisan issue. A healthy nation is a productive nation. 

Founded in 1994 as a local bakery, Dancing Deer has advanced to the national 

stage through creativity, hard work and a maniacal attention to quality, detail and 

customer satisfaction. As we learned what and who did and didn’t work organizationally, we developed a philosophy for the business. If people are happy, it shows 

in the food. Dancing Deer currently has approximately 70 full-time employees; The 

Company’s policies are tailored to the inner city employee base. Dancing Deer has 

a low hourly requirement for full-time benefits (just 24 hours per week) and a flexible PTO (paid time off) policy, which allows single parents access to health care, and 

other benefits while managing family commitments. 

For more information contact: Ursula Liff ; (617) 442–7300 ext. 210; Ursula.liff 

@Dancingdeer.com; 77 Shirley Street, Boston, MA 02119. 

THE MEDICAL LEGAL PARTNERSHIP FOR CHILDREN, 

BOSTON, MA 02118, 

February 12, 2007. 

Hon. EDWARD KENNEDY, 

317 Russell Senate Building, 

Washington, DC. 20510. 

DEAR SENATOR KENNEDY: We are a group of pediatricians who work among the 

most underserved populations in Boston, Massachusetts. Collectively we work at 

Boston Medical Center and the South End Community Health Center. We strongly 

support the Healthy Families Act because we believe the Healthy Families Act could 

be one of the most powerful treatments we have for children. 

As pediatricians, we support the well-being of the children and families with 

whom we work. Within the fabric of the family and the larger community, we seek 

to keep kids healthy. When there is a medicine, therapy, or treatment that will 

shorten the course of an illness or improve the health outcomes for children, we advocate for its use and make these recommendations to our patients and families. As 

physicians, we see what the research literature tells us: that children stay sick 

longer when their parents cannot be home to care for them.1 This is where we see 

the tremendous potential of the proposed legislation. As pediatricians seeking the 

best treatment and outcomes for our patients, we need to ensure that paid sick-time 

is available and accessible for all children and families, especially those without 

other resources. On a daily basis in the course of our practice, we are confronted 

with the many reasons that a parent would need the benefits of the Healthy Families Act. 

Children aged 5 to 17 year’s old miss an average of more than 3 days of school 

per year for health reasons.2 Younger children have higher rates of illness than 

those who are school age.3 The American Academy of Pediatrics recommends preventative medical care for children to stay healthy. It is of utmost importance that 

parents be present at these visits to give critical information to pediatricians about 

their children. The following examples clearly illustrates the importance and impact 

that the Healthy Families Act could have on children. 

‘‘L’’ is a school-aged child of a single working mother. His performance in school 

was fine until the third grade when his schoolwork started to deteriorate. He was 

starting to show signs of learning disabilities and Attention Deficit Hyperactivity 

Disorder (ADHD). L came with his grandmother to his yearly physical exam and 

a number of behavior-related visits, L’s mother was unable to come to these appointments because of her fear of losing her job if she missed work, and without his 

mother’s direct input, we had great difficulty understanding the scope and extent 

of the problem. It took many follow-up calls to schedule a time where his mother 

could bring him in for an appointment and subsequently make a treatment plan 

which has dramatically helped L’s school performance. This was not because L’s 

mother did not want to help her son—it was because she was forced to make the 

66 

4See, Jody Heymann. 5See, Jody Heymann. 6See, Jody Heymann. 7 Boston Medical Center & South End Community Health Center; 617–414–7430; 

jack.maypole@bmc.org, robyn.risenberg@bmc.org, Lauren.Smith@bmc.org, Megan.Sandel 

@bmc.org. 

unthinkable choice of keeping her job or bringing her child to important doctor appointments. 

Another story we would like to share with you is about ‘‘B.’’ B is a school-aged 

child with asthma. Because of the nature of her illness, she is admitted to the hospital a few times a year. Staying in the hospital is a scary situation for most people, 

especially children. Parents are allowed to stay with their children while hospitalized, however, this is not possible if the parent needs to be at work every day. That 

was the case with B. Her mother could not take time off of work to stay with B, 

and could only visit before and after work. Children like B who are alone in the 

hospital often tell us that they are afraid to sleep at night so they try to stay awake 

as long as possible. This stress prolonged B’s recovery and impacted her hospital 

stays. We believe such occasions—which are all too frequent—might be avoided if 

parents could be with their children throughout their hospitalization, without fear 

of economic consequences. Paid sick time would allow more parents to be at their 

child’s side during both illness and recovery—promoting recuperation, reducing 

stress on the family, and saving money for the health care system. We know that 

hospital stays are reduced by 31 percent if a parent is present in the children’s 

care.4 By supporting the Healthy Families Act, you support minimizing expensive 

hospital stays for children, and getting parents back to work more quickly. 

These brief vignettes reflect the unthinkable choices our families are forced to 

make—go to work, or tend to my child’s medical needs? Studies show that sick children have shorter recovery periods, better vital signs, and fewer symptoms when 

their parents participate in their care.5 Regardless of socioeconomic status, parents 

who received paid leave are five times more likely to be able to care for their sick 

children.6 And, this comes back to our essential point: The Healthy Families Act 

helps children get better quicker and families get back to work. 

For these reasons we offer our strongest support for the funding and passage of 

The Healthy Families Act.7

ROBYN RISEBERG, MD, 

JACK MAYPOLE, MD, 

LAUREN SMITH, MD, MPH, 

MEGAN SANDEL, MD, MPH. 

The authors are all affiliated with the Medical-Legal Partnership for Children at 

Boston Medical Center. 

CHILDREN’S HOSPITAL BOSTON, 

BOSTON, MA 02115, 

February 13, 2007. 

Hon. EDWARD M. KENNEDY, 

Chairman, 

Committee on Health, Education, Labor, and Pensions, 

U.S. Senate, 

Washington, DC 20510. 

DEAR SENATOR KENNEDY: On behalf of Children’s Hospital Boston and the children and families we care for, I want to thank you for introducing the Healthy Families Act. 

As the Medical Director of the Cerebral Palsy Program at Children’s Hospital Boston, I work with families all the time who are trying to balance work responsibilities 

with caring for their child with complex health care needs. Arranging the time off 

for medical appointments is a major source of stress. It is important for employers 

to give families flexibility to meet the health care needs of their child in a timely 

manner. Children need to have their parents present for emergencies as well as for 

management of their chronic health concerns. Affording families paid sick days also 

can reduce the spread of disease in child care settings, schools and at work. 

67 

1 Institute for Women’s Policy Research, analysis of March 2006 National Compensation Survey. 2Katherin Ross Phillips, Getting Time Off: Access to Leave among Working Parents (Policy 

Brief B-57), Urban Institute. 

This legislation eases some of the tough choices that families have to make to 

meet the competing demands of their family and professional lives. I appreciate 

your work on this important issue. 

Sincerely, 

LAURIE GLADER, M.D. 

STATEMENT OF JEFF LEVI, PH.D., EXECUTIVE DIRECTOR, TRUST FOR AMERICA’S

HEALTH (TFAH) 

TFAH SUPPORTS THE HEALTHY FAMILIES ACT; SICK AND FAMILY LEAVE MEASURES IN

BILL WOULD BE CRITICAL FOR CONTAINING A POSSIBLE PANDEMIC FLU OUTBREAK

‘‘People shouldn’t have to choose between protecting the health of their families 

and a paycheck during a crisis. The sick and family leave measures proposed in the 

Healthy Families Act, as introduced by Senator Edward Kennedy (D-MA), are important for ensuring that all Americans, regardless of their economic status, could 

take time off when they are sick or to care for family members. But the proposed 

sick and family leave policies are also essential for containing the spread of infectious disease and limiting the risk of illness during public health emergencies. 

Currently, 59 million workers in the United States do not have paid sick leave. 

Eighty-six million workers do not have paid sick leave that they can use to care for 

immediate family members. Three out of four ‘low-wage’ workers have no sick leave 

at all. 

One of the biggest current threats to our Nation’s health is a possible pandemic 

flu outbreak. The Centers for Disease Control and Prevention (CDC) is proposing 

that individuals who might become ill during a pandemic should stay home from 

work until they are fully recovered (an estimated 10 days), and that household 

members of those who are sick should also stay home while the individual is sick 

until it is clear that the household member has not become ill, which is known as 

voluntary home quarantine. The CDC has also suggested that schools could potentially close for 12 weeks during a pandemic, leading parents and guardians to struggle with managing child care issues during that time frame. 

Compliance with public health recommendations will be critical during the first 

wave of a pandemic, when vaccines would not yet be widely available. The minimum 

7 days of paid sick leave a year that employees could use to meet their own medical 

needs or care for sick family members would allow people to meet most of the minimum requirement for recuperation and family care during a pandemic. TFAH also 

encourages employers to plan for a possible pandemic, and create tiered sick leave 

plans to allow for more time off during a public health crisis, when designated by 

the U.S. Secretary of Health and Human Services.’’ 

Trust for America’s Health is a non-profit, non-partisan organization dedicated to 

saving lives by protecting the health of every community and working to make 

disease prevention a national priority. <http://www.healthyamericans.org> 

<http://www.pandemicfluandyou.org> 

Media Contacts: Laura Segal (202) 223–9870 x 27 or lsegal@tfah.org 

<mailto:lsegal@tfah.org> or Nicole Speulda (202) 223–9870 x29 or nspeulda@tfah.org 

<mailto:nspeulda@tfah.org>. 

RESPONSE TO QUESTIONS OF SENATORS KENNEDY AND ENZI BY DEBRA NESS

QUESTIONS OF SENATOR KENNEDY

Question 1. Would you please comment on why you think the provision of paid 

sick days is needed, and why reliance solely on voluntary benefits is insufficient? 

Answer 1. Currently, no Federal law guarantees paid sick days, and working families must rely on voluntary workplace policies. Consequently, nearly half (48 percent) of private-sector workers—and nearly four in five low-wage workers (79 percent)—lack even a single paid sick day.1 Two in five low-income working parents 

(41 percent), with household incomes below twice the poverty level, do not have any 

paid time off at all: no paid sick time, no paid vacation and no paid personal days.2

As a result, working people are forced to choose between taking care of their own 

health or a sick child or family member, and losing their pay—or even losing their 

68 

3Sara R. Collins, Gaps in Health Insurance: An All-American Problem, Commonwealth Fund, 

2006. 4 Bureau of Labor Statistics, 1996–1997 data (most recent available). 

5 United States Federal Government, USA Jobs: the Official Job Site for the United States 

Federal Government Web site, http://www.usajobs.gov/ei61.asp. 

job. An ordinary illness like the flu, can have devastating economic consequences 

for a struggling family. Clearly, reliance on voluntary benefits is not enough. 

