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PROTECTING EMPLOYEES, EMPLOYERS AND THE 

PUBLIC: H1N1 AND SICK LEAVE POLICIES 

HEARING 

BEFORE THE

COMMITTEE ON 

EDUCATION AND LABOR 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

HEARING HELD IN WASHINGTON, DC, NOVEMBER 17, 2009 

Serial No. 111–40 

Printed for the use of the Committee on Education and Labor 

( 

Available on the Internet: 

http://www.gpoaccess.gov/congress/house/education/index.html 
(II) 

COMMITTEE ON EDUCATION AND LABOR 

GEORGE MILLER, California, Chairman 

Dale E. Kildee, Michigan, Vice Chairman 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Rau ́l M. Grijalva, Arizona 

Timothy H. Bishop, New York 

Joe Sestak, Pennsylvania 

David Loebsack, Iowa 

Mazie Hirono, Hawaii 

Jason Altmire, Pennsylvania 

Phil Hare, Illinois 

Yvette D. Clarke, New York 

Joe Courtney, Connecticut 

Carol Shea-Porter, New Hampshire 

Marcia L. Fudge, Ohio 

Jared Polis, Colorado 

Paul Tonko, New York 

Pedro R. Pierluisi, Puerto Rico 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Dina Titus, Nevada 

Judy Chu, California 

John Kline, Minnesota, 

Senior Republican Member 

Thomas E. Petri, Wisconsin 

Howard P. ‘‘Buck’’ McKeon, California 

Peter Hoekstra, Michigan 

Michael N. Castle, Delaware 

Mark E. Souder, Indiana 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Joe Wilson, South Carolina 

Cathy McMorris Rodgers, Washington 

Tom Price, Georgia 

Rob Bishop, Utah 

Brett Guthrie, Kentucky 

Bill Cassidy, Louisiana 

Tom McClintock, California 

Duncan Hunter, California 

David P. Roe, Tennessee 

Glenn Thompson, Pennsylvania 

Mark Zuckerman, Staff Director 

Barrett Karr, Republican Staff Director 
(III) 

C O N T E N T S 

Page 

Hearing held on November 17, 2009 ...................................................................... 1 

Statement of Members: 

Kline, Hon. John, Senior Republican Member, Committee on Education 

and Labor ...................................................................................................... 4 

Prepared statement of ............................................................................... 5 

Additional submissions: 

Letter dated November 17, 2009, from various associations .......... 64 

Letter dated November 17, 2009, from various organizations, 

contractors, subcontractors, material suppliers and employees . 66 

Letter dated December 1, 2009, from Capital Associated Industries, Inc. ......................................................................................... 68 

Miller, Hon. George, Chairman, Committee on Education and Labor ......... 1 

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

Thompson, Hon. Glenn, a Representative in Congress from the State 

of Pennsylvania, letter dated November 16, 2009, from the House Committee on Small Business ............................................................................. 37 

Statement of Witnesses: 

Benjamin, Georges C., M.D., FACP, FACEP (E), executive director, American Public Health Association .................................................................... 13 

Prepared statement of ............................................................................... 15 

Clarke, A. Bruce, J.D., president and CEO, Capital Associated Industries, 

Inc. ................................................................................................................. 17 

Prepared statement of ............................................................................... 18 

Ness, Debra L., president, National Partnership for Women and Families 22 

Prepared statement of ............................................................................... 23 

Schuchat, RADM Anne, M.D., Assistant Surgeon General; Director, National Center for Immunization and Respiratory Diseases (NCIRD), 

Centers for Disease Control and Prevention, U.S. Department of Health 

and Human Services ..................................................................................... 7 

Prepared statement of ............................................................................... 9 

(1) 

PROTECTING EMPLOYEES, EMPLOYERS AND 

THE PUBLIC: H1N1 AND SICK LEAVE POLICIES 

Tuesday, November 17, 2009 

U.S. House of Representatives 

Committee on Education and Labor 

Washington, DC 

The committee met, pursuant to call, at 10:00 a.m., in room 

2175, Rayburn House Office Building, Hon. George Miller [chairman of the committee] presiding. 

Present: Representatives Miller, Kildee, Payne, Andrews, Scott, 

Woolsey, Hinojosa, McCarthy, Tierney, Wu, Holt, Davis, Bishop of 

New York, Loebsack, Hirono, Altmire, Hare, Clarke, Courtney, 

Shea-Porter, Fudge, Polis, Tonko, Titus, Chu, Kline, Petri, McKeon, 

Biggert, Wilson, McMorris Rodgers, Guthrie, Roe, and Thompson. 

Staff present: Aaron Albright, Press Secretary; Tylease Alli, 

Hearing Clerk; Tico Almeida, Labor Counsel (Immigration and 

International Trade); Jody Calemine, General Counsel; Lynn 

Dondis, Labor Counsel, Subcommittee on Workforce Protections; 

David Hartzler, Systems Administrator; Broderick Johnson, Staff 

Assistant; Gordon Lafer, Senior Labor Policy Advisor; Richard Miller, Senior Labor Policy Advisor; Alex Nock, Deputy Staff Director; 

Joe Novotny, Chief Clerk; Rachel Racusen, Communications Director; Meredith Regine, Junior Legislative Associate, Labor; James 

Schroll, Junior Legislative Associate, Labor; Dray Thorne, Senior 

Systems Administrator; Michele Varnhagen, Labor Policy Director; 

Mark Zuckerman, Staff Director; Andrew Blasko, Minority Speech 

Writer and Communications Advisor; Kirk Boyle, Minority General 

Counsel; Casey Buboltz, Minority Coalitions and Member Services 

Coordinator; Ed Gilroy, Minority Director of Workforce Policy; Rob 

Gregg, Minority Senior Legislative Assistant; Ryan Murphy, Minority Press Secretary; Jim Paretti, Minority Workforce Policy Counsel; Molly McLaughlin Salmi, Minority Deputy Director of Workforce Policy; and Linda Stevens, Minority Chief Clerk/Assistant to 

the General Counsel. 

Chairman MILLER [presiding]. The committee will come to order 

to conduct a hearing on ‘‘Protecting employees and employers and 

the public: H1N1 and sick leave policies.’’ I would like to welcome 

everyone this morning on a very important topic. 

We are meeting today in the midst of a global pandemic. The 

H1H1 virus is sweeping our country, closing hundreds of schools, 

idling thousands of workers, and affecting millions of Americans. 

The H1N1 flu virus is now officially widespread in at least 48 
2 

states, and the president has designated the virus a public health 

emergency. 

The Centers on Disease Control reports that the flu spread is 

very unusual this early in the season, and deaths among children 

and young adults are higher than expected. The CDC estimates 

that 22 million Americans have already become ill in the last 6 

months with H1N1, and 3,900 have died. A recent study predicted 

that 63 percent of Americans will be infected by the virus by the 

end of December. 

Fortunately, public health officials did have an early warning 

this spring on the potential of a widespread outbreak. The Obama 

administration and public health officials took immediate steps to 

develop policies to slow the spread of H1N1 flu and minimize the 

disruptions, but all of the planning and preparations cannot fully 

address the uncertainties surrounding the new highly contagious 

virus. 

While I applaud the quick identification and development of the 

vaccine, the delays of producing and delivering the vaccine to targeted populations have concerned millions of Americans. I am encouraged with the report that private vaccine manufacturers have 

worked out the production issues, and we seem to be back on track 

to getting the needed vaccine to the American people. The H1N1 

vaccine is the new viral tactic to slow the infection rate. 

While we fix the supply issues, the public health officials emphasize that there are additional ways to slow the spread of this dangerous virus. The CDC has issued guidance and recognizes the role 

employers and workers play in slowing the spread of the disease. 

According to the CDC, an individual who comes to work with H1N1 

will infect about 10 percent of his or her co-workers. 

They recommend that any worker with influenza-type illnesses 

stay home and that employers should allow workers to stay home 

without fear of any reprisals and without fear of losing their jobs. 

But the recommendation is easier made than followed, because for 

more than 50 million workers without paid sick leave, taking a day 

off from work means a pay cut or worse. Workers fear that they 

will be punished for taking time off either by losing pay because 

they do not have paid sick days or even by being fired. 

Employees of the food service, hospitality industry, school and 

health care fields are among those who cannot afford to stay home 

when they are sick. Because these employees have direct contact 

with the public, the consequences of coming to work sick are not 

only damaging to their health, but could damage the public health 

as well. 

Let us face one simple fact. When you are struggling to make 

ends meet, you are going to do everything possible not to miss a 

day’s pay. The lack of paid sick leave encourages workers who may 

have H1N1 to hide their symptoms and come to work sick, spreading the infection to co-workers, customers and the public. It is not 

good for our nation’s public health or for businesses. 

The National Partnership of Women and Families found that sick employees who go to work cost the economy about $180 billion 

in lost productivity. This is a significant loss of productivity for the 

American economy compared to the minimal cost of providing a few 

paid sick days a year. The Bureau Of Labor Statistics says the cost 
3 

of paid leave borne by employers for lower wage workers only accounts for 4.2 percent of their total compensation. 

Despite these minimal costs, current federal law does not mandate that employers provide paid sick leave to their workers. This 

is why members of Congress have been pushing for universal paid 

leave policies that will ensure workers at all income levels are able 

to take advantage of paid leave policies. I strongly support these 

efforts. 

However, the current H1N1 pandemic demanded an emergency 

response. Two weeks ago Congresswoman Woolsey and I introduced temporary and emergency legislation to help workers and 

employers deal with the spread of the H1N1 flu virus. The Emergency Influenza Containment Act will guarantee sick workers 5 

days of paid leave if their employer directs or advises them to stay 

home. 

This temporary legislation will slow the advance of H1N1 being 

spread through the workplace and encourage open communication 

between employees and their employers on sick leave policies. This 

emergency measure will not and should not supplant the need for 

comprehensive paid family leave policies, but I believe that it will 

be a circuit breaker needed to get this virus under control while 

protecting workers, employers and the public. 

I will continue to work with other members, such as Congresswoman Rosa DeLauro, in their efforts to win permanent reform in 

this area. 

But I would like to thank the witnesses for joining us today on 

this important hearing and look forward to all of your testimony. 

And with that, I would like to recognize the senior Republican 

member of our committee, Mr. Kline, for an opening statement. 

[The statement of Mr. Miller follows:] 

Prepared Statement of Hon. George Miller, Chairman, Committee on 

Education and Labor 

I would like to welcome everyone this morning on a very important topic. 

We are meeting today in the midst of a global pandemic. The H1N1 virus is 

sweeping our country—closing hundreds of schools, idling thousands of workers, and 

infecting many millions of Americans. 

The H1N1 flu virus is now officially ‘‘widespread’’ in at least 48 states and the 

President has designated the virus a public health emergency. 

The Centers for Disease Control reports that the flu’s spread is very unusual this 

early in the season and deaths among children and young adults are higher than 

expected. The CDC estimates that 22 million Americans have already become ill in 

the last six months with H1N1 and 3,900 have died. 

A recent study predicted that 63 percent of Americans will be infected with the 

virus by the end of December. 

Fortunately, public health officials did have an early warning this spring of the 

potential of a widespread outbreak. The Obama administration and public health 

officials took immediate steps to develop policies to slow the spread of the H1N1 

flu and minimize disruptions. 

But all the planning and preparations cannot fully address the uncertainties surrounding a new, highly contagious virus. While I applaud the quick identification 

and development of a vaccine, the delays of producing and delivering the vaccine 

to target populations have concerned millions of Americans. I am encouraged reports that private vaccine manufacturers have worked out production issues and we 

seem to be back on track to getting the needed vaccine to the American people. 