Our existing labor laws are outdated and don’t take into account the increasing 

numbers of working mothers and dual-earning families. The Healthy Families Act 

would establish a basic labor standard for paid sick days, much like the minimum 

wage does. From a business perspective, a basic labor standard levels the playing 

field for all businesses. While some may argue that businesses that provide paid 

sick days voluntarily are at a competitive disadvantage, a minimum standard would 

eliminate the perception of disadvantage. 

Question 2. The Healthy Families Act covers only businesses with 15 or more employees, which is also the threshold set in the ADA and Title VII. Would you please 

comment on why you think 15 employees is an appropriate threshold, and why you 

think that businesses of that size are likely to be able to readily provide paid sick 

leave? 

Answer 2. I believe the 15-worker threshold is appropriate as it tries to cover as 

many workers as possible, while mitigating the burden of compliance for businesses. 

As the smallest of businesses grow and reach the 15-worker threshold, they begin 

to seek assistance from human resource managers or employment lawyers. At this 

size, businesses must understand and comply with the requirements of the ADA and 

Title VII. They are also required to display State and Federal posters that inform 

workers about workplace discrimination. By adopting this 15-worker threshold, the 

Healthy Families Act ensures that its compliance standards for small businesses are 

simplified. 

Question 3. Could you please comment on whether or not the Healthy Families 

Act’s notice and medical certification provisions are reasonable and workable? 

Answer 3. The Healthy Families Act requires employers to post a notice describing leave available to workers under the act as well as pertinent information regarding the leave in conspicuous places or in employee handbooks. This is a reasonable 

and workable provision for employers. Most employers subject to the provisions of 

the Healthy Families Act already must comply with other posting requirements including minimum wage, FMLA, ADA, discrimination and safety and health standards. Therefore, they have the management and human resources capacities in place 

to accommodate the Healthy Families Act’s minimal posting requirements. Furthermore, the posting requirements under the act are intentionally minimal so not to 

place an undue burden on businesses, even if it may impose a challenge to workers 

seeking additional information. 

The Healthy Families Act requires that workers provide their employer with medical certification for leave longer than three consecutive work days. This provision 

is reasonable for employers because it balances the need for certification, which 

would alleviate employer concerns of abuse, against the desire to not overburden 

human resources professionals with unnecessary paperwork or accounting tasks, 

which may occur with a more-frequent certification provision. 

The medical certification provision is reasonable for workers as it requires certification only for leave longer than three consecutive work days. For low-wage workers, a more-frequent certification requirement would create a barrier likely preventing them from taking a paid sick day. Two in five low-wage working people (41 

percent), with incomes between $20,000 and $40,000 a year, were uninsured for at 

least part of 2005, the year the study was conducted.3 For low-wage workers without health insurance, the cost of a simple doctor’s visit to obtain certification would 

present a financial hardship. 

Question 4. The Healthy Families Act sets 7 paid sick days as a minimum required national standard. Why do you think this is an appropriate minimum? How 

does it compare with the standards set by other countries? 

Answer 4. The 7 paid sick days labor standard established by the Healthy Families Act is really a minimum number of days. Among the 52 percent of private-sector 

workers who currently have access to paid sick days, the leave available to them 

varies from 8 to 11 days in smaller firms, and 11 to 21 days in larger firms.4 The 

Federal Government guarantees their workers 13 paid sick days a year.5 By comparison, the Healthy Families Act establishes a standard of 7 days—significantly 

lower than what is currently offered to half the workforce in the private sector and 

69 

6 Jody Heymann, et al., The Work, Family, and Equity Index, How Does the United States 

Measure Up?, 2007. 7 U.S. Census Bureau, Living Arrangements of Children: 2001, July 2005. 8 National Alliance for Caregiving/AARP, Caregiving in the U.S., NAC/AARP, 2004. 9Trades Union Congress, Time off for Families, http://www.tuc.org.uk/tuc/families.pdf. 

10Government of Canada, Service Canada Web site, http://www1.servicecanada.gc.ca/en/ei/ 

types/compassionate—care.shtml#family. 11 Australian Government, Employment & Workplace Relations Services Web site, http:// 

www.workplace.gov.au/workplace/Programmes/WorkFamily/Carersleave.htm. 

Federal Government workforce—to set a minimum standard for paid sick days. 

Much like the minimum wage, the Healthy Families Act is intended to set a floor 

for the number of paid sick days. 

The United States lags behind other countries in paid sick day standards. Globally, 145 countries provide paid time off for short- or long-term illnesses, with 127 

providing a week or more annually. More than 79 countries provide sickness benefits for at least 26 weeks or until recovery. Additionally, 37 nations provide some 

type of paid time for working parents when a child is ill.6

Question 5. The Healthy Families Act provides that paid sick leave can be used 

to care for ‘‘a child, a parent, a spouse, or any other individual related by blood or 

affinity whose close association with the employee is the equivalent of a family relationship.’’ Could you please comment on why it is important to provide this scope 

of coverage? How is the act’s definition of family member similar to other laws and 

how other countries are defining family for purposes of short-term leave? 

Answer 5. The scope of coverage ensures the needs of all families, including blended, joint and non-traditional families, are adequately addressed. Twenty-nine percent of children are being raised outside the traditional two-parent family.7 In addition, as Baby Boomers retire, more working families are caring for elderly parents 

and relatives. An estimated 34 million people provide care for older family members.8 As the definition of ‘‘family’’ continues to evolve, it’s clear that our workplace 

policies too must change to fit the needs and realities of our families. Today’s families deserve the same peace of mind and opportunities to care for the members of 

their families as traditional families of past generations. 

Unlike the proposed Healthy Families Act, many older Federal workplace laws, 

such as FMLA, are not as inclusive in their scope. Leave under the FMLA allows 

workers to care for spouses, children (step and biological) and parents, but does not 

permit the care of same-sex partners or grandchildren. 

San Francisco’s paid sick day legislation, which passed in 2006, provides for a 

broader scope of coverage. Workers may provide care to ‘‘other persons’’ including 

a child, parent, legal guardian or ward, sibling, grandparent, grandchild, spouse, 

registered domestic partner under any State or local law, coworker or ‘‘designated 

person’’ of their choosing. 

Other countries have broader definitions of family member to accommodate the 

needs of today’s families or family-like relationships. For example, in the United 

Kingdom, all ‘‘employees’’ have the right to ‘‘reasonable’’ time off work to help family 

members or friends who depend on them for assistance in an emergency, including 

a parent, wife, husband or child, or someone who lives with the employee as part 

of their family. A dependent can also be someone who ‘‘reasonably’’ relies on the employee for help if they are ill, or has an accident or when their normal care arrangements have broken down, such as a neighbor or friend with a disability.9

In Canada, workers can take ‘‘compassionate care’’ leave to care for a child; 

spouse or common-law partner; parent or their spouse; grandchild or their spouses; 

sibling; son/daughter-in-law, father/mother-in-law; uncle/aunt or their spouse/partner; niece/nephew or their spouse/partner; former foster parent; or current/former 

foster child. Workers can also take ‘‘compassionate care’’ leave to care for a gravely 

ill person who considers you like a family member, such as a close friend or neighbor.10 In Australia, paid ‘‘carer’s leave’’ allows workers time off to provide care to 

a member of the worker’s immediate family or household.11

Question 6. A statement was made at the hearing that some employees do not 

need paid sick days because they could use flextime when they become ill or need 

medical care. Would you please comment on whether flextime is a workable substitute for paid sick days? 

Answer 6. Flex-time is not a suitable substitute for paid sick days. Some suggest 

that flex-time policies would allow workers to switch the time of their work when 

they are sick or when their child is sick. However, in most cases, flex-time does not 

give workers the option to choose their work hours. For these workers, their hours 

of work are at the discretion of their employers, and they don’t have the guarantee 

70 

12WorldatWork, FMLA Perspectives and Practices survey, April 2005, http:// 

www.worldatwork.org/pub/E157963FML05.pdf. 13Society for Human Research Management, 2006 Benefits, Survey Report, 2006, Table G-1. 

that they will have time off when they need it most, when they are sick or when 

they must care for an ill family member. 

The majority of private-sector workers who would benefit most from paid sick 

days legislation are in the food service, hotel and retail industries. Additionally, majorities of child care and nursing home workers also would benefit from the Healthy 

Families Act. These occupations are customer-service oriented and are among the 

least flexible since they have specific hours of operation and structured worksites. 

Even with flex-time provisions in place, these workers would have little or any control over when they choose to work. 

Question 7. Mr. King claimed that employers will have difficulties complying with 

the Healthy Families Act because of existing compliance requirements under the 

FMLA and workers’ compensation laws. Do you agree, why or why not? 

Answer 7. Mr. King’s argument that adding the Healthy Families Act to existing 

compliance requirements will increase employers’ ‘‘practical/operational and legal 

burdens’’ is exaggerated. First, the Healthy Families Act applies to businesses with 

15 or more workers. As businesses reach the 15-worker threshold, they seek out 

human resource managers or employment lawyers to help them with compliance. 

Therefore, by adopting this threshold, the added burden on compliance is minimal. 

Second, the notification requirements for this and other compliance requirements 

are intentionally minimal, so not to burden employers. The Healthy Families Act’s 

requirement to post a notice in a conspicuous place and in employee handbooks is 

a very minor charge. Mr. King also asserts that Healthy Families Act compliance 

would create additional administrative burdens, comparing it to the FMLA. However, the greatest potential administrative load created by the Healthy Families Act 

would arise only after a worker has taken leave for more than 3 consecutive days. 

At that point, the employer may require a certification issued by a health care professional. Requesting and reviewing certification would take little time and money. 

In fact, a survey of similar FMLA medical certification requirements found that it 

took 39 percent of surveyed employers less than 10 minutes per case to request and 

review certification, and an additional 21 percent less than 30 minutes.12

Finally, Mr. King’s assertion that the Healthy Families Act and its administrative 

requirements would hamper employers’ ability to compete with offshore businesses 

is unsubstantiated. The businesses that are the least likely to provide paid sick 

days, such as in the food service, hotel, retail, child care and nursing home industries, are the least likely to have offshore competition. Businesses in these industries provide direct services to customers in structured, established worksites, which 

cannot be outsourced. 

Question 8. King argued that compliance with the Healthy Families Act will be 

administratively burdensome on employers. Given that so many employers in the 

United States and around the world already provide paid sick days, do you see compliance with these additional requirements as a problem for employers? Why or why 

not? What, if any, administrative procedures would the act add to typical payroll 

procedures? 

Answer 8. The vast majority of employers in the United States guarantee paid 

time off to their workers,13 as do employers around the globe. These workplaces 

have administrative practices in place to track time off. The Healthy Families Act 

targets the employers that don’t offer the most basic workplace standard to their 

workforce: paid sick days. For these employers, the Healthy Families Act ensures 

that they are minimally burdened. 

The administrative recording requirements of the Healthy Families Act are in accordance with the Fair Labor Standards Act. To minimize any potential undue burden on employers, the Healthy Families Act states that paid sick time provided may 

be accrued as determined by the employer as long as it is less than a quarterly 

basis. The act also allows for leave to be counted on an hourly basis—or in the 

smallest increment that the employer’s payroll system uses to account for absences. 

Both of these provisions of the act would place a minimal administrative or procedural load on the business. 

Question 9. King asserted that employers will likely reduce benefits in response 

to the act’s paid sick days requirement. Would you please comment on why that 

may or may not be the case? 

71 

14Kosali Ilayperuma Simon and Robert Kaestner, ‘‘Do Minimum Wages Affect Non-Wage Job 

Attributes? Evidence on Fringe Benefits,’’ Industrial & Labor Relations Review 58, (Issue 1 

2004), Article 3. 15 Ron Goetzal, et al., ‘‘Health Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers,’’ Journal of Occupational 

and Environmental Medicine (April 2004). 16Peter Romeo, ‘‘NRA Virus Confab Frames Contagious Workers as Leading Food Safety 

Threat,’’ Restaurant News (7/27/07). 17 Centers for Disease Control and Prevention, Norovirus Outbreak Associated with Ill FoodService Workers, 1/2006. 18 Norman G. Marriott, Principles of Food Sanitation (An Aspen Publication: 1999). 

Answer 9. The argument that establishing a basic labor standard of paid sick days 

would result in an offsetting reduction of fringe benefits, including the receipt of 

health insurance, a partially-paid insurance premium, pension coverage or access to 

job training, is not new. It has been used most commonly against increases in the 

minimum wage, another basic labor standard. However, research has found no 

strong evidence that an increase in the minimum wage causes a reduction of fringe 

benefits or decline in working conditions.14

The Healthy Families Act is a basic labor standard that would guarantee to more 

working people paid time off and job protection when they are sick or need to care 

for an ill family member. For the businesses that already provide paid sick days for 

their workers, a basic labor standard such as this would level the competitive playing field by requiring all businesses to guarantee paid sick days. When workers are 

guaranteed a minimum number of paid sick days, employers benefit as healthier 

workers are more productive and the spread of illness in the workplace is reduced. 

Without paid sick days, ill workers have no alternative but to go to work sick and 

risk spreading illness to coworkers and customers, lowering the overall productivity 

of the workplace. More than half (56 percent) of human resources executives report 

that ‘‘presenteeism’’—the practice of coming to work even when sick—is a problem 

in their companies. Studies have shown that ‘‘presenteeism’’ costs our national economy $180 billion, or an average of $255 per worker per year, in lost productivity 

annually. This productivity loss exceeds the cost of absenteeism and medical and 

disability benefits.15

Businesses that don’t offer their workers paid sick days may also be making 

themselves more vulnerable to illness-related costs, bad publicity and lawsuits. The 

recent surge in ‘‘stomach-flu’’ food-borne outbreaks in restaurants and on cruise 

ships is alarming the restaurant industry in particular. According to Restaurant 

News, the industry’s own publication, the frequent outbreaks are a ‘‘near-indictment 

of prevailing sick-leave practices.’’ 16 Nearly half of ‘‘stomach flu’’-related outbreaks 

(largely caused by the norovirus) are linked to ill food-service workers,17 who are 

the least likely to have paid sick days. 

A single food-borne outbreak could cost a restaurant up to $75,000 in direct costs, 

including clean up, re-staffing, restocking, settlements and regulatory sanctions. For 

a chain restaurant with several locations within a metropolitan area, the negative 

publicity resulting from a single food-borne outbreak can be devastating to the entire chain. The indirect loss of business resulting from a single food-borne outbreak 

at one establishment can total up to $7 million for all the restaurants in the chain 

within the metropolitan area.18

QUESTIONS OF SENATOR ENZI

Question 1. In your written testimony, you state that paid sick leave will reduce 

‘‘presenteeism’’ and therefore be good for businesses. The study you cited found that 

the most productivity-reducing conditions were depression and other mental illnesses, hypertension, heart disease, and arthritis. Considering that the mandate 

will reduce employer income margins by about $1,000 per employee, I think anyone 

can see that employers will have to look for a way to pay for this, and that way 

may be reducing healthcare benefits. For example, one could increase co-pays, reduce or eliminate prescription drug coverage, or worse. Can you see that employees 

with a mental illness, hypertension, heart disease, or arthritis—all of which are 

often treated with prescription drugs and none of which typically require time off— 

could be negatively impacted by this mandate? 

Answer 1. Studies have shown that both employers and workers would benefit 

significantly from the savings associated with the Healthy Families Act. 

I am not aware of the origin of the estimated $1,000 cost per employee cited in 

the above question. According to a cost-benefit analysis of the Healthy Families Act, 

costs associated with the bill were much less, at just $3.04 per worker per week, 

calculated for all wage and salary workers. The low cost of the Healthy Families 

72 

1Dr. Lovell and the Institute for Women’s Policy Research are both well-respected for their 

quantitative techniques and original research, as well as their efforts towards research dissemination and citizen education. 

Act is far outweighed by the benefits associated with the bill. The total savings associated with the bill, calculated for all wage and salary workers, is $4.26 per week— 

clearly higher than its cost. The costs and benefits are higher if calculated for only 

workers covered by the HFA: the per-worker per week cost of $5.98 is significantly 

less than the savings of $8.38 per worker per week. 

In addition, providing paid sick days to workers could result in health care cost 

savings for employers. Health care costs will decline because workers will be able 

to use the paid sick days to take care of their own health and the health of family 

members without being penalized by a cut in pay or disciplined. Workers would be 

more likely to access preventative care for themselves and family members, including regular physicals, vaccinations and screenings for diseases such as cancer, diabetes and heart disease. This could lead to reduced health care costs in the long 

run, and even a reduction in employer-paid insurance premiums. 

Question 2. What was the methodology used in the ‘‘presenteeism’’ study? Who 

conducted it? Has the study, its methodology or its findings been subjected to any 

kind of academic peer review or professional validation? If so, who has conducted 

this review or validation and where are the findings reported? How was the $180 

billion savings estimate calculated? 

Answer 2. The study, ‘‘Health, Absence, Disability, and Presenteeism: Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers,’’ 

was conducted by a group of researchers affiliated with the Cornell University Institute for Health and Productivity Studies, led by researcher Ron Goetzel, Ph.D. It 

was published in the Journal of the American College of Occupational and Environmental Medicine in April of 2004, a highly-regarded scientific publication that contains clinically-oriented research articles to guide physicians, nurses, and researchers. The journal maintains a rigorous peer review procedure. Each article is reviewed, using a double-blind procedure, by a group of academics in the field. 

Goetzel et al. calculated the direct and indirect costs of productivity loss associated with 10 common health conditions, using administrative data sources (insurance claims regarding medical care, employee absenteeism, and short-term disability payments) as well as employee self-reported data on presenteeism. Researchers found that presenteeism losses accounted for 61 percent of the total cost of the 

10 selected health conditions—higher than medical costs in most cases. 

The American Productivity Audit (APA) calculated that presenteeism costs $180 

billion in lost productivity each year. The APA is a survey of nearly 30,000 workers 

that aims to put a numeric value on the effects of health conditions on work. The 

survey measures lost productive time, in both hours of work and dollars, related to 

health. 

Question 3. What is the direct labor cost to the private sector of the paid leave 

mandate contained in the Healthy Families Act? How was that cost calculated? 

What individual(s) or organization(s) calculated these direct private sector costs, 

what was the methodology utilized, and has the study, calculation and/or estimate 

been fully peer-reviewed? 

Answer 3. Dr. Vicky Lovell of the Institute for Women’s Policy Research 1 estimated the total costs and benefits of taking leave under the Healthy Families Act 

using several data sources and analytical methods. Lovell estimated that the HFA’s 

annual cost would be $20,235,900 for wages paid to workers taking HFA-provided 

paid sick days, payroll taxes, and administrative expenses. This number breaks 

down to $5.98 per HFA-covered worker per week. These costs, however, are far outweighed by the benefits of implementing the Healthy Families Act. According to 

Lovell’s analysis, the total savings associated with the HFA would be $8.38 per 

HFA-covered worker per week. The sources of the costs and savings identified by 

Lovell’s analysis are outlined below. 

• Costs of the Healthy Families Act 

Lovell’s analysis measured the costs associated with the HFA. Lovell calculated 

how many workers would be affected were the HFA to be enacted. Lovell used the 

numbers of workers who meet the HFA eligibility criteria, the number of workers 

who currently have no paid sick days or are not allowed to use their leave for ill 

children or to attend doctor visits, and the number of workers who currently have 

fewer paid sick days than provided by the HFA and would have access to additional 

paid sick days under the HFA. 

73 

Lovell used data from a variety of sources, including the National Health Interview Survey, to calculate how many paid sick days workers would take if the law 

were enacted, for their own medical needs, for family care, for doctor visits, and for 

maternity leave and corresponding time for new mothers’ partners. 

Next, Lovell utilized data on how much workers earn, the cost of legally mandated 

payroll taxes, the cost of administrative expenses, and the cost of replacing workers 

on HFA leave, should employers elect to hire a temporary worker during the leave. 

Again, the cost of the HFA, paid by employers, is estimated at $5.98 per HFA-covered worker per week. 

• Savings from the Healthy Families Act 

The savings associated with allowing workers to take paid sick days to care for 

their own illness or family members’ illness are difficult to quantify. For the purposes of the analysis, Lovell estimated only the quantifiable aspects of the bill, including its health-related benefits, and then suggested other benefits that should be 

included in the analysis when the necessary data becomes available. Therefore, the 

analysis did not include all the possible benefits that may be associated with the 

bill. 

• Savings from Reduced Presenteeism 

The first cost savings Lovell identified was the savings associated with wages that 

businesses currently pay to sick workers on the job but with diminished productivity 

(‘‘presenteeism’’ costs). Lovell calculated the number of HFA-eligible workers who do 

not have paid sick days, as well as the cost of wages to sick workers with low productivity, the costs of the hourly wages of these workers, and the associated payroll 

taxes. Lovell found that the HFA would save $41,571,500 annually in wages that 

would have been paid to sick workers on the job who are less productive due to illness. 

• Savings from Reduced Turnover 

Second, Lovell calculated the cost savings associated with reduced turnover. 

Lovell cited research that concluded having paid sick days reduced workers’ voluntary turnover by 5.58 percentage points for married men, by 3.61 percentage 

points for married women, 5.75 percentage points for single women, and 6.43 percentage points for single men. If all employers offered paid sick days, voluntary 

turnover would reduce as workers considering a job change would have the same 

option of paid sick days at their current job as at a potential job—with the exception 

of firms with fewer than 15 workers. 