The H1N1 vaccine is one vital tactic to slow the infection rate. While we fix the 

supply issues, public health officials emphasize that there are additional ways to 

slow the spread of this dangerous virus. 

The CDC has issued guidance that recognizes the role employers and workers 

play in slowing the spread of disease. According to the CDC, an individual who 
4 

comes to work with H1N1 will infect about 10 percent of his or her co-workers. They 

recommend that any worker with an influenza-type illness stay home, and that employers should allow workers to stay home ‘‘without fear of any reprisals’’ and ‘‘without fear of losing their jobs.’’ 

But, that recommendation is easier made than followed. 

Because for the more than 50 million workers without paid sick leave, taking a 

day off from work means a pay cut or worse. Workers fear they will be punished 

for taking time off, either by losing pay because they do not have paid sick days 

or even fired. Employees in the food-service and hospitality industry, schools and 

health care fields are among those who cannot afford to stay home when they’re 

sick. 

Because these employees have direct contact with the public, the consequences of 

coming into work sick are not only damaging to their health, but could be damaging 

for the public’s health as well. 

Let’s face some simple facts: when you’re struggling to make ends meet you’re 

going to do everything possible to not miss a day’s pay. The lack of paid sick leave 

encourages workers who may have H1N1 to hide their symptoms and come to work 

sick—spreading infection to coworkers, customers and the public. 

This isn’t good for our nation’s public health or for businesses. 

The National Partnership for Women and Families found that sick employees who 

still go to work cost the economy $180 billion in lost productivity. This is a significant loss in productivity for the American economy compared to the minimal cost 

of providing a few paid-sick days a year. 

The Bureau of Labor Statistics says that the costs of paid leave borne by employers for lower-wage workers only accounts for 4.2 percent of their total compensation. 

Despite these minimal costs, current federal law does not mandate that employers 

provide paid leave to their workers. 

This is why members of Congress have been pushing for universal paid leave policies that will ensure workers of at all income levels are able to take advantage of 

paid leave policies. 

I strongly support these efforts. 

However, the current H1N1 pandemic has demanded an emergency response. 

Two weeks ago, Congresswoman Woolsey and I introduced temporary and emergency legislation to help workers and employers deal with the spread of the H1N1 

flu virus. The Emergency Influenza Containment Act will guarantee sick workers 

five days of paid sick leave if their employer directs or advises them to stay home. 

This temporary legislation will slow the advance of H1N1 being spread through 

the workplace and encourage open communications between employees and their 

employers on sick leave policies. 

This emergency measure will not, and should not, supplant the need for comprehensive paid family leave policies. But I believe it will be a circuit breaker needed to get this virus under control, while protecting workers, employers and the public. 

I will continue to work with other members such as Congresswoman DeLauro in 

their efforts to win permanent reform in this area. 

I would like to thank the witnesses for joining us today for this important hearing 

and forward to your testimony. 

Mr. KLINE. Thank you, Mr. Chairman. 

Good morning to all. I absolutely concur with the chairman that 

our topic today is indeed a timely one, with employers, workers and 

their families facing the uncertainty of a widespread influenza outbreak was wide-ranging effects. 

Unfortunately, the uncertainty I mentioned is pervasive. Even 

the scope of the outbreak is apparently unknown. The Washington 

Post reported on Friday that, ‘‘Total H1N1 cases in the United 

States range from 14 million to 44 million and total deaths range 

from 2,500 to 6,100.’’ 

Adding to the confusion, the administration’s early estimates of 

vaccine availability were significantly overstated, resulting in long 

lines and shortages while vaccine production ramped up. Nonetheless, Americans are coping with the situation as well as they can. 

From schools and workplaces to shopping centers and transit sys-
5 

tems, we are seeing the implementation of simple safeguards, such 

as using hand sanitizer and limiting person-to-person contact in an 

effort to reduce exposure. 

We are here this morning to talk specifically about workplace 

policies designed to limit the spread of H1N1, including the availability of sick leave for workers who fall ill. To understand these 

issues, we need a bit of context. 

We should know that in 2008 nearly all full-time employees in 

the United States, fully 93 percent, had access to paid sick leave. 

The majority of part-time workers had paid sick leave as well, although 82 percent of these workers are employed part-time voluntarily in order to have the flexibility to manage work and family 

obligations. 

We all know federal mandates are particularly onerous for small 

businesses, so it is important to look specifically at this category 

of employers as we consider new federal policies. The data tell us 

that 76 percent of all workers in small businesses with fewer than 

50 employees have paid illness leave, while other employers have 

informal plans—for example, granting paid time off for health-related concerns on a case-by-case basis. 

We must also be mindful of the existing Family Medical Leave 

Act, which provides unpaid leave for medical reasons and carries 

a host of notification and certification procedures of its own. With 

so many workers already having access to a variety of sick leave 

options, we need to look very carefully at proposals to add a new 

layer of federal leave mandates. 

A number of questions remain unanswered. How would these 

paid leave requirements interact with existing leave policies? What 

kind of notification or certification would be required? And is it a 

wise idea to put employers in the business of diagnosing medical 

conditions and deciding when workers should be sent home and 

when they are well enough to return to work? 

The H1N1 outbreak is a serious concern, and employers across 

the country are taking steps already to minimize infection and prevent the spread of the flu in their workplaces. This is clearly new 

and unknown territory, and we must tread very carefully as we attempt to minimize the spread of H1N1 while avoiding the creation 

of confusing, duplicative and costly new mandates that could harm 

the very workers we are trying to protect. 

I look forward to hearing from our witnesses and gaining a better 

understanding of the existing policies and practices and how they 

are being applied to the current influenza outbreak. 

And with that, Mr. Chairman, I thank you and yield back. 

[The statement of Mr. Kline follows:] 

Prepared Statement of Hon. John Kline, Senior Republican Member, 

Committee on Education and Labor 

Good morning Chairman Miller. Our topic today is a timely one, with employers, 

workers, and their families facing the uncertainty of a widespread influenza outbreak with wide ranging effects. 

Unfortunately, the uncertainty I mentioned is pervasive. Even the scope of the 

outbreak is unknown. The Washington Post reported on Friday that ‘‘total H1N1 

cases in the United States range from 14 million to 34 million, and total deaths 

range from 2,500 to 6,100.’’ 
6 

Adding to the confusion, the Administration’s early estimates of vaccine availability were significantly overstated, resulting in long lines and shortages while vaccine production ramped up. 

Nonetheless, Americans are coping with the situation as well as they can. From 

schools and workplaces to shopping centers and transit systems, we are seeing the 

implementation of simple safeguards such as using hand sanitizer and limiting person-to-person contact in an effort to reduce exposure. 

We’re here this morning to talk specifically about workplace policies designed to 

limit the spread of H1N1, including the availability of sick leave for workers who 

fall ill. 

To understand these issues, we need a bit of context. We should know that in 

2008, nearly all full-time employees in the United States—fully 93 percent—had access to paid sick leave. A majority of part-time workers have paid sick leave as well, 

although 82 percent of these workers are employed part-time voluntarily in order 

to have the flexibility to manage work and family obligations. 

We all know federal mandates are particularly onerous for small businesses, so 

it’s important to look specifically at this category of employers as we consider new 

federal policies. The data tell us that 76 percent of all workers in small businesses 

with fewer than 50 employees have paid illness leave, while other employers have 

informal plans—for example, granting paid time off for health-related concerns on 

a case-by-case basis. 

We must also be mindful of the existing Family and Medical Leave Act, which 

provides unpaid leave for medical reasons—and carries a host of notification and 

certification procedures of its own. 

With so many workers already having access to a variety of sick leave options, 

we need to look very carefully at proposals to add a new layer of federal leave mandates. 

A number of questions remain unanswered. How would these paid leave requirements interact with existing leave policies? What kind of notification and certification would be required? And is it a wise idea to put employers in the business 

of diagnosing medical conditions and deciding when workers should be sent home, 

and when they’re well enough to return to work? 

The H1N1 outbreak is a serious concern, and employers across the country are 

taking steps already to minimize infection and prevent the spread of the flu in their 

workplaces. This is clearly new and unknown territory, and we must tread very 

carefully as we attempt to minimize the spread of H1N1 while avoiding the creation 

of confusing, duplicative, and costly new mandates that could harm the very workers we’re trying to protect. 

I look forward to hearing from our witnesses and gaining a better understanding 

of the existing policies and practices, and how they’re being applied to the current 

influenza outbreak. Thank you, and I yield back. 

Chairman MILLER. Thank you very much. 

And with that, I would like to introduce our panel and say that 

pursuant to committee rule 7C, all members may submit an opening statement in writing, which will be made part of the permanent 

record. 

Our first witness will be Dr. Anne Schuchat, who currently 

serves as the assistant surgeon general of the United States Public 

Health Service and director of the National Center for Immunization and Respiratory Diseases at the Center for Disease Control 

and Prevention. In addition, Dr. Schuchat is also the chief health 

officer for the CDC’s H1N1 response. Dr. Schuchat has spent more 

than 20 years at CDC, working on immunization, respiratory and 

infectious diseases. 

Dr. Georges Benjamin has served as executive director of the 

American Public Health Association, the nation’s oldest and largest 

organization of public health professionals since December of 2002. 

Prior to this position, Dr. Benjamin served as secretary of many divisions of the Maryland Department of Health, as well as also serving as acting commissioner of public health for the District of Co-
7 

lumbia. Dr. Benjamin is also a member of the Institute of Medicine 

at the National Academies of Science. 

Bruce Clarke is the president and CEO of Capital Associated Industries and also serves as chairman of the Employment and Labor 

Policy Subcommittee of the National Association of Manufacturers. 

Capital Associated Industries is a nonprofit employers association, 

which provides 1,200 member companies with executive, management and human resource information and services. 

Debra Ness is the president of the National Partnership for 

Women and Families, one of the country’s leading organizations 

promoting policies to help women and men meet the dual demands 

of work and family. Prior to assuming her current role, Ms. Ness 

served as the executive vice president of the National Partnership 

for 13 years. Ms. Ness is also a national leader in efforts to improve health care, including serving on the National Quality Forum 

established by the president’s Advisory Commission on Consumer 

Protection and Quality in the Health Care Industry, with the mission of developing national strategies for health care quality measurement and reporting. 

Welcome to all of you. Thank you for taking your time to share 

your knowledge and expertise with the committee. 

And, Dr. Schuchat, we will begin with you. You have been here 

before, but a green light will go on. That will tell you that you have 

5 minutes for your testimony. An orange light will come on to suggest you might want to start wrapping up with about a minute left. 

And then you wrap up when the red light is on in the manner most 

coherent and convenient to you. So, welcome. 

STATEMENT OF DR. ANNE SCHUCHAT, DIRECTOR, NATIONAL 

CENTER FOR IMMUNIZATION AND RESPIRATORY DISEASES, 

CHIEF HEALTH OFFICER, H1N1 RESPONSE, CENTERS FOR 

DISEASE CONTROL AND PREVENTION 

Dr. SCHUCHAT. Thank you, Chairman Miller, Ranking Member 

Kline, and other members of the committee. It is really a pleasure 

to come back to update the committee on the administration’s comprehensive response to the H1N1 virus and discuss the impact that 

the pandemic is having on work, school and society. 

We have estimated that the first 6 months of this pandemic, the 

virus has led 22 million people to become ill, 98,000 people to be 

hospitalized, and about 4,000 people to die. The virus is spreading 

widely in 46 states. It is beginning to decrease in many places, but 

it is still way higher than baseline for this time of year. 