Access to paid sick days also affects involuntary turnover by decreasing job termination related to unauthorized absences from work by sick workers or workers caring for sick family members. There are no data for estimating the savings associated 

with involuntary turnover, however, and Lovell’s estimates did not include these 

savings. 

Turnover-related costs, which include expenses such as the cost of recruiting a 

new worker, low productivity of new workers, training, and human resources processing time for exit and entry, can be expensive for businesses, up to 25 percent 

of a worker’s total compensation. 

Lovell’s formula for calculating the costs associated with the HFA included the 

number of HFA-eligible workers who currently do not have paid sick days, the reduction in turnover associated with providing paid sick days, the cost of turnover, 

workers’ hourly wages, and wages as a percent of total compensation (necessary for 

calculating the cost of turnover). Using this formula, Lovell estimated that the savings associated with reductions in turnover total $25,840,000 annually. 

• Savings from Reduced Spread of Flu 

Third, Lovell calculated the cost savings associated with the reduced spread of the 

flu within workplaces, due to reductions in absences and lowered productivity. 

Lovell used flu-related data to calculate savings, because the flu is highly contagious 

and accounts for a large proportion of illness-related worker absences. Lovell’s analysis, which included both employers’ wage costs and workers’ medical costs, found 

that the savings due to reductions in the spread of the flu in workplaces would total 

$738.5 million annually if the HFA were enacted. 

• Savings from Reduced Short-Term Nursing Home Stays 

Fourth, Lovell added the cost savings associated with reduced short-term nursing 

home stays if workers were given the flexibility under the HFA to provide informal 

care for disabled, elderly, and medically-fragile relatives. Lovell found that the savings from reductions in short-term nursing home stays would total $225 million annually. 

• Conclusion: The HFA Yields Savings for Stakeholders, Particularly Employers 

Lovell outlined the distributed costs and savings to stakeholders under the 

Healthy Families Act. While the costs of the bill would be paid for by employers, 

74 

2 Bureau of Labor Statistics, 1996–1997 data (most recent available). 

3 United States Federal Government, USA Jobs: the Official Job Site for the United States 

Federal Government Web site, http://www.usajobs.gov/ei61.asp. 4 Vicky Lovell, Valuing Good Health: An Estimate of Costs and Savings for the Healthy Families Act, 2005, www.iwpr.org/pdf/B248.pdf. 5Williams, Joan. One Sick Child Away from Being Fired. University of California, Hastings 

College of Law. Undated. Boushey, 2008. Analysis of U.S. Census Bureau, Current Population 

Survey, Annual Social and Economic Supplements, Tables F14, F13, F10, and FINC03. 6 Vicky Lovell, No Time to be Sick, Institute for Women’s Policy Research, May 2004. 7Lovell, 2005, ‘‘Valuing Good Health.’’ 

employers reap the large majority of the estimated net savings, $2.40 per HFA-covered worker per week, which accrues to employers, workers, families, and taxpayers. 

Question 4. What is the indirect cost to the private sector of the paid leave mandate contained in the Healthy Families Act? How was that cost calculated? What 

individual(s) or organization(s) calculated these indirect private sector costs, what 

was the methodology utilized, and has the study, calculation and/or estimate been 

fully peer-reviewed? 

Answer 4. See answer for Question 3 for a complete answer to this query. 

Question 5. Do you believe that the bill’s 15 employee coverage threshold is appropriate? Why shouldn’t the threshold be 50 employees? Why shouldn’t the threshold 

be 2 employees? 

Answer 5. We believe the 15-worker threshold is appropriate as it tries to cover 

as many workers as possible, while mitigating the burden of compliance for businesses. 

As the smallest of businesses grow and reach the 15-worker threshold, they begin 

to seek assistance from human resource managers or employment lawyers. At this 

size, businesses must understand and comply with the requirements of the ADA and 

Title VII. They are also required to display State and Federal posters that inform 

workers about workplace discrimination. By adopting this 15-worker threshold as 

well, the Healthy Families Act ensures that its compliance standards for small businesses are simplified. 

Question 6. Do you believe that the bill’s entitlement of 7 paid sick days is appropriate? Why shouldn’t the entitlement be 3 paid sick days? Why shouldn’t the entitlement be 14 paid sick days? 

Answer 6. We believe a guarantee of 7 days per year is a reasonable minimum 

number of paid sick days employers should provide to workers. The intent of the 

Healthy Families Act is to establish a basic labor standard, much like the minimum 

wage. From this point, employers can offer additional days as appropriate for their 

workforce. 

Among the 52 percent of private-sector workers who currently have access to paid 

sick days, the time available to them varies from 8 to 11 days in smaller firms, and 

11 to 21 days in larger firms.2 The Federal Government guarantees their workers 

13 paid sick days a year.3 By comparison to a large portion of the private sector 

and our government, the Healthy Families Act’s minimum standard of 7 days is significantly lower. 

On average, workers currently miss about four and a half days of work per year 

to recover from illness or address health needs.4 With all adults working in 70 percent of today’s families,5 and a stay-at-home parent no longer the norm, working 

people need additional days to care for ill family members. The 7-day standard accommodates the very basic health needs of working people and their families. 

School-age children miss at least 3 school days per year due to health reasons.6

While the 7-day standard is intended to set a minimum standard for paid sick 

time, the reality is that the overwhelming majority of workers will not take the 

maximum number of the days they are guaranteed. An analysis of the 2003 National Health Interview Survey (NHIS) showed that when constrained to 7 days of 

work loss, workers offered paid sick days miss only 1.8 days annually on average 

due to illness and injury, excluding maternity leave. Workers who are not provided 

with paid sick days miss an average of 1.3 days annually, and the average for all 

workers is 1.6 days.7

Question 7. As I am sure you are aware, under the Fair Labor Standards Act, 

Federal workers can enter into voluntary arrangements with their employers to establish flex-time schedules, i.e. 80 hour bi-weekly schedules, as a means to better 

balance work, personal and family life. Would you be in favor of extending this to 

workers in the private sector? What is [are] the reason[s] for your view? 

75 

Answer 7. Flex-time is not a suitable substitute for paid sick days. Some suggest 

that flex-time policies would allow workers to switch the time of their work when 

they are sick or when their child is sick. However, in most cases, flex-time does not 

give workers the option to choose their work hours. For these workers, their hours 

of work are at the discretion of their employers, and they don’t have the guarantee 

that they will have time off when they need it most, when they are sick or when 

they must care for an ill family member. 

The majority of private-sector workers who would benefit most from paid sick 

days legislation are in the food service, hotel and retail industries. Additionally, majorities of child care and nursing home workers also would benefit from the Healthy 

Families Act. These occupations are customer-service oriented and are among the 

least flexible since they have specific hours of operation and structured worksites. 

Even with flex-time provisions in place, these workers would have little or any control over when they choose to work. 

Flex-time schedules that establish an 80-hour 2-week work period would hurt millions of working families by giving them less control over their daily schedules and 

serve as a pay cut. The Fair Labor Standards Act established a 40-hour work week 

to enable working people to spend more time away from work and with their families, and discourage employers from requiring excessive overtime by making overtime more expensive. Undermining the 40-hour work week would result in employers requiring more people to work more overtime. For example, under an 80-hour 

2-week work period, workers who work 50 hours in 1 week would not receive any 

overtime pay. Workers who rely on time-and-a-half overtime pay under a 40-hour 

work week may need to get a second job to make ends meet, which would put additional stress on working families that are already stretched thin. For employers, 

maintaining a 40-hour work week that provides for overtime pay beyond 40 hours 

ensures that they recruit and retain talented, dedicated workers. 

Question 8. Please provide the committee with a copy of the study which you cite 

in footnote 23 of your testimony. 

Answer 8. Please see attached for the full text of the report. 

[Editor’s Note: Due to the high cost of printing, previously published materials will not be reprinted. The above report can be found in committee 

files or by contacting the American College of Occupational and Environmental Medicine.] 

RESPONSE TO QUESTIONS OF SENATORS KENNEDY, ENZI, AND COBURN

BY JODY HEYMANN, M.D., PH.D. 

QUESTIONS OF SENATOR KENNEDY

Question 1. Would you please comment on why you think the provision of paid 

sick days is needed, and why reliance solely on voluntary benefits is insufficient? 

Answer 1. The Healthy Families Act is crucial because of the transformation that 

has occurred in the workplace and in American families. Today, the clear majority 

of working Americans are caring for children, or disabled or elderly family members. 

According to the Bureau of Labor Statistics, 70 percent of mothers with children 

under 18 are in the workforce. At the same time, between 25 percent and 35 percent 

of working Americans are currently providing care for someone over 65. According 

to the Census Bureau, 2 in every 7 families report having at least one member with 

disabilities. The ability of Americans to provide essential health care for their families while working depends enormously on the availability of paid sick days. 

Yet, in the absence of a Federal mandate on paid sick days, the private sector 

has not filled the gap. Nearly half of private sector workers have no paid sick days 

at all. An even larger percentage lack the ability to take days off to care for sick 

family members. While many families cannot reliably count on paid sick days, working poor families are at the highest risk. As The Widening Gap, a book reporting 

a series of national studies on American working families, notes, 76 percent of lowincome working parents do not consistently have paid sick days. Moreover, despite 

greater caregiving demands, working women are less likely than men to have paid 

sick days.1 While voluntary adoption of paid sick day policies has covered some 

Americans, the only way to address these gaps for all Americans is through Federal 

legislation. 

Question 2. Is additional research needed to determine who lacks paid sick days 

in America, whether paid sick days would make a difference, and whether the 

United States can remain competitive while requiring paid sick days? Do you think 

there has been adequate research to demonstrate the need for paid sick days? 

76 

Answer 2. The research evidence on sick days is by now thoroughly comprehensive. The benefits of paid sick days for individual and family health are clear. From 

as far back as 1965, studies of hospitalized children have shown that sick children 

have shorter recovery periods, better vital signs, and fewer symptoms when their 

parents are available to provide care.234 Numerous studies from 1972 onward have 

indicated that sending children to day care sick with contagious diseases increases 

the rate of observed infections in day care centers,5678 including respiratory and 

gastrointestinal infections.9 10 11 Research on both families and child care providers 

makes clear that when parents lack paid sick days they are far more likely to send 

sick children to both child care and school.12 13 I led the research team that carried 

out the first primary data collection to look at the impact of paid sick days on the 

ability of parents to care for children when they are sick. This peer-reviewed research by Heymann, Toomey and Furstenberg found that parents with paid sick 

days are five times as likely to be able to care for sick children at home and are 

also more likely to provide preventive health care.14

Since 1993, a wealth of research has also shown that when sick adults receive 

support from family members, they have substantially better health outcomes from 

conditions such as heart attacks 15 16 and strokes.17 In addition, elderly individuals 

live longer when they have higher levels of social support from friends and family 

members.18 19 Studies have also demonstrated that taking time off from work to rest 

and recuperate when sick encourages a faster recovery 20 and may prevent minor 

health conditions from progressing into more serious illnesses that require longer 

absences from work and more costly medical treatment.21 22 23

In 1996, a Pediatrics article by Heymann, Earle, and Egleston detailed the first 

study to examine how many paid sick days families might need, using the National 

Medical Expenditure Survey to look at illness in a national sample and the NLSY 

to make estimates of paid sick leave availability across America.24 The study found 

that one in more than a third of families, family members were sick enough to stay 

home from school or work for 2 weeks or more each year. However, the study also 

found that millions of Americans lacked paid sick days. The wide gaps between 

what Americans need in sick days and what employers provide have thus been clear 

for over a decade. The impact of meeting sick needs on success at work is also clear. 