So far, there has been no change in the illness pattern, the age 

pattern or underlying conditions. Ninety percent of people who 

have died from this virus are under 65 years of age, a complete opposite with what we see for seasonal flu. Two-thirds of the children 

who have died have underlying conditions—asthma, neurologic 

problems and so forth, and so we know that pregnant women and 

adults with chronic medical conditions are at higher risk than others. 

So far, there has been no change in the virus. This is good news, 

because it means it hasn’t become more virulent. It is also good 

news, because the vaccines that we are making perfectly match the 

strain and should have good effectiveness. 
8 

But influenza, including the H1N1 virus, is unpredictable, and 

we do not know the trajectory that the virus will have in the weeks 

and months ahead. We know that previous pandemics have had 

multiple waves, and we are mindful the disease may continue to 

spread and that we may have waves of this disease through the 

next several months. The typical flu season goes from December to 

May, and we are mindful that we have a long road ahead. 

CDC’s role I am going to go through in a little bit of detail, but 

first I want to thank Congress for the incredible support that we 

have received to strengthen the preparedness of the country. It 

really is a little terrifying to think of where we would be if we had 

not been investing in the past several years in improved preparedness at the state and local level, the federal level, and the global 

level. 

CDC responded promptly last fall, identifying and characterizing 

this new virus, developing a strain to form a candidate for vaccine 

development, carrying not epidemiologic and laboratory surveillance in the U.S. and around the world. Our response has been 

comprehensive and aggressive, using science as the base for our approaches. 

We rapidly deployed assets, including life-saving antivirals and 

a significant portion of respiratory protection from our strategic national stockpile. We prepared and shaped laboratory kits to states 

around the country and to over 150 countries. We sent field teams 

to assist at home and abroad. 

We have issued guidance for schools, businesses and so forth, reminding them about how important sick leave is. We have issued 

guidance and updated that guidance for health care workers, mentioning respiratory protection and the steps that could be taken to 

extend the supply of respiratory protection. 

We have incorporated new antiviral medicines that can be delivered intravenously with the help of the FDA. We have focused on 

communication, and we have focused on vaccination. We are in the 

midst of a large national voluntary vaccination effort that is unprecedented in its scope. 

We, like others, are disappointed in the vaccine production and 

has been to some extent the victim of a slow-growing virus, but 

production is accelerating, and substantial amounts are now becoming available. Today 48.5 million doses of H1N1 vaccine has become available for the states to order. They have prioritized groups 

at highest risk to receive the vaccine during this phase where it is 

in limited supply, and we are supporting states and local authorities to make the best decisions about how to reach the priority 

groups with the scarce vaccine. 

We think it is very important to use vaccine as soon as it is 

available as effectively and efficiently as possible. We are focusing 

on safety and not taking any shortcuts either in vaccine release or 

in monitoring safety as the vaccine is in larger scale use, working 

hard with our partners in HHS and beyond to focus on the state 

and local infrastructure that is so vital in our response. 

Today’s hearing highlights the human and economic impact that 

influenza has, and in general illness really can cause work loss and 

threaten business continuity. Our guidance is for individuals to 
9 

stay home when they are sick. Twenty-four hours after a fever is 

gone is what we have recommended, based on updated evidence. 

We know that we have issued guidance to businesses to be flexible in sick leave and make it easy for workers to do the right thing. 

It is important to have the right policies in place and have careful 

planning for contingencies at businesses. Our goal in public health 

is to make it easy for employees to make the right choices to stay 

home, avoid infecting co-workers, and recover. 

I look forward to regular communications with the public and 

Congress and to answering the questions that you have. 

[The statement of Dr. Schuchat follows:] 

Prepared Statement of RADM Anne Schuchat, M.D., Assistant Surgeon General; Director, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, U.S. Department of Health and Human Services 

Chairman Miller, Ranking Member Kline, members of the Committee, thank you 

for this opportunity to update you on the public health challenges of 2009 H1N1 influenza. 

The Centers for Disease Control and Prevention (CDC) and our colleagues 

throughout the Department of Health and Human Services (HHS) are working in 

close partnership with many parts of the federal government, as well as with states 

and localities, under a national preparedness and response framework for action 

that builds on the efforts and lessons learned from the past few months, this previous spring and influenza preparedness trainings conducted during the last several 

years. Working together with governors, mayors, tribal leaders, state and local 

health departments, the medical community and our private sector partners, we 

have been monitoring the spread of H1N1 and facilitating prevention and treatment, including implementing a vaccination program. CDC also has deployed staff, 

both domestically and globally, to assist in epidemiologic investigation of the virus 

and support state, local and territorial health departments with the H1N1 mass 

vaccination campaign. 

Influenza is probably the least predictable of all infectious diseases, and the 2009 

H1N1 pandemic has presented considerable challenges—in particular the delay in 

production of a vaccine due to slow growth of the virus during the manufacturing 

process. Today I will update you on the overall situation, provide an update on vaccination status, and discuss other steps we are taking to address these challenges. 

This hearing is also an important opportunity to consider the impact this pandemic has had on work, school, and society. And although we are focused this year 

on the impact of the H1N1 pandemic, it is important to remember that even in a 

normal year, individuals and institutions are impacted by illnesses, as reflected in 

lost work and school days and lower productivity. Data from our National Center 

for Health Statistics in 2008 show, for example, that employed adults 18 years of 

age and over experienced an average of 4.4 work-loss days per person due to illness 

or injury in the past 12 months, for a total of approximately 698 million work-loss 

days. 

Tracking and Monitoring Influenza Activity 

One major area of effort is the tracking and monitoring of influenza activity, 

which helps individuals and institutions monitor and understand the impact of the 

2009 H1N1 virus. Since the initial spring emergence of 2009 H1N1 influenza, the 

virus has spread throughout the world. H1N1 was the dominant strain of influenza 

in the southern hemisphere during its winter flu season. Data about the virus from 

around the world—much of it collected with CDC assistance—have shown that the 

circulating pandemic H1N1 virus has not mutated significantly since the spring, 

and the virus remains very closely matched to the 2009 H1N1 vaccine. This virus 

also remains susceptible to the antiviral drugs oseltamivir and zanamivir, with very 

rare exception. 

Unlike a usual influenza season, flu activity in the United States continued 

throughout the summer, at summer camps and elsewhere. More recently, we have 

seen widespread influenza activity in 48 states; any reports of widespread influenza 

this early in the season are very unusual. Visits to doctors for influenza-like illness 

as well as flu-related hospitalizations and deaths among children and young adults 

also are higher than expected for this time of year. We are also already observing 
10 

that more communities are affected than those that experienced H1N1 outbreaks 

this past spring and summer. 

Almost all of the influenza viruses identified so far this season have been 2009 

H1N1 influenza A viruses. However, seasonal influenza viruses also may cause illness in the upcoming months—getting one type of influenza does not prevent you 

from getting another type later in the season. Because of the current H1N1 pandemic, several additional systems have been put in place and existing systems modified to more closely monitor aspects of 2009 H1N1 influenza. These include the following: 

Enhancing Hospitalization Surveillance: CDC has greatly increased the capacity 

to collect detailed information on patients hospitalized with influenza. Using the 198 

hospitals in the Emerging Infections Program (EIP) network and 6 additional sites 

with 76 hospitals, CDC monitors a population of 25.6 million to estimate hospitalization rates by age group and monitor the clinical course among persons with 

severe disease requiring hospitalization. 

Expanding Testing Capability: Within 2.5 weeks of first detecting the 2009 H1N1 

virus, CDC had fully characterized the new virus, disseminated information to researchers and public health officials, and developed and begun shipping to states 

a new test to detect cases of 2009 H1N1 infection. CDC continues to support all 

states and territories with test reagents, equipment, and funding to maintain laboratory staff and ship specimens for testing. In addition, CDC serves as the primary 

support for public health laboratories conducting H1N1 tests around the globe and 

has provided test reagents to 406 laboratories in 154 countries. It is vital that accurate testing continue in the United States and abroad to monitor any mutations in 

the virus that may indicate increases in infection severity, resistance to antiviral 

drugs, or a decrease in the match between the vaccine strain and the circulating 

strain. 

Health Care System Readiness: HHS is also using multiple systems to track the 

impact the 2009 H1N1 influenza outbreak has on our health care system. HHS is 

in constant communication with state health officials and hospital administrators to 

monitor stress on the health care system and to prepare for the possibility that federal medical assets will be necessary to supplement state and local surge capabilities. To date, state and local officials and health care facilities have been able to 

accommodate the increased patient loads due to 2009 H1N1, but HHS is monitoring 

this closely and is prepared to respond quickly if the situation warrants. 

Implementing a Flu-related School Dismissal Monitoring System: CDC and the 

U.S. Department of Education (ED), in collaboration with state and local health and 

education agencies and national non-governmental organizations, have implemented 

a flu-related school dismissal monitoring system for the 2009-2010 school year. This 

monitoring system generates a verified, near-real-time, national summary report 

daily on the number of school dismissals by state across the 130,000 public and private schools in the United States, and the number of students and teachers impacted. The system was activated August 3, 2009. This has helped us to calibrate 

our messages and guidance and may have contributed to the smaller number of 

school closings seen in the fall relative to those seen in the spring. 

Providing Science-Based Guidance 

A second major area of effort in support of individuals and institutions is to provide science-based guidance that allows them to take appropriate and effective action. Slowing the spread and reducing the impact of 2009 H1N1 and seasonal flu 

is a shared responsibility. We can all take action to reduce the impact flu will have 

on our communities, schools, businesses, other community organizations, and homes 

this fall, winter, and spring. 

There are many ways to prevent respiratory infections and CDC provides specific 

recommendations targeted to a wide variety of groups, including the general public, 

people with certain underlying health conditions, infants, children, parents, pregnant women, and seniors. CDC also has provided guidance to workers and in relation to work settings, such as health care workers, first responders, and those in 

the swine industry, as well as to laboratories, homeless shelters, correctional and 

detention centers, hemodialysis centers, schools, child care settings, colleges and 

universities, small businesses, and federal agencies. 

With the holidays coming up, reducing the spread of 2009 H1N1 influenza among 

travelers will be an important consideration. 

CDC quarantine station staff respond to reports of illness, including influenza-like 

illness when reported, in international travelers arriving at U.S. ports of entry. Interim guidance documents for response to travelers with influenza-like illness, for 

airline crew, cruise ship personnel and Department of Homeland Security port and 

field staff have been developed and posted online. As new information about this 
11 

2009 H1N1 influenza virus becomes available, CDC will evaluate its guidance and, 

as appropriate, update it using the best available science and ensure that these 

changes are communicated to the public, partners, and other stakeholders. 

In preparation for the upcoming months when we expect many families and individuals to gather for the holidays, we are preparing to launch a national communications campaign to encourage domestic and international travelers to take steps 

to prevent the spread of flu. Plans are to display public advertisements with flu prevention messages in ports of entry and various other advertising locations, such as 

newspapers and online advertisements, both before and during the upcoming holiday travel season. 

Supporting Shared Responsibility and Action through Enhanced Communication 

A third major area of effort is to support shared responsibility and action through 

enhanced communication to individuals. Our recommendations and action plans are 

based on the best available scientific information. CDC is working to ensure that 

Americans are informed about this pandemic and consistently updated with information in clear language. The 2009 H1N1 pandemic is a dynamic situation, and it 

is essential that the American people are fully engaged and able to be part of the 

mitigation strategy and overall response. CDC will continue to conduct regular 

media briefings, available at flu.gov, to get critical information about influenza to 

the American people. 

Some ways to combat the spread of respiratory infections include staying home 

when you are sick and keeping sick children at home. Covering your cough and 

sneeze and washing your hands frequently will also help reduce the spread of infection. Taking personal responsibility for one’s health will help reduce the spread of 

2009 H1N1 influenza and other respiratory illnesses. 

CDC is communicating with the public about ways to reduce the spread of flu in 

more interactive formats such as blog posts on the Focus on Flu WebMD blog, radio 

public service announcements, and podcasts. 

Through the CDC INFO Line, we serve the public, clinicians, state and local 

health departments and other federal partners 24 hours/day, 7 days/week, in 

English and Spanish both for phone and email inquiries. Our information is updated 

around the clock so we are well positioned to respond to the needs and concerns 

of our inquirers. Our customer service representatives get first-hand feedback from 

the public on a daily basis. In addition to the H1N1 response, we continue to provide this service for all other CDC programs. 

Prevention through Vaccination 

A fourth major area of effort is prevention through vaccination. Vaccination is our 

most effective tool to reduce the impact of influenza. Despite rapid progress during 

the initial stages of the vaccine production process, the speed of manufacturing has 

not been as rapid as initially estimated. CDC, in collaboration with Food and Drug 

Administration (FDA), characterized the virus, identified a candidate vaccine strain, 

and our HHS partners expedited manufacturing, initiated clinical trials, and licensed four 2009 H1N1 influenza vaccines all within five months. The speed of this 

vaccine development was made possible due to investments made in vaccine advanced research and development and vaccine manufacturing infrastructure building through the office of the Assistant Secretary for Preparedness and Response 

(ASPR), Biomedical Advanced Research and Development Authority (BARDA) over 

the past four years, and in collaboration with CDC, the National Institutes of 

Health (NIH), and FDA. The rapid responses of HHS agencies, in terms of surveillance, viral characterization, pre-clinical and clinical testing, and assay development, were greatly aided by pandemic preparedness efforts for influenza pandemics 

set in motion by the H5N1 virus re-emergence in 2003, and the resources Congress 

provided for those efforts. 

Pandemic planning had anticipated vaccine becoming available 6-9 months after 

emergence of a new influenza. 2009 H1N1 vaccination began in early October—5 

months after the emergence of 2009 H1N1 influenza. Critical support from Congress 

resulted in $1.44 billion for states and hospitals to support planning, preparation, 

and implementation efforts. States and cities began placing orders for the 2009 

H1N1 vaccine on September 30th. The first vaccination with 2009 H1N1 influenza 

vaccine outside of clinical trials was given October 5th. Tens of millions of doses 

have become available for ordering, and millions more become available each week. 

Although significant delays in vaccine production by manufacturers have complicated the early immunization efforts, vaccine will become increasingly available 

over the weeks ahead, and will become more visible through delivery in a variety 

of settings, such as vaccination clinics organized by local health departments, 

healthcare provider offices, schools, pharmacies, and workplaces. 
12 

CDC continues to offer technical assistance to states and other public health partners as we work together to ensure the H1N1 vaccination program is as effective 

as possible. Since September 30th, although the number of H1N1 vaccine doses produced, distributed, and administered has grown less quickly than projected, states 

have begun executing their plans to provide vaccine to targeted priority populations. 

Although we had hoped to have more vaccine distributed by this point, we are working hard to get vaccine out to the public just as soon as we receive it. 

H1N1 vaccines are manufactured by the same companies employing the same 

methods used for the yearly production of seasonal flu vaccines. H1N1 vaccine is 

distributed to providers and state health departments similarly to the way federally 

purchased vaccines are distributed in the Vaccines for Children program. Two types 

of 2009 H1N1 vaccine are now available: injectable vaccine made from inactivated 

virus, including thimerosal-free formulations, and nasal vaccine made from live, attenuated (weakened) virus. 

CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended 

that 2009 H1N1 vaccines be directed to target populations at greatest risk of illness 

and severe disease caused by this virus. On July 29, 2009, ACIP recommended targeting the first available doses of H1N1 vaccine to five high-risk groups comprised 

of approximately 159 million people; CDC accepted these recommendations. These 

groups are: pregnant women; people who live with or care for children younger than 

6 months of age; health care and emergency services personnel; persons between the 

ages of 6 months through 24 years of age; and people from ages 25 through 64 years 

who are at higher risk for severe disease because of chronic health disorders like 

asthma, diabetes, or compromised immune systems. These recommendations provide 

a framework from which states can tailor vaccination to local needs. 

Ensuring a vaccine that is safe as well as effective is a top priority. CDC expects 

that the 2009 H1N1 influenza vaccine will have a similar safety profile to seasonal 

influenza vaccine, which historically has an excellent safety track record. So far the 

reports of adverse events among H1N1 vaccination are generally mild and are similar to those we see with seasonal flu vaccine. We will remain alert, however, for 

the possibility of rare, severe adverse events that could be linked to vaccination. 

CDC and FDA have been working to enhance surveillance systems to rapidly detect 

any unexpected adverse events among vaccinated persons and to adjust the vaccination program to minimize these risks. Two primary systems used to monitor vaccine 

safety are the Vaccine Adverse Events Reporting System (VAERS), jointly operated 

between CDC and FDA, and the Vaccine Safety Datalink (VSD) Project, a collaborative project with eight managed care organizations covering more than nine million members. These systems are designed to determine whether adverse events are 

occurring among vaccinated persons at a greater rate than among unvaccinated persons. CDC has worked with FDA and other partners to strengthen these vaccine 

safety tracking systems and we continue to develop new ways to monitor vaccine 

safety, as announced earlier this week by the Federal Immunization Safety Task 

Force in HHS. In addition, based on the recommendation of the National Vaccine 

Advisory Committee (NVAC), HHS established the H1N1 Vaccine Safety Risk Assessment Working Group to review 2009 H1N1 vaccine safety data as it accumulates. This working group of outside experts will conduct regular, rapid reviews of 

available data from the federal safety monitoring systems and present them to 

NVAC and federal leadership for appropriate policy action and follow-up. 

More than 36,000 people die each year from complications associated with seasonal flu. CDC continues to recommend vaccination against seasonal influenza viruses, especially for all people 50 years of age and over and all adults with certain 

chronic medical conditions, as well as infants and children. As of the fourth week 

in October, 89 million doses of seasonal vaccine had been distributed. It appears 

that interest in seasonal flu vaccine has been unprecedented this year. Manufacturers estimate that a total of 114 million doses will be brought to the U.S. market. 

Reducing the Burden of Illness and Death through Antiviral Distribution and Use 

In the spring, anticipating commercial market constraints, HHS deployed 11 million courses of antiviral drugs from the Strategic National Stockpile (SNS) to ensure 

the nation was positioned to quickly employ these drugs to combat 2009 H1N1 and 

its spread. In early October, HHS shipped an additional 300,000 bottles of the oral 

suspension formulation of the antiviral oseltamivir to states in order to mitigate a 

predicted near-term national shortage indicated by commercial supply data. In addition, the Secretary authorized the release of the remaining 234,000 bottles of pediatric Tamiflu(r) on October 29th. We will continue to conduct outreach to pharmacists and providers related to pediatric dosing and compounding practices to help 

assure supplies are able to meet pediatric demand for antiviral treatment. Finally, 

CDC and FDA have also worked together to address potential options for treatment 
13 

of seriously ill hospitalized patients with influenza, including situations in which 

physicians may wish to use investigational formulations of antiviral drugs for intravenous therapy. The FDA issued an emergency use authorization (EUA) on October 

23rd, 2009, for the investigational antiviral drug peramivir intravenous (IV) authorizing the emergency use of peramivir for the treatment of certain hospitalized adult 

and pediatric patients with confirmed or suspected 2009 H1N1 influenza infection. 

Physician requests for peramivir to be used under the EUA are managed through 

a CDC web portal. 

Closing Remarks 

CDC is working hard to limit the impact of this pandemic, and we are committed 

to keeping the public and the Congress fully informed about both the situation and 

our response. We are collaborating with our federal partners as well as with other 

organizations that have unique expertise to help CDC provide guidance to multiple 

sectors of our economy and society. There have been enormous efforts in the United 

States and abroad to prepare for this kind of challenge. 

Our nation’s current preparedness is a direct result of the investments and support of Congress over recent years, effective planning and action by Federal agencies, and the hard work of state and local officials across the country. We look forward to working closely with Congress as we address the situation as it continues 

to evolve in the weeks and months ahead. 

Again, Mr. Chairman, thank you for the opportunity to participate in this conversation with you and your colleagues. I look forward to answering your questions. 

Chairman MILLER. Thank you very much. 

Dr. Benjamin? 

STATEMENT OF DR. GEORGES C. BENJAMIN, EXECUTIVE 

DIRECTOR, AMERICAN PUBLIC HEALTH ASSOCIATION 

Dr. BENJAMIN. Well, good morning, Chairman Miller and Ranking Member Kline and members of the committee. Thank you very 

much for allowing me to be here. 

As you know, APHA has been around for quite a while. We have 

been around since 1872, and I spent last evening looking at our 

recommendations back in 1918, the last time we had a great pandemic in our country. And interestingly enough, short of vaccine, 

many of our recommendations were the same. They were: try to be 

in good health, wash your hands, cover your nose and mouth when 

you cough and sneeze, and avoid being around other people, or try 

to, where you might, unfortunately, infect them. 

Dr. Schuchat and you, Mr. Chairman, talked a great deal about 

the data, and you have my written remarks, and I won’t repeat 

those, but just to point out that one of the things that APHA has 

been talking about a lot is the importance for us to have a resilient 

community. And part of resiliency means that you have to have a 

much more comprehensive engagement in just the health and public health people in this response. 

Obviously, this type of an outbreak dramatically affects business. 

And we think that there is a huge role that paid sick leave for 

workers plays in really building an essential and resilient community. So let me talk first about the paid sick leave benefits for business. 

We think legislation like the one you have, Chairman, and others, as you mentioned, that are being talked about on the Hill 

today can be a win-win for both the public health and business. 

And, you know, employers don’t want sick people in the workplace, 

and sick workers don’t want to be at work. But the incentives that 

we have today often incentivize workers to come to work, particu-
14 

larly when they are not well and they don’t get paid for staying 

home. And I asked myself as I came into work today—I came in 

my building, so let me just walk you through what I saw. 

So when you walk into our building, we have a really nice building on I Street in downtown D.C., and we have a receptionist that 

you walk past. And then you get in an elevator with other people 

as you drive up to the various floors. I noticed my staff congregating around the coffee pot in a nice, relatively enclosed room and, 

of course, some meeting in a conference room. Many of our employees are in open cubicles. 

I would argue that, despite this being a public health association, 

having lots of hand sanitizer around and lots of signs, and I remember the last time I actually, like many other people, tried to 

tough it out and came to work when I wasn’t feeling well, the 

workplace can very well be an incubator for the spread of infectious 

diseases, if we don’t encourage people not to come to work. 

So we think very strongly that sick pay, sick leave for employees, 

can enhance productivity, catch people before they want to come to 

work. See, the problem when you come to work and you send people home when they are sick, because they are incentivized to come 

to work and tough it out, is that they are infecting people all the 

way along the way as they come into the workplace. And so we 

think that any proposal ought to incentivize people not to come to 

work when they are sick, to do the right thing and stay home. 

Secondly, I think the paid sick leave benefits for employees and 

their families goes without saying. Certainly, if you have a sick 

loved one at home, you want to be able to stay home and take care 

of them. Many parents—good, caring parents—when they have to 

make a decision around paying the bills and paying the mortgage 

and a child is not too sick, we all know stories of parents sending 

their kids to school or to day care, only to get called in the middle 

of the day, because the child really isn’t feeling well, and you have 

got to go pick them up. 