Other researchers have found that without paid sick days, working families who 

take time off to provide care for family members are prone to both wage and job 

loss.25 26 27 In 2000, results from the first nationally representative daily diaries survey to gauge how often working Americans disrupt work for family members, published in The Widening Gap, revealed that the leading reason for disruptions is 

health.28 A peer-reviewed study by Earle and Heymann, published in 2002, used 

over a decade of longitudinal data to look at job loss and found that, after controlling for a wide range of human capital factors and social conditions, ill health and 

the poor health of children are leading determinants of job loss.29 Moreover, an article by Earle, Ayanian, and Heymann, published in the Journal of Women’s Health 

in 2006, demonstrated the importance of paid sick days in improving the return to 

work among adults with major health problems, finding that nurses are more than 

twice as likely to return to work after a heart attack or angina if they have paid 

days.30

Policy options have also thoroughly been explored. Since 2004, Institute for Women’s Policy Research (IWPR) has been publishing pieces on the availability of paid 

sick days in the United States and the affordability of remedying the gap. Their 

studies in Massachusetts and California have likewise shown the importance of paid 

sick days and their ready feasibility. Since 2004, the National Partnership for 

Women and Families has documented state by state the general shortage of provisions available for private sector employees to take paid time off from work in order 

to care for their own health, as well as for the health of their families. In 2004, The 

Project on Global Working Families conducted the first studies to look at the global 

availability of paid sick days and leave 31 and, in 2006, how provision of paid sick 

days is related to the ability of countries to compete economically.32 This second 

study published in the Journal of Comparative Policy Analysis found that the more 

economically competitive countries are more likely to provide paid sick days and 

leave. 

This is only a fraction of the research that has been conducted on sick days. As 

a researcher, it would be easy to call for more research, but the reality is we know 

enough for Congress to act. 

Question 3. The Healthy Families Act covers only businesses with 15 or more employees, which is also the threshold set in the ADA and Title VII. Would you please 

comment on why you think 15 employees is an appropriate threshold, and why you 

77 

think that businesses of that size are likely to be able to readily provide paid sick 

leave? 

Answer 3. Providing sick days to employees is feasible for businesses of all sizes. 

While absences due to illnesses can be challenging, businesses already deal with 

these absences. In companies that provide paid sick days, employees are not even 

absent a day more a year on average than in companies which do not provide sick 

days.33 The real difference is that it’s paid and your job is protected. Moreover, we 

know from practical experience that the smallest companies in the United States 

are able to provide paid sick days and remain economically competitive. In businesses with only one to nine employees, 42 percent of employees are currently eligible for paid sick days. Lastly, countries around the world have ensured paid sick 

days for firms of all sizes. Thus, limiting this benefit to businesses with more than 

15 employees is a conservative approach. 

Question 4. Could you please comment on whether or not the Healthy Families 

Act’s notice and medical certification provisions are reasonable and workable? 

Answer 4. Clearly, there are some health care needs that working Americans have 

flexibility in scheduling. Examples of these include routine checkups and annual 

preventive medical tests. While employees will face some constraints due to the 

health care system in scheduling these, it makes sense that they should make a reasonable effort to schedule these at a time that is not unduly disruptive to work. 

Other health care needs, such as caring for a sick child, addressing one’s own serious acute illness, or caring for a dying parent, clearly cannot be scheduled. The 

Healthy Families Act has been drafted to require employees to make the important 

effort to meet schedulable health care needs while trying to minimize any unnecessary impact on work. 

Question 5. The Healthy Families Act sets 7 paid sick days as a minimum required national standard. Why do you think this is an appropriate minimum? How 

does it compare with the standards set by other countries? 

Answer 5. A national standard of 7 guaranteed paid sick days is a minimum compared to international norms. At least 136 countries provide a week or more of paid 

sick days annually.34 All of the most economically competitive countries, with the 

exception of the United States, guarantee paid sick days, and 18 of the top 20 provide 31 or more sick days with pay. 

Question 6. The Healthy Families Act provides that paid sick leave can be used 

to care for ‘‘a child, a parent, a spouse, or any other individual related by blood or 

affinity whose close association with the employee is the equivalent of a family relationship.’’ Could you please comment on why it is important to provide this scope 

of coverage? How is the act’s definition of family member similar to other laws and 

how other countries are defining family for purposes of short-term leave? 

Answer 6. The definition of family used in the Healthy Families Act comes from 

the regulations covering Federal employees issued after passage of the Federal Employees Family Friendly Leave Act of 1997. (See 5 CFR § 630.201.) Just like Federal 

employees, Americans have a wide range of close family relationships, and it is crucial for legislation to honor American families in all the ways they care for each 

other. 

The Widening Gap reports evidence from a study that asked working Americans 

in every State across the country when they had to disrupt work to care for a family 

member. While care for children accounted for 42 percent of work disruptions that 

were related to family, 15 percent were to care for parents, 12 percent to care for 

spouses or partners, 7 percent for grandchildren, and 24 percent for other family 

members. This should not come as a surprise to us. When a grandparent is caring 

for a grandchild whose parents are serving in the military, they need to be able to 

take time from work to care for that grandchild. When an American is caring for 

an aging aunt who has no children and becomes gravely ill, the niece or nephew 

may be the only person available to provide care. These are only two of a number 

of crucial circumstances that need to be covered. It will be important to have specific 

guidelines on the interpretation of this clause, but this is best done in regulation, 

not in law, to ensure that it covers American families well as their circumstances 

change. 

Recognition of the breadth of family commitments is shared by many other countries. Just to cite a few examples of countries that ensure leave to care for sick family members: Austria’s coverage includes all persons in need of care living in the 

same household; New Zealand similarly includes people who depend on the employee for care. Nor is a full understanding of family limited to high-income countries. El Salvador, for example, covers spouses, ascendants, descendants, and others 

who depend economically on the worker. 

78 

Question 7. A statement was made at the hearing that some employees do not 

need paid sick days because they could use flextime when they become ill or need 

medical care. Would you please comment on whether flextime is a workable substitute for paid sick days? 

Answer 7. Flextime is not a workable substitute for paid sick days. Currently, 

most flextime programs require substantial advance notification which makes it unworkable for covering unexpected illnesses. Even when flextime is available with little notice—a far less common circumstance—it is not an adequate substitute for 

paid sick days. For example, employees who have been sick for a week cannot readily make up 40 hours of work at a different time while simultaneously caring for 

their health and their family. 

Question 8. Mr. G. Roger King, who testified at the hearing, claimed that employers will have difficulties complying with the Healthy Families Act because of existing compliance requirements under the FMLA and workers’ compensation laws. Do 

you agree, why or why not? 

Answer 8. Employers should not have difficulty complying with the Healthy Families Act while complying with the FMLA and the workers’ compensation laws. In 

fact, half of the private sector already provides paid sick days, as noted above. These 

companies are successfully ensuring their employees can care for their health, and 

are able to do this without conflict with the FMLA or workers’ compensation laws. 

Paid sick days may be used to cover both common health problems—these are not 

covered by the FMLA, and so there is no overlap at all—and serious illness. In the 

case of serious illness, nothing in the FMLA prohibits paying employees, so ensuring 

they are paid under the Healthy Families Act for 7 days will not create any compliance difficulties. 

Question 9. Mr. King argued that compliance with the Healthy Families Act will 

be administratively burdensome on employers. Given that so many employers in the 

United States and around the world already provide paid sick days, do you see compliance with these additional requirements as a problem for employers? Why or why 

not? What, if any, administrative procedures would the act add to typical payroll 

procedures? 

Answer 9. An employer that does not currently provide sick days will need to develop a system for granting requests for sick days and keeping track of the number 

of sick days taken and remaining for the year. Those procedures, however, can easily be integrated into existing payroll procedures, as has already been done by employers for half of all private sector employees. 

Question 10. Mr. King asserted that employers will likely reduce benefits in response to the act’s paid sick days requirement. Would you please comment on why 

that may or may not be the case? 

Answer 10. As currently written, the act clearly prohibits employers from reducing benefits in response to the act’s passage. Any employers that reduce benefits in 

response to the act if it passes would violate the law. 

ENDNOTES

1 Heymann J. (2000). The Widening Gap: Why America’s Working Families are in 

Jeopardy and What Can Be Done about It. New York: Basic Books. 2 Van der Schyff G. (1979). The role of parents during their child’s hospitalization. 

Aust Nurs J. 8:57–61. 3Mahaffy P. (1965). The effects of hospitalization on children admitted for tonsillectomy and adenoidectomy. Nurs Res. 14:12–19. 4Palmer S.J. (1993) Care of sick children by parents: A meaningful role. J Adv 

Nurs. 18:185. 5Loda F.A., W.P. Glezen, & W.A. Clyde. (1972). Respiratory disease in group day 

care. Pediatrics 49:428–0437. 6Sullivan P., W.E. Woodward, L.K. Pickering, & H.L. Dupont. (1984). Longitudinal study of occurrence of diarrheal disease in day care centres. Am J Public 

Health 74:987. 7Dahl I.L, M. Grufman, C. Hellberg, & M. Krabbe. (1991). Absenteeism because 

of illness at daycare centers and in three-family systems. Acta Paediatr Scand. 

80:436. 8Mottonen M. & M. Uhari. (1992). Absences for sickness among children in day 

care. Acta Paediatr. 81:929. 9Loda F.A., W.P. Glezen, & W.A. Clyde. (1972). Respiratory disease in group day 

care. Pediatrics 49:428–437. 

79 

10Strangert K. (1976). Respiratory illness in preschool children with different 

forms of day care. Pediatrics 57:191. 11Doyle A.B. (1976). Incidence of illness in early group and family day care. Pediatrics 58:607. 12 Heymann S.J. (2000) The Widening Gap: Why American Families are in Jeopardy and What Can Be Done About It. Basic Books: New York. 13 Heymann S.J., Vo PH, and Bergstrom CA. (2002). Child care providers’ experiences caring for sick children: Implications for public policy. Early Child Development and Care 172(1): 1–8. 14 Heymann S.J., S. Toomey, & F. Furstenberg. (1999). Working parents: What 

factors are involved in their ability to take time off from work when their children 

are sick? Archives of Pediatrics & Adolescent Medicine 153:870–874. 15 Bennet S.J. (1993). Relationships among selected antecedent variables and coping effectiveness in postmyocardial infarction patients. Research in Nursing and 

Health 16:131–139. 16Gorkin L. E.B. Schron, M.M. Brooks, I. Wiklund, J. Kellen, J. Verter, J.A. 