Well, in an infectious disease, that is a real problem. Paid sick 

leave certainly encourages people not to put themselves at risk, not 

put their kids at risk, not put their communities at risk, and so we 

strongly support that as a core principle. 

And then, obviously, paid sick leave benefits the community and 

consumers just simply because if you are in a business and someone is sick and that business, particularly with this kind of infectious disease, they may often infect your customers. And the last 

thing you want to do, of course, is make a customer ill. So we think 

that legislation like this and other legislation that we have, discussing like this on the Hill today, aptly promote the public health 

and promote productivity in the workplace, and we are here to support that. 

APHA has had a policy which supports employers to make comprehensive plans around these kinds of events, particularly contingency in emergency preparedness plans, continuity of operations 

plans. And the worst thing one can do, and the worst problem one 

has, even as a small employer, is to not be prepared for this kind 

of thing. I know that there is a lot of debate about what this costs 

small employers, but I would submit that the cost to not do this 

can certainly put a small employer out of business as well. 
15 

i U.S. Centers for Disease Control and Prevention. Weekly 2009 H1N1 Flu Media Briefing, November 12, 2009. Available at www.cdc.gov/media/. ii U.S. Centers for Disease Control and Prevention. 2009 H1N1 Flu (‘‘Swine Flu’’) and You. 

Available at http://www.cdc.gov/h1n1flu/qa.htm. 

With that, I will stop. Thank you very much. 

[The statement of Dr. Benjamin follows:] 

Prepared Statement of Georges C. Benjamin, M.D., FACP, FACEP (E), 

Executive Director, American Public Health Association 

Chairman Miller, Ranking Member Kline, members of the Committee, thank you 

for the opportunity to join you this morning to represent the views of the American 

Public Health Association (APHA) on the important role that sick leave policies play 

in the containment of H1N1 infection and in the public health well-being of America. APHA is the oldest and most diverse organization of public health professionals 

in the world representing a broad array of health officials, educators, environmentalists, policy-makers, and health providers at all levels working both within 

and outside government organizations and education institutions to improve the 

health of our nation and the world. 

Influenza is a public health threat that arrives in our communities every fall. 

However, the emergence this year of the novel H1N1 virus has demonstrated the 

capacity for a widespread outbreak and the potential complications should the virus 

become a more virulent strain than exists today. We are very pleased that the Committee is looking at the critical issues facing both employees and employers as we 

deal with the impacts of H1N1 on the workplace. 

Since identified in April of this year, health officials estimate that 22 million people have been sickened by H1N1. Latest infection estimates indicate that about 

98,000 people have been hospitalized and about 4,000 have died due to H1N1; 

36,000 and 540 of which are children, respectively.i

Information analyzed by CDC indicates that the 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. Compared with seasonal flu, there are relatively fewer cases and deaths reported in 

those over 65 years of age. More so than seasonal flu, therefore, H1N1 flu is affecting the younger workforce.ii

The response toward building a resilient and healthy community requires thorough planning and a comprehensive approach at all levels of society from individuals to families; and in all places where we play, learn and work. Resiliency enables 

a community to withstand the ravages of a pandemic and hasten the community’s 

return to normal. Paid sick leave for workers is essential to building resilient communities in an infectious emergency. 

Operationalizing our response to the H1N1 outbreak requires a coordinated effort 

across all levels of society. The federal government sets the national tone for successful emergency response and provides the latest information, guidance, research 

and advice. In the face of H1N1, the federal government has successfully led preparedness efforts by creating a national plan, working quickly to identify the viral 

strain, create the substrate to grow the vaccine, and collaborating with state and 

local health departments to respond to the outbreak. 

However, all sectors in our communities must be prepared as well. Businesses 

need to have a plan in place to reduce the spread of infectious disease in the workplace, and personnel policies that supports the goal of ensuring the health and 

wellbeing of their employees, their customers and their business. Paid sick leave for 

employees supports this goal. 

We know that people with H1N1 are going into work everyday. Companies subject 

to the Family and Medical Leave Act are required to offer unpaid sick leave, but 

most employees without a paid sick leave benefit do not have the financial security 

necessary to stay home from work when they or a family member are sick. This 

problem is especially problematic during the current H1N1 pandemic. 

I. Paid Sick Leave Benefits for Business 

An unhealthy worker or somebody in the workplace spreading disease affects 

business. CDC estimates that a sick worker can infect one in ten co-workers. While 

voluntary action is an option, an infectious worker who may spread disease to coworkers and customers is a threat not only for the business, but to the public at 

large as well. Sick workers are not productive ones and by spreading disease in the 

workplace risk the overall productivity of the business. By providing paid leave for 

sick workers, worker safety and business productivity can both be enhanced—a winwin for employers. This is particularly a plus for small employers where preventable 
16 

iii American Public Health Association. H1N1 Facts. Available at www.getreadyforflu.org/preparedness/H1N1—new.htm. iv Center for Infectious Disease and Policy. Conference poll: 18% of businesses have pandemic 

plan [press release], February 15, 2006. Available at www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/feb1506survey.html. v American Public Health Association. Preparing for Pandemic Influenza, Policy Number: 

20063, November 8, 2006. 

losses of even a small number of workers can have a devastating effect on the business. Mandatory sick leave encourages employees to stay out of the workplace when 

appropriate, protecting the business and I believe hastens the employees return to 

productive work. 

II. Paid Sick leave Benefits for Employees and Their Families 

While we want to encourage workers to make healthy and rational decisions, 

when they are faced with the choice of staying home sick without pay or going into 

work sick so they can put food on the table and pay their mortgage, many workers 

choose to go to work and ‘‘tough it out,’’ putting their co-workers and their customers at risk. 

Additionally, if an employee has a sick family member, often a child, the employee 

has to decide if they should stay home to care for the sick family member and loose 

pay or, send the child to school or daycare so they can go to work. Obviously, sick 

children should stay at home, however even caring parents challenged with the decision to pay the bills or not; may err on the side of sending the child to school, if 

the child does not appear to be too ill. Sick children are not productive learners, 

and being in school or daycare puts the rest of the community at risk, particularly 

with infectious diseases like influenza. Employees who are parents should not have 

to make this choice. 

III. Paid Sick Leave Benefits for Customers and the General Public 

Prevention is the best tool individuals, businesses, and communities have to staving off the spread of influenza infection. Vaccination is always the first line of defense with vaccine preventable diseases. Seasonal flu vaccine is available now and 

should be given as recommended by public health authorities. Initial doses 2009 

H1N1 flu vaccine should also be given as recommended as available. 

Nonpharmaceutical measures such as: 

1. Covering your nose and mouth with a tissue, or your elbow, when you cough 

or sneeze; 

2. Washing your hands frequently with soap and water, or alcohol-based handrubs if soap and water are not available; and 

3. Social distancing strategies such as staying home from work or school if you 

get sick, and limit contact with others until you are symptom free for at least 24 

hours to keep from infecting others.iii Paid sick leave is an important tool to make 

social distancing an effective strategy in the workplace. 

While there have been some improvements, too few businesses today have pandemic influenza preparedness plans in place.iv APHA policy strongly supports the 

development and implementation of pandemic preparedness plans within the business communities.v Such plans should include: 

1. Employee training and education programs related to pandemic influenza to ensure that employees are aware of how to prevent transmission of the flu, signs and 

symptoms of the virus, and the need to stay home from work when they are sick; 

and 

2. Policies for employee compensation and sick leave that would be used during 

a pandemic that are not punitive and provide employees with adequate financial security to enable them to stay home from work when they or a family member are 

sick. 

Our last line of defense against spreading infection lies with each and every one 

of us. We have both an individual and collective responsibility to keep ourselves 

healthy and help prevent the spread of flu. We should follow the guidance from 

health authorities: get vaccinated against both seasonal and H1N1 flu, wash our 

hands often with soap and water, and avoid close contact with those who are sick. 

If we become ill, it also means helping our family, friends, co-workers and community stay healthy by staying home from work, avoiding public places, covering our 

mouth and nose when we cough or sneeze, and practicing good hand hygiene. 

We’ve come a long way in being prepared for public health emergencies such as 

an H1N1 flu outbreak, but we have more work to do to protect America’s health. 

Paid sick leave for employees is one important next step. 
17 

Chairman MILLER. Thank you. 

Mr. Clarke? 

STATEMENT OF BRUCE CLARKE, PRESIDENT AND CEO, 

CAPITAL ASSOCIATED INDUSTRIES, INC. 

Mr. CLARKE. Good morning, Chairman Miller, Ranking Member 

Kline, committee members, panelists. I am Bruce Clarke. I am 

CEO of Capital Associated Industries, a nonprofit employers’ association that serves over 1,000 North Carolina employers and helps 

them manage well, pay well, benefit well, and stay in compliance 

with thousands of federal, state and local workplace rules. 

Our members are concerned about employee health, their families’ health, and, yes, even business continuity in a pandemic. We 

understand the emergency, and we are adapting to it. But we also 

understand the longer-term issues caused by paid leave mandates. 

We survey our members and their benefits practices and link our 

survey data with similar groups around the nation. 

When it comes to availability of paid time for absence due to illness, the glass is not just half full—the glass is over 80 percent 

full. I believe the marginal visible benefit of the proposed national 

mandates will create far more invisible and unintended consequences and that the glass will actually be less full than it is 

today. Here is why. 

Employers provide dozens of benefits to give employees paid time 

away from work. There are literally hundreds of mixtures and combinations of these benefits crafted to suit a specific workplace best. 

An example: we have a large food processor that provides no paid 

sick days as such. Instead, they chose to purchase a fully insured 

short-term disability policy for every single hourly employee in the 

facility, providing a wage substitute during their illness of up to 6 

months. This is designed to prevent true financial ruin during a 

medium-term illness. 

Who is to say this company should spend their benefits dollars 

on 5 or 7 sick days instead? Who wins from that trade-off? Employers are usually rational economic units. If told to carve out 3 percent of payroll for a specific benefit, they will do so, and then reduce spending on other pay and benefits. 

This problem of benefits substitution may be most acute in PTO, 

or paid time-off policies, which typically lump vacation, sick and 

personal days into one bank and allow use for any of these purposes. Employers that provide PTO time without labeling days specifically as sick days must decide whether to add the new mandated benefit to the current benefit or to reduce one while creating 

the other. One-quarter of employers use PTO accounts and would 

face this dilemma. 

Anything that forces a PTO plan to carve out days specifically for 

illness also punishes people who want those days available for 

other personal use or simply desire privacy about the reason for 

their use. 

Our own surveys of employers nationwide tell us that 80 percentplus of employers provide a paid sick day benefit, with the average 

being 7 to 9 days per year when there is a defined number. Seventy 

to 90 percent allow use of sick time for non-emergency needs like 
18 

dental visits, routine doctors visits, plus used for family members’ 

needs. 

Vacation pay is provided by 95 percent-plus of employers, and 

virtually all employers allow its use for any reason. More than half 

of the employers provide qualified part-time employees vacation 

and/or sick days on a reduced schedule. Mandating paid sick time 

policies will force a new baseline from which all employers with 15 

employees will be required to rewrite their many types of pay when 

not working policies. 

Flexibility will be reduced to balance costs. Examples of my 

members’ recent flexible responses to H1N1 include extra pandemic 

flu time off banks that go beyond current sick or PTO days, borrowing from future sick time accruals when current accounts are 

exhausted, making up lost paid time on other days and on other 

projects, unlimited paid days—sick days—for flu-like symptoms 

whenever there is a national or local pandemic declared, granting 

extra paid sick days if the employee or family member took the flu 

shot, if it was available, paying for the flu shots. 

Employers are working hard to treat employees as they would 

wish to be treated within the bounds of hard economic realities. 

These are the reasons why I believe we should leave that paid time 

off glass over 80 percent full, and we should not risk damaging the 

overall level and types of paid time off by favoring one type over 

another through a national mandate. 

In closing, my comments today have focused primarily on the impact of the Healthy Families Act upon employer policies and flexibility. I would like to make a brief comment on the recently proposed Emergency Influenza Containment Act. 

I am concerned that the bill leaves too many key provisions unclear and ill-defined for a law designed to take effect 15 days after 

enactment. Employers are not expert at diagnosing illness, and idle 

comments about that from a supervisor or manager may be perceived as directing or suggesting that they go home. 

The safe harbor provision may or may not apply when an employer uses its normal processes for leave. With the safe harbor applied to PTO plans, which do not mention sick pay specifically? It 

suffers as well from the problems caused by any national mandate 

in the context of a complex but effective employer-provided way of 

paid leave. 

Thank you for the time to speak with you today. I look forward 

to your questions. 

[The statement of Mr. Clarke follows:] 

Prepared Statement of A. Bruce Clarke, J.D., President and CEO, Capital 

Associated Industries, Inc. 

Good morning Chairman Miller, Ranking Member Kline and distinguished members of the Committee. I appreciate the opportunity to speak with you today about 

employer-paid sick leave policies and ways that employers are responding to the 

current H1N1 influenza outbreak. 

I am Bruce Clarke, President and CEO of Capital Associated Industries (CAI), a 

non-profit employers’ association that helps 1,000 North Carolina employers manage 

well, pay well, provide high-quality benefits and stay in compliance with thousands 

of federal, state and local workplace rules. 

While the Committee continues to explore paid leave issues, it is important to recognize the broad scope of their impact and the efforts that are already underway 

by employers to respond to the current H1N1 pandemic. 
19 

CAI shares your goal of protecting the health of the American workforce while 

minimizing the spread of any contagious disease. As the Committee considers legislation, however, it is important that any proposal support and protect the existing 

paid leave programs and workplace flexibility initiatives employers have in place— 

especially among our nation’s smallest employers. 

Overview of Existing Employer Leave Practices 

Our national network of Employer Associations cooperates each year on surveys 

asking hundreds of questions about pay and benefits at thousands of workplaces nationwide. 

I can say confidently that when it comes to the availability of paid leave from employers for sick leave, the glass is not just half full; it is more than 80 percent full. 

I believe the marginal perceived visible benefit of a proposed national mandate will 

create far more invisible and unintended detriments that will, most importantly, result in that glass being considerably less full than it is today. 

Today, employers provide dozens of types of benefits that give employees paid 

leave. Manufacturers in particular have provided generous family-friendly benefits 

that include leave programs. According to the Department of Labor’s Bureau of 

Labor Statistics (BLS), nearly all full-time workers have access to paid illness leave. 

Specifically, the Monthly Labor Report in February 2009 shows that 93 percent of 

full-time workers and over half of part-time employees have access to paid sick 

leave. 

According to the BLS, manufacturing employees on average earn over 20 percent 

more in compensation than the rest of the workforce and 96 percent of manufacturers provide a paid leave benefit that their employees can use specifically for illness, 

doctor’s appointments or to care for an ill family member. 

While some may point to the lack of formal requirements for employers in the 

U.S. to provide paid leave, the reality is that such types of leave are already widespread in our workforce. Paid leave is an important component of a wide variety 

of different types of leave provided to employees. 

Annually, my organization surveys our members on hundreds of business practices, wages, health care benefits and other data to keep them competitive and 

aware of market conditions. Our most recently published Policy and Benefits survey 

for 2009-2010 shows: 

Over 80 percent of employers in North Carolina provide a specific paid leave benefit, with the average being 7 to 9 days per year; 

70 to 90 percent of respondents allow use of sick time for non-emergency needs 

like dental and routine doctor visits and for ill family members; 

Vacation pay is such a common benefit in the group of employers with more than 

15 employees that we only ask them how many days they provide, not whether they 

provide it. Virtually all allow its use for personal and family illness; 

60 percent of employers in this survey even provide long-term disability policies 

for employees; and 

More than half of the employers provide qualified part-time employees accrual of 

vacation and/or sick days on a reduced schedule. 

While most private sector employees are provided some form of paid leave, many 

employers don’t differentiate between various types of leave. There is evidence of a 

growing trend by employers to provide general paid time off (PTO) plans that allow 

employees to use their leave in the way that best fit their needs. A flexible PTO 

policy supports and encourages employees to stay home when they are sick or to 

take care of ill family members. These systems also protect employees’ privacy as 

employees often do not have to disclose to their employers the reasons why they are 

requesting time off. 

In particular, over one-quarter of manufacturers use such a policy, and that number is growing. Employers require the flexibility to continue to provide their employees with the benefits and paid leave models that best fit the needs of their individual businesses and workforces. 

Employer Response to the H1N1 Outbreak 

Just as many families across the country are taking steps to protect against the 

further spread of the H1N1 flu, many employers also have developed or are in the 

process of developing continuity plans to proactively mitigate the spread of H1N1 

in the workplace. These plans seek to ensure that businesses can function during 

this national emergency while addressing the needs of their employees. 

Examples of these responses include: telecommuting, job sharing, waiving notice 

requirements, absence forgiveness and paid time off for the employee’s own illness 

or to care for ill family members. 
20 

Mandating paid sick leave policies will create a new baseline structure from which 

all employers with over 15 employees will be required to re-write their many types 

of ‘‘pay when not working’’ policies. I believe that starting over from that mandated 

foundation and its rigid terms will discourage the kinds of innovative and additive 

benefits we see employers spontaneously creating during this pandemic. 

I have recently asked our members in North Carolina what specific steps that 

they are taking. I have heard a wide variety of responses from many members, including: 

Paying for vaccines to be administered at job sites; 

Advising employees to stay home if they are displaying flu-like symptoms without 

any disciplinary actions or having the leave count against them; 

Allowing employees to make up for the missed hours with additional shifts; 

Allowing them to work from home with greatly reduced responsibilities; 

Enabling employees to advance sick days forward; and 

Allowing employees additional paid time off to take care of ill family members. 

While some employers may not have taken specific action in response to the H1N1 

outbreak, these employers are clearly the exception to the widespread practices taking place today. These types of creative approaches are the result of flexibility that 

employers have to develop policies that best fit their workforce needs. Any proposal 

that mandates the type of leave that employers must provide will ultimately threaten overall levels and types of responses employers are engaged in. 

Congressional Proposals 

There has been much discussion of paid leave proposals in light of this outbreak. 

However, it’s important that Congressional activity not threaten employers’ ability 

to creatively design programs that meet the unique needs and constraints of their 

workforce. 

Federal paid leave policy should encourage employers to provide paid sick leave 

rather than impose restrictive, one-size-fits-all mandates. Such requirements applied to the broad, diverse industries that make up our nation’s economy negatively 

impact all employers, especially small businesses, and limit our ability to retain and 

create new jobs. 

Many of the proposals introduced, such as the Healthy Families Act, are overly 

burdensome because they apply to the smallest of employers. Under the Healthy 

Families Act proposal—employers of all sizes would be subject to the same restrictive leave mandate that includes both part-time and full-time employees. This would 

be on top of or in addition to requirements in place in several states and municipalities. Congress has previously recognized the disproportionate impact leave mandates 

have on small employers in related employment statutes like the Family Medical 

Leave Act. Federal legislation should continue to reflect these principles. 

In many ways, such mandate proposals would actually hinder current efforts by 

employers. Specifically, the Emergency Influenza Containment Act would place requirements on employers without comprehensive guidance from the Department of 

Labor on how to implement them. 

Additionally, the language of this proposal creates a leave entitlement to employees directed, instructed or advised by their employer to not come into work or to 

leave work if they are displaying contagious symptoms. This overly broad definition 

will make effective implementation by employers difficult. In many workplaces, it 

may also discourage employers from sending employees home. We have several 

questions about how this bill would be implemented: 

• The bill states that paid leave should be provided to employees who are directed 

by their employer to come into work. However—how should ‘‘directed’’ be interpreted? Employers could have a range of conversations or contacts with their employees, which might or might not rise to the level of a ‘‘direction’’. 

• Who is the employer? What if a lower level supervisor says something that is 

later revoked by someone with more authority? 

• What does it mean to have the employer ‘‘believe the employee has symptoms 

of a contagious illness?’’ Is one sneeze enough for them to form this conclusion? Employers are typically not medical professionals able to make this determination. 

• How is an employer to protect the rights of employees’ privacy with regard to 

their determination if an employee has been in close contact with an individual who 

has such symptoms? 

• Under this bill—an employer can terminate the paid leave if he or she ‘‘believes 

the employee * * * has symptoms of a contagious illness or poses a threat of contagion to other employees or to the public.’’ How would an employer formulate this 

belief if the employee isn’t present in the workplace? 

• This bill would take effect 15 days after enactment without any implementation 

regulations or timeliness for when guidance from the federal government will be 
21 

provided. How are employers expected to meet this bill’s requirements without appropriate regulations in place? 

• This bill attempts to provide a safe harbor for employers who either do not employ 15 or more employees or already meet its conditions. (See Sec. 10 (3) (A), (B).) 

How would employers provide PTO plans, where an employee has paid leave provided without specifying the reason for being treated? Such plans are becoming very 

popular as they relieve employers of the need to track multiple kinds of leave and 

the reasons for the leave and typically allow employees to receive the paid leave in 

compensation when they terminate employment. 

Would employers get credit only for offering a traditional paid sick leave style 

plan? 

What happens if an employee is provided leave but has exhausted it by the time 

he or she needs to be out under this bill? 

How should part-time employees be treated with respect to whether an employer 

employs 15 or more employees? 

What if the company uses an employee agency? How should those employees be 

counted? 

The language of Section (B) says that for an employer policy to qualify, it must 

not only provide five days of paid sick leave per 12 month period, but that this leave 

‘‘may be used at the employee’s discretion.’’ Such a requirement would disqualify 

many employer leave policies that would otherwise satisfy this safe harbor as employers frequently include a provision that leave be subject to notification, scheduling, or other requirements. Would such requirements disqualify a leave policy 

from satisfying this safe harbor? 

These proposals lack the necessary clarity for employers to effectively implement 

and would limit the flexibility employers have to address their workforce needs. 

Further, these current proposals do not recognize employers that are already providing generous levels of paid leave from any mandated leave requirements. Specifically, they will require employers that provide generous leave benefits through a 

PTO system to add additional leave on top of their existing benefit mix—thus adding costs. 

If employers are required to carve out 3 percent of overall payroll dollars for a 

specific benefit to be used under specific conditions with specific rollover provisions 

and penalties for violations, they will do so as a group but by reducing expenditures 

on other pay and benefits. The problems with benefit substitution are most acute 

in employers that utilize general PTO policies which typically combine vacation/sick/ 

personal days into one bank of time and allow use for any of those purposes. If employers are mandated to provide a certain level of a specific leave benefit—they 

must decide whether to add that on top of existing employer leave policies or to reduce the existing in order to meet the new mandate. 

A mandate would be a strong disincentive for employers to utilize PTO programs. 

Under such a system, they could no longer control the terms of use and accrual on 

the newly mandated days of paid sick time. Employers would either have to carve 

out separate leave to meet the definitions of the new mandate or have to convert 

their entire PTO system to be subject to the same procedural rules as the new mandate. 