Schoenberger, Y. Pawitan, M. Morris, & S. Shumaker. (1993). Psychosocial predictors of mortality in the Cardiac Arrhythmia Suppression Trial-1 (CAST-1). American 

Journal of Cardiology 71:263–267. 17Tsouna-Hadjis E., K.N. Vemmos, N. Zakopoulos, & S. Stamatelopoulos. (2000). 

First-stroke recovery process: The role of family support. Archives of Physical Medicine and Rehabilitation 81:881–887. 18Seeman T.E. (2000). Health promoting effects of friends and family on health 

outcomes in older adults. American Journal of Health Promotion 14:362–370. 19 Berkman L.F. (1995). The role of social relations in health promotion. Psychosomatic Medicine 57:245–254. 20Gilleski D.B. (1998). A dynamic stochastic model of medical care use and work 

absence. Econometrica 66:1–45. 21 Aronsson G., K. Gustafsson, & M. Dallner. (2000). Sick but yet at work: An empirical study of sickness and presenteeism. Journal of Epidemiology and Community 

Health 54:502–509. 22Grinyer A. and V. Singleton. (2000). Sickness absence as risk-taking behaviour: 

A study of organizational and cultural factors in the public sector. Health, Risk, and 

Society 2:7–21. 23 Johannsson G. (2002). Work-life balance: The case of Sweden in the 1990s. Social Science Information 41:303–317. 24 Heymann S.J., Earle A., and Egleston B. (1996). Parental availability for the 

care of sick children. Pediatrics 98(2 part 1):226–230. 25Murphy B., H. Schofield, J. Nankervis, S. Bloch, H. Herman, & B. Singh. 

(1997). Women with multiple roles: The emotional impact of caring for ageing parts. 

Ageing and Society 17:277–291. 26 Joshi H., P. Paci, & J. Waldfogel. (1999). The wages of motherhood: Better or 

worse? Cambridge Journal of Economics 23:543–564. 27 National Alliance for Caregiving and American Association of Retired People. 

(2004). Caregiving in the U.S. Available at http://www.caregiving.org/data/ 

04finalreport.pd. 28 Heymann J. (2000). The Widening Gap: Why America’s Working Families are 

in Jeopardy and What Can Be Done about It. New York: Basic Books. 29 Earle A. & S.J. Heymann. (2002). What causes job loss among former welfare 

recipients? The role of family health problems. Journal of the American Medical 

Women’s Association 57:5–10. 30 Earle A., J.Z. Ayanian, & S.J. Heymann. (2006). What predicts women’s ability 

to return to work after newly diagnosed coronary heart disease: Findings on the importance of paid leave. Journal of Women’s Health 15(4): 430–441. 31 Heymann, S.J., Earle A., Simmons S., Breslow S.M., and Kuehnhoff A. (2004). 

Work, Family, and Equity Index: Where Does the United States Stand Globally? Boston: Project on Global Working Families. 32 Earle A. & J. Heymann. (2006). A comparative analysis of paid leave for the 

health needs of workers and their families around the world. Journal of Comparative Policy Analysis 8(3):241–257. 33Lovell V. (2005). Valuing Good Health: An Estimate of Costs and Savings for 

the Healthy Families Act. Washington, D.C. : Institute for Women’s Policy Research. 

Available online at: http://www.iwpr.org/pdf/B248.pdf. 34 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: 

How Does the United States Measure Up? Boston/Montreal: Project on Global Working Families. Available online at: http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf. 

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1 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: How Does 

the United States Measure Up? Boston/Montreal: Project on Global Working Families. Available 

online at: http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf. 

QUESTIONS OF SENATOR ENZI

Question 1. In your written testimony you said that the Healthy Families Act is 

‘‘superbly constructed.’’ By that, do you mean that it is the bill supporters’ intention 

to cover cosmetic procedures such as botox injections or teeth whitening? 

Answer 1. Currently, American mothers who stay home to care for an infant with 

a 104 degree fever are being fired. Sons who seek to address the health needs of 

elderly parents are having to choose between neglecting their own mothers and fathers and losing jobs. To avoid losing pay, millions of Americans are going to work 

every month sick and spreading infections to their coworkers and those they come 

into contact with at work. Restaurant workers need paid sick days so they don’t 

spread disease to all those they serve, and health care workers need paid sick days 

so they don’t spread illness to their vulnerable patients. The Healthy Families Act 

is indeed well constructed to begin to meet these crucial needs and to have a substantial positive impact on public health at an affordable cost. 

Question 2. Vacation time has demonstrable effects on employee morale, and productivity. Would you favor mandating paid vacation time for all private sector employees? 

Answer 2. As you correctly note, vacation time has important benefits for both 

employees and employers. Moreover, it is readily affordable. One hundred thirtyseven countries guarantee paid annual leave.1 The majority of the most competitive 

countries globally guarantee paid annual leave. That having been said, the bill 

under consideration addresses a far more urgent need—paid sick days. Whether or 

not we have consensus on other legislation, paid sick days are crucial to public 

health, the health of employees and their families, to the long-term economic productivity of the country, and to the welfare of all Americans. 

Question 3. What is the direct labor cost to the private sector of the paid leave 

mandate contained in the Healthy Families Act? How was that cost calculated? 

What individual(s) or organization(s) calculated these direct private sector costs, 

what was the methodology utilized, and has the study, calculation and/or estimate 

been fully peer-reviewed? 

Answer 3. Please see answer 4. 

Question 4. What is the indirect cost to the private sector of the paid leave mandate contained in the Healthy Families Act? How was that cost calculated? What 

individual(s) or organization(s) calculated these indirect private sector costs, what 

was the methodology utilized, and has the study, calculation and/or estimate been 

fully peer-reviewed? 

Answer 4. In response to questions 3 and 4: During the testimony, you received 

cost estimates from Heidi Hartmann. The details on these estimates including methodology are publicly available through the Institute for Women’s Policy Research. 

In carrying out these estimates, they have received input from a wide range of researchers in the field. 

The bigger question is what do we know about the affordability of paid sick days? 

First, half of all employees in America currently work for businesses which provide 

paid sick days. These businesses have been able to successfully compete both locally 

and globally while providing paid sick days. This is true of firms of every size category, from the smallest to the largest. The problem is that the lack of a Federal 

mandate has left nearly half of American workers in the private sector with no paid 

sick days. Countries around the world have shown they can compete while mandating paid sick days. All of the most competitive countries, with the exception of 

the United States, guarantee paid sick days. In short, we have excellent evidence 

that it is affordable. 

Question 5. Do you believe that the bill’s 15 employee coverage threshold is appropriate? Why shouldn’t the threshold be 50 employees? Why shouldn’t the threshold 

be 2 employees? 

Answer 5. Providing sick days to employees is feasible for businesses of all sizes. 

While absences due to illnesses can be challenging, businesses already deal with 

these absences. In companies that provide paid sick days, employees are not even 

absent a day more a year on average than in companies which do not provide sick 

81 

2Lovell V. (2005). Valuing Good Health: An Estimate of Costs and Savings for the Healthy 

Families Act. Washington, D.C. : Institute for Women’s Policy Research. Available online at: 

http://www.iwpr.org/pdf/B248.pdf. 3 Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, & Equity Index: How Does 

the United States Measure Up? Boston/Montreal: Project on Global Working Families. Available 

online at: http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf. 

days.2 The real difference is that it’s paid and your job is protected. Moreover, we 

know from practical experience that the smallest companies in the United States 

are able to provide paid sick days and remain economically competitive. In businesses with only one to nine employees, 42 percent of employees are currently eligible for paid sick days. Lastly, countries around the world have ensured paid sick 

days for firms of all sizes. Thus, limiting this benefit to businesses with more than 

15 employees is a conservative approach. 

Question 6. Do you believe that the bill’s entitlement of 7 paid sick days is appropriate? Why shouldn’t the entitlement be 3 paid sick days? Why shouldn’t the entitlement be 14 paid sick days? 

Answer 6. A national standard of 7 guaranteed paid sick days is a minimum compared to international norms. At least 136 countries provide a week or more of paid 

sick days annually.3 All of the most competitive countries, with the exception of the 

United States, guarantee paid sick days, and 18 of the top 20 provide 31 or more 

sick days with pay. 

Question 7. As I am sure you are aware, under the Fair Labor Standards Act, 

Federal workers can enter into voluntary arrangements with their employers to establish flex-time schedules, i.e. 80 hour bi-weekly schedules, as a means to better 

balance work, personal and family life. Would you be in favor of extending this to 

workers in the private sector? What is [are] the reason[s] for your view? 

Answer 7. There is a range of alternative work schedules that can help employees 

balance work, personal, and family life that are already possible for all employers 

in the United States to offer, including flexible work hours and part-time schedules 

as examples. Some countries go further and have laws requiring employers to make 

flexible hours schedules available to their workers. The United Kingdom has a law 

that facilitates flexibility by providing working parents with the right to request 

flexible schedules in order to care for children. A law in New South Wales, Australia, gives employees in companies with more than five people the right to have 

reasonable accommodations made, including flexible scheduling, in order to allow 

them to care for any immediate family member in need of care. Laws in the Netherlands and Germany give employees the right to request a reduction or extension in 

the number of hours worked. While these laws only require companies to consider 

requests and to enact them if feasible, I would be happy to put you in touch with 

other experts on these new approaches to flexibility. 

QUESTIONS OF SENATOR COBURN

Question 1. In your review of other countries and their government-mandated 

leave policies, how many of the countries had Federal constitutions like the U.S. 

Constitution which limits the role of the Federal Government unless specifically authorized to act? 

Answer 1. Congress has passed labor legislation on a wide variety of important 

issues that range from prohibitions on child labor, to ensuring occupational safety, 

to passing a minimum wage. All of these have been accomplished while respecting 

the American Constitution. The Healthy Families Act is quite similar to the minimum wage and other legislation that has already been passed to ensure basic decent working conditions for Americans. With respect to other countries, as 145 countries ensure paid sick days or paid sick leave, these represent the full range of constitutional and non-constitutional systems—including Federal Governments, as well 

as governments that are not based on a Federal system—and the full political and 

economic spectrum. 

Question 2. Section 5(d)(3) of S. 932—the Healthy Families Act—introduced by 

Senator Kennedy in the 109th Congress sets out that leave can be used for the ‘‘purpose of caring for a child, a parent, a spouse, or any other individual related by 

blood or affinity whose close association with the employee is the equivalent of a family relationship. . .’’ (emphasis added) Please explain what situations and who Section 5(d)(3) could encompass. 