As our economy begins to recover from the most severe recession since the Great 

Depression, businesses need to maintain flexibility in order to survive, grow and 

provide jobs in the face of ongoing challenges, including the potential impact of contagious illnesses such as H1N1. 

Conclusion 

During this public health crisis and challenging economic times, I strongly caution 

against Congress rushing legislation that doesn’t recognize and protect efforts currently underway by employers and hinders existing response and job creation efforts. Employers are in the best position to understand the needs of their workforce. 

Employers have serious concerns with many aspects of the paid leave proposals 

as currently drafted. However, I look forward to working with the Committee to 

meet our shared goal of maintaining a healthy and productive workforce while ensuring the job retention and job creation that will assist economic recovery efforts. 

Thank you for the opportunity to testify before the Committee, and I welcome 

your questions. 

Chairman MILLER. Ms. Ness? 
22 

STATEMENT OF DEBRA L. NESS, PRESIDENT, NATIONAL 

PARTNERSHIP FOR WOMEN AND FAMILIES 

Ms. NESS. Good morning, Chairman Miller, Ranking Member 

Kline, members of the committee and fellow panelists. 

The National Partnership for Women and Families is a nonprofit, 

nonpartisan advocacy group that has been working on issues important to women and families for almost four decades. I thank you 

for inviting me to testify in support of this legislation that workers 

urgently need during this national H1N1 emergency. 

And, Mr. Chairman, a special thank you to you for all you have 

done to shine a spotlight on this issue. 

The National Partnership leads a very broad-based coalition in 

support of paid sick days. I am testifying today on behalf of the 

millions of people represented by civil rights, women’s, children’s, 

anti-poverty, disability, labor, health and faith-based communities. 

We all urge you to move quickly to pass legislation that guarantees 

working people paid, job protected time off from work to recover 

from their own illness or to care for a sick child or family member, 

especially during this H1N1 epidemic. 

It is a travesty that millions of hard-working people in this country have no paid sick days. Almost half of private-sector workers 

and four in five low-wage workers, most of them women, don’t have 

a single paid sick day. And especially now, when H1N1 has infected millions, our failure to provide a minimum standard of paid 

sick days is taking a terrible toll. 

Over the past few months, experts and public officials from the 

CDC to the president have been telling us to stay home and keeps 

sick children home to prevent the spread of the virus. That is great 

advice, but unfortunately, millions of workers simply cannot take 

that advice. For them, staying home means risking their paychecks 

and even their jobs. 

So what is responsible? What is doing the right thing when staying home means risking that paycheck that your family depends 

on? 

People who provide care for family members face even greater 

challenges. We know that the H1N1 virus attack rate among children and youth is especially high. Many of them need a parent to 

care for them when they get sick. And that is why the lack of paid 

sick days is particularly challenging for working women who have 

primary responsibility for child care as well as elder care. 

Our failure to guarantee paid sick days also is particularly hard 

on low-income people and those in communities of color, who tend 

to hold the low-wage, no benefit jobs. The Boston Public Health 

Commission recently reported that the incidence of H1N1 is much 

higher for African-Americans and Latinos in that city. Without 

paid sick days and the ability to stay home or get care, the disease 

spreads more rapidly and people get sicker. 

The lack of paid sick days is also putting our public health at 

risk. Only 22 percent of food service and public accommodation 

workers have paid sick days. Workers in child care centers and 

nursing homes disproportionately lack paid sick days. They are 

forced to work when they are sick, and in so doing they put their 

co-workers, those they care for, and the public at risk. 
23 

And while the need for paid sick days is particularly compelling 

during this H1N1 emergency, the reality is that working families 

struggled without paid sick days prior to this emergency, and they 

will continue to struggle unless and until Congress acts. Every year 

seasonal flu and other illnesses strike millions of us, and every 

year our failure to let workers earn paid sick days puts the economic security of families at risk. And the recession we are in exacerbates the problem. 

I certainly don’t need to tell you how many families that once relied on two incomes are now managing on one or none. In a survey 

last month, five out of six workers said the recession was creating 

more pressure to show up for work, even when they are sick. 

Mr. Chairman and members of the committee, we need a minimum standard of paid sick days so that taking time off for the flu 

or any other illness does not lead to financial disaster. 

Finally, I would like to end with the point that paid sick days 

are also good for business and our economy. Today Stanford University Press is releasing a book called ‘‘Raising the Global Floor,’’ 

a book by Jody Heymann that reports on an 8-year study examining the impact of paid sick days, paid family leave, breast-feeding 

and other family-friendly policies around the world. 

It concludes that nations that guarantee leave to care for personal or family health needs are actually ranked highest in terms 

of economic competitiveness. And I would be happy to provide copies of that book for every member of this committee. 

The research confirms that when businesses take care of their 

workers, they are better able to retain them. And when workers 

have paid time off, their commitment, their productivity and their 

morale increases. Employers reap the benefit of lower turnover in 

training cost. 

The cost of losing an employee is often much greater than the 

cost of providing short-term leave to retain an employee. And in 

this economy and during this health emergency, smart businesses 

know that they can’t afford presenteeism, workers who go to work 

sick and get other people sick and cause more absenteeism. 

Presenteeism costs our national economy $180 billion annually 

more than absenteeism. 

So like the minimum wage, our nation needs a basic federal 

labor standard of paid sick days that protect all employees, is paid, 

is job protected, is accessible to workers at their discretion, and is 

available to care for a sick child or parent. I urge you to pass the 

Healthy Families Act quickly. And I thank you for this opportunity 

to testify. 

[The statement of Ms. Ness follows:] 

Prepared Statement of Debra L. Ness, President, National Partnership for 

Women and Families 

Good morning Chairman Miller, Ranking Member Kline, members of the Committee and my distinguished fellow panelists. Thank you for inviting us to talk 

about the policies our nation’s workers urgently need during this H1N1 flu emergency. Chairman Miller, you’ve been a consistent champion on a broad range of 

issues that support working families, including paid sick days. Your leadership during this national H1N1 emergency has caused media and the public to acknowledge 

the connection between giving workers the chance to earn paid sick days and stopping the spread of H1N1. 
24 

I am Debra Ness, President of the National Partnership for Women & Families, 

a non-profit, non-partisan advocacy group dedicated to promoting fairness in the 

workplace, access to quality health care, and policies that help workers meet the 

dual demands of work and family. I am here to testify on behalf of a broad coalition 

of 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. They include 9to5, MomsRising.org, the Leadership Conference on Civil Rights, the AFL-CIO and SEIU, the Family Values @ Work Consortium, the National Organization for Women and dozens of other organizations. Together, we urge Congress to quickly pass legislation that guarantees working people 

paid, job-protected time off from work to recover from illness and to care for a sick 

child or family member—especially during this national H1N1 flu emergency. 

Workers Need Paid Sick Days During this H1N1 Flu Emergency 

In recent months, much attention has focused on the H1N1 virus and the best 

ways to contain it—and with good reason. H1N1 is a novel flu virus that experts 

predict may result in many more illnesses, hospitalizations and deaths this year 

than would be expected in a typical flu season.1 Forty-eight states had ‘‘widespread 

flu activity’’ as of Oct. 31, according to the Centers for Disease Control and Prevention (CDC).2 The CDC recorded nearly 18,000 hospitalizations and nearly 700 

deaths related to H1N1 flu between Aug. 30 and Oct. 31.3 The virus is now so widespread that the CDC and World Health Organization are no longer keeping track 

of the number of individual cases. Officials estimate that if 30 percent of the population contract the virus, it could mean approximately 90 million people in the U.S. 

could become ill, 1.8 million may need to be hospitalized, and approximately 30,000 

could die.4 As a result, President Barack Obama declared the H1N1 flu outbreak 

a national emergency, allowing hospitals and local governments to quickly set up 

alternate sites for treatment and triage procedures, if needed, to handle any surge 

of patients.5

Week after week, government officials urge sick workers to stay home and keep 

sick children at home to prevent the spread of the H1N1 virus. Commerce Secretary 

Gary Locke said that ‘‘if an employee stays home sick, it’s not only the best thing 

for that employee’s health, but also his coworkers and the productivity of the company.’’ 6 Health and Human Services Secretary Kathleen Sebelius said that ‘‘one of 

the most important things that employers can do is to make sure their human resources and leave policies are flexible and follow public health guidance.’’ 7

The CDC has also issued recommendations: ‘‘People with influenza-like illness 

[must] remain at home until at least 24 hours after they are free of fever * * * 

without the use of fever-reducing medications.’’8 In addition to the guidance for 

workers, officials have stated that schools and child care providers will need to rely 

on parents to keep children at home if they are feverish.9 This is excellent advice, 

as far as it goes, but unfortunately, taking this advice isn’t an option for millions 

of workers. They may want to do the right thing and do all they can to prevent the 

spread of the H1N1 virus. But for many, doing their part means risking their paychecks and even their jobs, because they lack job-protected paid sick days. 

Working people need paid time off from their jobs to recover from the H1N1 flu 

and care for sick family members—and prevent further spread of the virus. Yet, the 

reality is that nearly half (48 percent) of private-sector workers lack paid sick 

days.10 The same is true for nearly four in five low wage workers—the majority of 

whom are women.11 Women also are disproportionately likely to lack paid sick days 

because they are more likely than men to work part-time, or to cobble together an 

income by holding more than one part-time position. Only 16 percent of part-time 

workers have paid sick days, compared to 60 percent of full-time workers.12

Especially during this epidemic, workers with caregiving responsibilities in particular have an urgent need for paid sick days. The highest H1N1 virus attack rate 

is among 5-to 24-year olds, many of whom need to stay home from school when 

sick—often with a parent to care for them.13 That’s why the lack of paid sick days 

is particularly challenging for working women—the very people who have primary 

responsibility for most family caregiving. In fact, almost half of working mothers report that they must miss work when a child is sick. Of these mothers, 49 percent 

do not get paid when they miss work to care for a sick child.14

Our Failure to Establish a Paid-Sick-Days Standard is Putting the Public Health 

at Risk During the H1N1 Emergency 

Our nation’s failure to provide a minimum standard of paid sick days is putting 

our public health at risk. Many of the workers who interact with the public every 

day are without paid sick days. Only 22 percent of food and public accommodation 

workers have any paid sick days, for example. Workers in child care centers and 
25 

nursing homes, and retail clerks disproportionately lack paid sick days.15 Because 

the lack of paid sick days forces employees to work when they are ill, their coworkers and the general public are at risk of contagion. 

Research released this year by Human Impact Partners, a non-profit project of the 

Tides Center, and the San Francisco Department of Public Health, found that providing paid sick days to workers will significantly improve the nation’s health. This 

groundbreaking study found that guaranteeing paid sick days would reduce the 

spread of pandemic and seasonal flu. More than two-thirds of flu cases are transmitted in schools and workplaces. Staying home when infected could reduce by 15 

to 34 percent the proportion of people impacted by pandemic influenza. 

The Human Impact Partners analysis also found that if all workers had paid sick 

days, they would be less likely to spread food-borne disease in restaurants and the 

number of outbreaks of gastrointestinal disease in nursing homes would reduce. The 

researchers provided evidence that paid sick days may be linked to less severe illness and shorter disability due to sickness, because workers with paid sick days are 

14 percent more likely to visit a medical practitioner each year, which can translate 

into fewer severe illnesses and hospitalizations. They also found that parents with 

paid time off are more than five times more likely to provide care for their sick children. 

Recent data on the impact of the H1N1 virus in Boston, Mass. shows that the 

outbreak has hit certain mostly low-income communities harder than other communities. The Boston Public Health Commission reported that more than three in four 

Bostonians who were hospitalized because of H1N1 were black or Hispanic.16 Boston’s experience is not unique. Communities of color all across the country face similar health disparities and they may be due, in part, to the fact that low-wage workers are less likely to have paid sick days. 