Answer 2. The definition of family used in the Healthy Families Act comes from 

the regulations covering Federal employees issued after passage of the Federal EmVerDate Aug 31 2005 12:36 Sep 03, 2008 Jkt 000000 PO 00000 Frm 00085 Fmt 6633 Sfmt 6621 S:\DOCS\33446.TXT SLABOR1 PsN: DENISE
82 

ployees Family Friendly Leave Act of 1997. (See 5 CFR § 630.201.) Just like Federal 

employees, Americans have a wide range of close family relationships, and it is crucial for legislation to honor American families in all the ways they care for each 

other. 

The Widening Gap reports evidence from a study that asked working Americans 

in every State across the country when they had to disrupt work to care for a family 

member. While care for children accounted for 42 percent of work disruptions that 

were related to family, 15 percent were to care for parents, 12 percent to care for 

spouses or partners, 7 percent for grandchildren, and 24 percent for other family 

members. This should not come as a surprise to us. When a grandparent is caring 

for a grandchild whose parents are serving in the military, they need to be able to 

take time from work to care for that grandchild. When an American is caring for 

an aging aunt who has no children and becomes gravely ill, the niece or nephew 

may be the only person available to provide care. These are only two of a number 

of crucial circumstances that need to be covered. It will be important to have specific 

guidelines on the interpretation of this clause, but this is best done in regulation, 

not in law, to ensure that it covers American families well as their circumstances 

change. 

Recognition of the breadth of family commitments is shared by many other countries. Just to cite a few examples of countries that ensure leave to care for sick family members: Austria’s coverage includes all persons in need of care living in the 

same household; New Zealand similarly includes people who depend on the employee for care. Nor is a full understanding of family limited to high-income countries. El Salvador, for example, covers spouses, ascendants, descendants, and others 

who depend economically on the worker. 

Question 3. Section 5(e) of S. 932—the Healthy Families Act—introduced by Senator Kennedy in the 109th Congress, sets out that ‘‘An employee shall make a rea- sonable effort to schedule leave under paragraphs (2) and (3) of subsection (d) in a 

manner that does not unduly disrupt the operations of the employer.’’ (emphasis 

added) Please explain what the term ‘‘reasonable effort’’ could encompass. 

Answer 3. Clearly, there are some health care needs that working Americans have 

flexibility in scheduling. Examples of these include routine checkups and annual 

preventive medical tests. While employees will face some constraints due to the 

health care system in scheduling these, it makes sense that they should make a reasonable effort to schedule these at a time that is not unduly disruptive to work. 

Other health care needs, such as caring for a sick child, addressing one’s own serious acute illness, or caring for a dying parent, clearly cannot be scheduled. The 

Healthy Families Act has been drafted to require employees to make the important 

effort to meet schedulable health care needs while trying to minimize any unnecessary impact on work. 

Question 4. Are you aware of any States or localities (other than San Francisco) 

that are considering legislative action to address this issue? 

Answer 4. Numerous States and localities—from Maine to Montana, from Maryland to Massachusetts, to the city of Madison, Wisconsin, among many others—have 

or are considering legislative action on paid sick days or paid family leave, because 

of the current vacuum that has been left at the Federal level. Yet, an increasing 

number of companies are noting that it will be far easier for them to comply if this 

is addressed at a Federal level with more uniform standards. Until these basic 

needs are met by Federal legislation, it makes sense that State and local governments will and should pass legislation to protect the health of their residents. At 

the same time, the best solution, both for ease of administration for companies and 

for ensuring a level playing field for all Americans, is Federal passage. 

RESPONSE TO QUESTIONS OF SENATORS KENNEDY, ENZI, AND COBURN

BY RAJIV BHATIA, M.D., MPH 

QUESTIONS OF SENATOR KENNEDY

Question 1. The Healthy Families Act covers only businesses with 15 or more employees, which is also the threshold set in the ADA and Title VII. Would you please 

comment on why you think 15 employees is an appropriate threshold, and why you 

think that businesses of that size are likely to be able to readily provide paid sick 

leave? 

Answer 1. As a public health physician, I believe providing paid sick leave has 

benefits to employees, employers, society, and government with regards to economic 

well being as well as physical and mental health. As sickness does not discriminate 

based on the number of employees in a business, all employees, irrespective of the 

83 

size of the business need and should have the ability to access paid sick days. With 

regards to feasibility, San Francisco’s paid sick day law requires all employers to 

provide sick leave to all employees regardless of the size of the business. Smaller 

businesses are allowed to cap the accrued leave to 40 hours while all other businesses may cap accrued leave at 72 hours. Businesses of all sizes are currently complying with this law in San Francisco. Internationally, businesses in countries that 

require universal paid sick leave benefits appear to be competitive and successful. 

Question 2. Mr. King asserted that employers will likely reduce benefits in response to the act’s paid sick days requirement. Would you please comment on why 

that may or may not be the case? 

Answer 2. It is not clear specifically which benefits Mr. King is referring to. In 

theory, some employers may conceivably reduce benefits that they already provide 

(e.g. vacation) in order to provide paid sick days leave. I don’t believe many employers would reduce existing benefits for two reasons. First, I believe the number of 

employers which provide substantial benefits without providing paid sick day benefits is relatively small. In general, the provision of diverse benefits appears to be 

correlated positively. For example, employers who provide vacation benefits also provide sick day benefits. Employers who do not provide paid sick days also do not provide vacation and other benefits. Second, sick leave benefits are not comparable to 

other benefits in that they are not utilized uniformly by all employees. Typically, 

vacation benefits are used or accrued. Health care insurance benefits are paid by 

the employer irrespective of utilization of care. Paid sick days are utilized only when 

there is an illness or need for care. In a particular time period, paid sick leave benefits are typically not utilized completely by all employees who have them. Many employees may utilize little or no sick leave. Only a minority of employees have chronic 

or acute care needs requiring full utilization of all leave. I believe few employers 

would be likely to reduce an existing benefit (like vacation) for all employees as a 

trade-off for a new benefit whose utilization may vary substantially among employees. 

QUESTIONS OF SENATOR ENZI

Question 1. Your testimony about the public health value of mandating sick leave 

referenced infectious diseases such as influenza, stomach flu, and viral meningitis 

that are indeed very dangerous for the general population. I am concerned that the 

Healthy Families Act as introduced last Congress would cover many more far less 

compelling cases. The paid leave mandated under this bill could be applied for any 

‘‘absence resulting from obtaining professional medical care.’’ As a Doctor, you know 

that ‘‘professional medical care’’ could apply to numerous cosmetic health procedures 

and a host of other plainly elective options. Under this bill, an employee, working 

for a small employer, could choose to have a teeth-whitening procedure done in the 

middle of the work day. This employee would have to be paid for the time away 

from work, and the employer would have to find a replacement employee to fill in 

for the absence with very little notice. Do you think this type of sick leave utilization is appropriate? If not, why doesn’t the bill restrict sick leave to medically necessary conditions and procedures? 

Answer 1. In my testimony, I articulated the benefits with regards to both acute 

infectious diseases as well as more chronic diseases. There are additional potential 

benefits of paid sick days mediated through the care and prevention of chronic diseases, prevention of cancers, and treatment of functional disabilities; and care for 

children. Sick leave would be appropriate for some elective procedures however, it 

may be appropriate to limit paid sick leave for procedures that do not have a medical necessity, a preventative health purpose, or a functional benefit. With regards 

to elective procedures, I would personally make the distinction between (1) elective 

procedures that prevent or ameliorate an existing or potential functional disability 

(knee surgery to improve or preserve the range of motion of the knee); (2) elective 

procedures that screen for or prevent more serious preventable conditions 

(colonoscopy for colon cancer); and (3) elective procedures that has no relationship 

to a disease or disability (e.g. cosmetic surgery for purely aesthetic purposes). With 

regards to this latter sub-category of elective procedures (3), paid sick days would 

not appear to have a compelling public health benefit. 

Question 2. Do you believe sick leave should be limited to full day increments? 

How small should the allowable time increments be? 

Answer 2. I do not believe that sick leave should be limited to full day increments. 

Full day increments do not correspond to common health care needs in a variety 

of circumstances. For example, for some disease conditions, an individual may need 

frequent but brief appointments with his or her physician, appointments with a 

84 

physical therapist, or appointments for laboratory work. In these situations the 

medical care could be short (e.g. 1 hour). Thus, an employee could take sick leave 

to attend a routine medical appointment and also potentially work for the majority 

of a workday. This is advantageous for both employees and employers. 

Question 3. Assuming that employer resources are not limitless, from a public 

health perspective, do you think employer benefit dollars are best spent on providing accessible and affordable health insurance or on paid sick leave programs for 

employees? 

Answer 3. I do not view the two types of benefits comparable with regards to type 

of benefit or fiscal implications for employers; therefore, it is not possible for me to 

evaluate the tradeoffs suggested by the question. Health care insurance benefits are 

typically paid as insurance premiums and there is no rebate to employees for 

healthy employees who do not utilize resources in any premium period. In contrast, 

there is variable utilization of paid sick day benefits and potential employer benefits 

on productivity, employee retention, and health care costs. Furthermore, paid sick 

leave and heath care insurance benefits are complimentary. Health insurance can 

prevent some illness among employees and reduce the need for paid sick days. Paid 

sick days had potential to increase the utilization of primary and preventive care 

and reduce the utilization of more expensive therapeutic and hospital care, thus reducing the health care cost burden borne by employers collectively. 

QUESTIONS OF SENATOR COBURN

Question 1. Section 5(d)(3) of S. 932—the Healthy Families Act—introduced by 

Senator Kennedy in the 109th Congress sets out that leave can be used for the ‘‘purpose of caring for a child, a parent, a spouse, or any other individual related by 

blood or affinity whose close association with the employee is the equivalent of a family relationship. . .’’ (emphasis added) Please explain what situations and who Section 5(d)(3) could encompass. 

Answer 1. In my opinion, typical situations could include care for an individual 

who is suffering from, under evaluation for, or under treatment for an illness, disease, injury, or infirmity, whether permanent, temporary, acute, or chronic. I believe 

the subjects being cared for could include: a child, stepchild, foster child, or adopted 

child; parent or step-parent; spouse; grandparent or grandchild; domestic partner; 

or a sibling. 

Question 2. Section 5(e) of S. 932—the Healthy Families Act—introduced by Senator Kennedy in the 109th Congress, sets out that ‘‘An employee shall make a reasonable effort to schedule leave under paragraphs (2) and (3) of subsection (d) in a 

manner that does not unduly disrupt the operations of the employer.’’ (emphasis 

added) Please explain what the term ‘‘reasonable effort’’ could encompass. 

Answer 2. In my opinion, a reasonable effort on the part of the employee could 

encompass the following: conferring with the employer to learn when medical appointments may be least disruptive; scheduling routine or preventative medical care 

on a day or at a time of day that is least disruptive to the employee’s business if 

care is available at that time; scheduling more immediate or acute health care needs 

at a time of day least disruptive to the employer’s business if care is available; providing the employer timely advanced notice of routine or preventative care. Caring 

for a family member with an acute or emergency health condition, of course, cannot 

be scheduled in advance, but notice should be provided to the employer as soon as 

practicable. 

Question 3. Are you aware of any States or localities (other than San Francisco) 

that are considering legislative action to address this issue? 

Answer 3. I understand that in the United States, the States of California, Connecticut, Vermont, Washington, and Massachusetts currently have pending legislation to provide paid sick days to employees, and initial work on policy development 

is underway in several others. 

RESPONSE TO QUESTIONS OF SENATORS ENZI AND COBURN BY G. ROGER KING

QUESTIONS OF SENATOR ENZI

Question 1. I know that many large employers voluntarily offer their employees 

paid Family and Medical Leave Act time in an effort to remain competitive. In your 

experience working with employers who are covered by FMLA, is there a higher 

likelihood of abuse among employees who have access to paid vs. unpaid leave? Can 

you offer any suggestions as to why this may be the case? 

85 

1The term or phrase ‘‘sick leave’’ is a term or concept that is no longer used by a substantial 

number of employers in this country. Paid sick leave has been replaced or folded into comprehensive leave programs such as paid time off (‘‘PTO’’) and other similar leave policies and 

procedures. This approach combines traditional paid sick leave days, vacation days and other 

paid leave time (e.g., personal days, attendance incentive pay, etc.) into a consolidated or comprehensive paid leave program. Under this approach, a worker is given the option of when to 

take such paid leave time and may choose to do so within general constraints for any reason 

for which he or she chooses, including taking leave for personal or family illness situations. 

Answer 1. There is the potential for abuse among employees who have access to 

paid vs. unpaid sick leave. This is likely because certain employees who receive paid 

sick leave often view this leave as an ‘‘entitlement’’ or part of their compensation, 

rather than a benefit that is to be used only when necessary. As evidence of this, 

some clients who have traditional sick leave programs have advised us that they 

see an increase of sick leave on Mondays and Fridays or around national holidays 

or traditional vacation periods (i.e., Christmas or Independence Day). Some employees will take ‘‘mental health’’ days and call in ‘‘sick’’ when they are not actually ill. 

The problem with using sick leave in this manner is that the leave is often unscheduled and thus creates staffing issues and considerable increased expenses for employers. 

Human Resources professionals and clients have advised us that when sick leave 

and vacation leave are provided as two separate benefits, employees use sick leave 

because they have it. When employers switch to using a paid time off (‘‘PTO’’) leave 

bank system they usually find that utilization of unscheduled time off changes drastically. Instead of using unscheduled ‘‘sick days,’’ employees will save their time and 

use it for planned vacation and truly needed time off. 

Question 2. It appears that Section 5(g)(2) of the bill would freeze all leave policies 

upon enactment, and would effectively bar a covered employer from ever changing 

those policies in the future. Moreover, under Section 5(g) were those existing policies 

not deemed to be ‘‘equivalent’’ it would appear that the mandated leave called for 

under the bill would be in addition to that which an employer was voluntarily providing. Is that a fair reading of Section 5(g)? Could this wind up punishing employers that currently provide paid leave? Do you believe the bill language is clear as 

to the meaning of ‘‘equivalent’’? 

Answer 2. I agree with your reading of 5(g)(2) of the bill (which states that an 

employer may not eliminate or reduce the leave that it offers at the time the bill 

is enacted in order to comply with the HFA). As discussed in my written testimony, 

this edict would appear to contradict other sections of the HFA that will require employers to substantially modify their leave policies to become compliant with the 

HFA. Further, Section 5(g)(2) is troubling as it states ‘‘an employer may not eliminate or reduce leave in existence on the date of enactment of this Act, regardless 

of the type of such leave, in order to comply with the provisions of this Act.’’ As 

noted above, does this subsection prohibit even minor adjustments to an employer’s 

current leave programs? For example, it is unclear under the bill as currently written whether an employer that has a paid time-off program 1 that does not specifically identify sick leave would be prevented from changing in any manner how this 

paid time-off system works, including the eligibility and accrual levels associated 

with such plan. The ‘‘equivalency’’ provision of the HFA raises serious questions as 

to how such PTO and analogous programs would deem to be ‘‘equivalent’’ to the 7- 

day paid sick leave requirement of the HFA. Indeed, the cost of regulatory staff and 

time associated with such ‘‘equivalency’’ reviews no doubt would be considerable as 

would be the cost of the inevitable litigation that will arise from such determinations. 

QUESTIONS OF SENATOR COBURN

Question 1. In your testimony you mentioned the problems that have arisen with 

FMLA. Please discuss some of the litigation trends related to FMLA and whether 

you consider the Healthy Families Act as another bill that could spur similar litigation? 

Answer 1. If the HFA is enacted based on the experience of many employers 

under FMLA, employers of all sizes may be discouraged from implementing any additional improvements in their paid leave programs—assuming after paying for 

their additional paid leave costs, administrative expenses, and litigation costs associated with the HFA that they would even have any resources left to make such 

improvements. Indeed, in many instances it may be that the added administrative 

and litigation costs and other compliance expenses associated with the HFA will 

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drain any resources that otherwise would have been available for paid leave benefit 

improvements. 

As an employment attorney, I have seen the following issues in FMLA litigation 

that would likely arise with similar frequency under the Healthy Families Act: 

(1) The use (and abuse) of intermittent leave; 

(2) The inadequacy of notice and certification before a leave period begins; 

(3) Impact on attendance incentive programs; 

(4) Litigation costs associated with compliance; 

(5) Potential class claims (such as those that are currently plaguing employers in 

the wage and hour arena). 

Intermittent leave is one area that particularly deserves this committee’s attention. Two different regulations, the regulation permitting intermittent leaves when 

there is no planned and scheduled medical treatment on the day of the absence and 

the regulation embracing chronic conditions as covered ‘‘serious health conditions,’’ 

intersect to create one of the biggest problems for employers in terms of day-to-day 

operations. Together, these regulations allow an employee to have unscheduled absences of up to 60 single work days per year or approximately 25 percent of all 

workdays for conditions that may not be a serious health condition. This means that 

an employee could be absent for 1.2 days every single week in a calendar year or 

a consecutive 12 month period. 

Additionally, intermittent leave can be taken in as little as 10 or 15 minute increments with the potential, therefore, for an employee to take off a portion of his or 

her workday everyday in the calendar year or in a consecutive 12 month period. 

Further, if the employee manages to work 1,250 hours in the previous 12 months, 

the employee will be eligible to continue this cycle. 

Similar concerns will arise with the Healthy Families Act if employees use the 

7 days of paid leave intermittently. The use of intermittent paid leave will subject 

small employers (those not covered by the FMLA) to similar scheduling and coverage issues as those employers currently covered by the FMLA and will serve to 

exacerbate the already difficult situation faced by employers who are covered under 

the FMLA. The impact of unnoticed intermittent sick leave on a small employer 

could be devastating to production and/or operations. 

Question 2. Section 5(d)(3) of S. 932—the Healthy Families Act—introduced by 

Senator Kennedy in the 109th Congress sets out that leave can be used for the ‘‘purpose of caring for a child, a parent, a spouse, or any other individual related by 

blood or affinity whose close association with the employee is the equivalent of a family relationship. . . (emphasis added) Please explain what situations and who Section 5(d)(3) could encompass. 

Answer 2. This is, in my estimation, one of the fundamental definitional flaws in 

the act. This phrase is susceptible to a very broad inclusion of a variety of individuals. It could be construed to include frequent visitors to a household, a nanny or 

other domestic help, domestic partners, friends who live together as roommates— 

the list is potentially limitless. The potential litigation that might arise from this 

definition will likely further increase employers’ burden in complying with the act. 

Question 3. Section 5(e) of S. 932—the Healthy Families Act—introduced by Senator Kennedy in the 109th Congress, sets out that ‘‘An employee shall make a reasonable effort to schedule leave under paragraphs (2) and (3) of subsection (d) in a 

manner that does not unduly disrupt the operations of the employer.’’ (emphasis 

added) Please explain what the term ‘‘reasonable effort’’ could encompass. 

Answer 3. This open-ended and minimal requirement of notice to an employer for 

unscheduled leave will pose significant practical, financial, and operational problems. The term ‘‘a reasonable effort’’ is entirely subjective and most employers will 

be unwilling to challenge any notice provided by an employee, even if that notice 

comes too late for the employer to cover the employee’s absence. 

Question 4. Are you aware of any States or localities (other than San Francisco) 

that are considering legislative action to address this issue? 

Answer 4. Yes. Currently there are State efforts to enact legislation similar to 

that of San Francisco’s in Maine, Maryland, Massachusetts, Michigan, Montana, 

Wisconsin, Vermont, and Washington and municipal efforts in Madison, Wisconsin 

and Washington D.C. Also, the Federal Government and all State governments currently provide paid sick leave to their workers. Seven States (California, Connecticut, Hawaii, Maine, Minnesota, Washington, and Wisconsin) provide that workers who have paid sick days must be permitted to use them to care for family members. Many of these initiatives are quite recent and largely untested. For example, 

it is interesting to note that numerous problems have arisen regarding the San 

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Francisco ordinance in this area and this new law has therefore been delayed in its 

implementation. 

QUESTIONS OF SENATOR KENNEDY TO HEIDI HARTMANN, PH.D. 

Question 1. Please explain how you arrived at the estimated cost of the Healthy 

Families Act, and address Mr. King’s statement that the act would cost employers 

approximately $80 billion a year. 

Question 2. The Healthy Families Act covers only businesses with 15 or more employees, which is also the threshold set in the ADA and title VII. Would you please 

comment on why you think 15 employees is an appropriate threshold, and why you 

think that businesses of that size are likely to be able to readily provide paid sick 

leave? 

Question 3. The Healthy Families Act sets 7 paid sick days as a minimum required national standard. Why do you think this is an appropriate minimum? How 

does it compare with the standards set by other countries? 

Question 4. A statement was made at the hearing that some employees do not 

need paid sick days because they could use flextime when they become ill or need 

medical care. Would you please comment on whether flextime is a workable substitute for paid sick days? 

Question 5. Mr. King asserted that employers will likely reduce benefits in response to the act’s paid sick days requirement. Would you please comment on why 

that may or may not be the case? 

[Editor’s Note: Responses to the above questions were not available at 

time of print.] 

[Whereupon, at 11:42 a.m., the hearing was adjourned.] 

Æ