Beyond the H1N1 Emergency 

While the need for paid sick days may seem particularly compelling during the 

H1N1 emergency, the reality is that working families struggled without paid sick 

days prior to this emergency, and they will continue to struggle after this emergency 

unless Congress takes action. Paid sick days aren’t just about protecting the public’s 

health—they are also about protecting the economic security of millions of workers 

and their families. One in six workers report that they or a family member have 

been fired, suspended, punished or threatened with being fired for taking time off 

due to personal illness or to care for a sick relative, according to a 2008 University 

of Chicago survey commissioned by the Public Welfare Foundation. To put a face 

on some of those statistics, I’d like to share with you a few stories from working 

people: 

• Heather from Cedar Crest, New Mexico told us: ‘‘In October, I got very sick with 

diverticulitis. My doctor put me on bed rest for two weeks. While I was out, my boss 

hounded me to come back, but I was way too sick. I told him I would be back as 

soon as I could. I was not receiving sick pay at all. When I did go back to work 

early, he fired me and told me he needed someone he could count on. I worked for 

this man for two years. I was shocked. Sometimes things happen and you get sick. 

How are you to foresee these things?’’ 

• Noel from Bellingham, Washington wrote to us: ‘‘I had to work while having 

bouts of awful bronchitis and walking pneumonia. I got no time off at all even when 

I was in severe pain, coughing up phlegm or vomiting. Instead I had to act like I 

wasn’t sick, and keep up the same standards and smiling face. * * * I couldn’t take 

unpaid days off from work because I couldn’t afford to do that. I needed the money 

to pay for things like rent and food. When my quality of work suffered substantially 

from having to go to work while so sick, I was fired from my job because according 

to my then-supervisor, I did not create a happy environment for the customers.’’ 

The H1N1 outbreak has come during a painful recession, and both have exacerbated the need for paid sick days. I don’t need to tell you that the economic crisis 

has been devastating for working families. More than 11.6 million workers have lost 

their jobs, and millions more are underemployed. In October, the unemployment 

rate was 10.2 percent—the highest level since December 1983. The unemployment 

rate for African Americans was 15.7 percent, the rate for Hispanics was 13.1 percent, and the rate for whites was 9.5 percent in October 2009.17 For many families 

that once relied on two incomes, this crisis has meant managing on one income or 

no income at all. As a result, families are not only losing their economic stability, 

but their homes: one in nine mortgages is delinquent or in foreclosure.18

Five out of six workers (84 percent) say the recession and the scarcity of jobs are 

creating more pressure to show up for work, even when they are sick.19 Workers 

are understandably anxious about their job security, and many are unable to take 

any risk that might jeopardize their employment—even if they are stricken with 
26 

H1N1. Especially now, when so many workers are suffering terribly, we must put 

in place a minimum labor standard so taking time off for illness doesn’t lead to financial disaster. Workers have always gotten sick and always needed to care for 

children, family members and older relatives—and they have always managed to be 

productive, responsible employees. But without a basic labor standard of paid sick 

days, families’ economic security can be at grave risk when illness strikes. 

In addition, as our population ages, more workers are providing care for elderly 

parents. When working people have to take unpaid time off to care for a parent, 

spouse or sibling, they face often-terrible financial hardship. More than 34 million 

caregivers provide assistance at the weekly equivalent of a part-time job (more than 

21 hours per week), and the estimated economic value of this support is roughly 

equal to $375 billion 20—a huge contribution to the health and well-being of their 

families. Caregivers contribute more than time; 98 percent reported spending on average $5,531 a year, or one-tenth of their salary, for out-of-pocket expenses.21 Yet, 

many lose wages each time they must do something as simple as taking a family 

member to the doctor. 

Businesses Benefit from Paid Sick Days Policies 

Research confirms what working families and responsible employers already 

know: when businesses take care of their workers, they are better able to retain 

them, and when workers have the security of paid time off, their commitment, productivity and morale increases, and employers reap the benefits of lower turnover 

and training costs. Furthermore, studies show that the costs of losing an employee 

(advertising for, interviewing and training a replacement) is often much greater 

than the cost of providing short-term leave to retain existing employees. The average cost of turnover is 25 percent of an employee’s total annual compensation.22

As mentioned previously, paid sick days policies also help reduce the spread of 

illness in workplaces, schools and child care facilities. In this economy, and during 

this time of a national health emergency, businesses cannot afford ‘‘presenteeism,’’ 

which occurs when, rather than staying at home, sick employees come to work and 

infect their co-workers, lowering the overall productivity of the workplace. 

‘‘Presenteeism’’ costs our national economy $180 billion annually in lost productivity. For employers, this costs an average of $255 per employee per year and exceeds the cost of absenteeism.23 In addition, paid sick days policies help level the 

playing field and make it easier for businesses to compete for the best workers. 

Already, many savvy employers have responded to the H1N1 outbreak by expanding or improving their paid sick days policies. For example, Medtronic Inc. has reacted by granting all its employees, including hourly workers, three additional paid 

sick days. Best Buy has instructed its managers to send employees home if they arrive at work sick, and to pay them for the remainder of the day, even if they do 

not have any sick time.24 Texas Instruments, Inc. has relaxed its sick days policy, 

allowing workers to take as many days as they need to recover, by granting them 

the option of borrowing against future leave.25 These businesses and many others 

know that it is in their best interest to make sure that they do not have masses 

of sick workers on the job. They know that paid sick days must be part of their operating plans if they are going to keep their doors open and their businesses thriving 

during these difficult economic times when H1N1 flu is spreading. 

The Nation Needs Policies that Allow Workers to Meet their Job and Family Responsibilities 

Our nation has a proud history of passing laws that help workers in times of economic crisis. Social Security and Unemployment Insurance became law in 1935; the 

Fair Labor Standards Act and the National Labor Relations Act became law in 

1938, all in response to the crisis the nation faced during the Great Depression. 

Working people should not have to risk their financial health when they do what 

all of us agree is the right thing—take a few days to recover from contagious illness, 

or care for a family member who needs them. Now is the time to protect our communities and put family values to work by adopting policies that guarantee a basic 

workplace standard of paid sick days. 

At present, no state requires private employers to provide paid sick days. The cities of San Francisco, the District of Columbia and Milwaukee have passed ordinances requiring that private employers provide paid sick days. This year, more 

than 15 cities and states have considered paid sick days laws to ensure that this 

basic labor standard becomes a right for all workers. This is a national movement 

now, and we expect it to expand to more than 25 campaigns next year. But illness 

knows no geographic boundaries, and access to paid sick days should not depend 

on where you happen to work. That’s why a federal paid sick days standard is so 

badly needed. 
27 

Like the minimum wage, there should be a federal minimum standard of paid sick 

days that protects all employees, with states and individual employers given the 

freedom to go above the federal standard as needed to address particular needs of 

their residents or workers. 

Working people need a basic labor standard of sick time that is: 

• Paid; 

• Job protected; 

• Accessible to workers at their discretion (by notifying the employer verbally or 

in writing); 

• Available for workers to use to care for themselves or a child or parent; and 

• Up to seven days (or 56 working hours). 

These key principles are included in the Healthy Families Act. The legislation 

guarantees workers the right to determine whether they need to take a paid sick 

day, provides strong job protections, and lets workers take paid time off to care for 

a sick child or parent. 

These core principles are supported not only by advocates, but also by members 

of the House of Representatives and the Senate. They are reflected not only in the 

Healthy Families Act, but in proposed legislation in more than a dozen states, including California. 

These core principles may never be more important than they are during this national H1N1 emergency. To that end, we support emergency legislation for the duration of the H1N1 epidemic that contains these core principles and addresses the 

unique circumstance of this H1N1 emergency. 

Because of the dangers posed by H1N1 and its ability to spread quickly in a community, in addition to the principles outlined above, we would support legislation 

to fully protect workers and the public health by: 

• Enabling workers to take paid sick time during closure of a workplace or a 

child’s school or care facility due to a contagious illness; 

• Covering all sizes of employers and all types of employees, so that no workplace 

or worker is left vulnerable to the H1N1 virus; and 

• Establishing a Dept. of Labor and Dept. of Health and Human Services toll-free 

telephone call center and website to enable workers to report violations, which the 

government would investigate and resolve, working with the employer. 

Such emergency legislation would be effective immediately upon passage, and it 

would sunset in two years. 

Congress should waste no time in passing paid sick days legislation so that working people can earn paid time off and help prevent the spread of illnesses, without 

jeopardizing their economic security. This year’s public health crisis is the H1N1 

virus but, in reality, millions of working people face the heart-wrenching decision 

of whether to send a feverish child to school and collect a paycheck, or stay home 

with her and lose pay. Or they must choose whether to go to work sick and get paid, 

or stay home to recover and fall behind on the rent. 

Chairman Miller and members of the Committee, I thank you for the opportunity 

to participate in this important discussion, and we look forward to working with you 

to ensure that America’s workers have a basic right of paid sick days. We sincerely 

appreciate your efforts in recent weeks to highlight this critical issue. Like you, we 

share the desire to promptly pass both emergency and long-term, permanent legislation that will protect the public health and is feasible for both employers and workers. And we look forward to working with you. 

ENDNOTES

1 U.S. Dept. of Health and Human Services, ‘‘About the Flu,’’ http://pandemicflu.gov/ 

individualfamily/about/index.html 2 Centers for Disease Control and Prevention, 2009-2010 Influenza Season Week 42 ending 

October 24, 2009, http://www.cdc.gov/flu/weekly/ 3 CDC, 2009 H1N1 Flu U.S. Situation Update, 10/2/09, http://www.cdc.gov/h1n1flu/updates/ 

us/. 4The President’s Council of Advisors on Science and Technology. ‘‘Report to the President on 

U.S. Preparations for 2009—H1N1 Influenza’’, 8/7/09, www.whitehouse.gov/assets/documents/ 

PCAST—H1N1—Report.pdf 5 New York Times, ‘‘Obama Declares Swine Flu a National Emergency’’, www.nytimes.com/ 

aponline/2009/10/24/health/AP-US-ObamaSwineFlu.html?scp=3&sq=obama%20national%20emergency%20swine%20flu&st=cse, 10/24/09. 6 Associated Press, ‘‘Government enlists employers’ help to contain flu,’’ 8/19/09. 

7 HHS News Release, 8/19/09, www.hhs.gov/news/press/2009pres/08/20090819a.html 

8 CDC, Recommendations for the Amount of Time Persons with Influenza-Like Illness Should 

be Away, www.cdc.gov/h1n1flu/guidance/exclusion.htm 9 Center for Infectious Disease Research & Policy, Univ. of Minn., www.cidrap.umn.edu/ 

cidrap/content/influenza/swineflu/news/aug0709schools3.html 
28 

10 Vicky Lovell, Institute for Women’s Policy Research, Women and Paid Sick Days: Crucial 

for Family Well-Being, 2007. 11 Economic Policy Institute, Minimum Wage Issue Guide, 2007, www.epi.org/content.cfm/ 

issueguides—minwage. 12 Vicky Lovell, Institute for Women’s Policy Research, No Time to be Sick, 2004. 13 CDC, Novel H1N1 Flu: Facts and Figures, www.cdc.gov/h1n1flu/surveillanceqa.htm. 14Kaiser Family Foundation, ‘‘Women, Work and Family Health: A Balancing Act,’’ Issue 

Brief, April 2003. 15 Vicky Lovell, Institute for Women’s Policy Research, No Time to be Sick, 2004. 16 Cases of swine flu higher among city blacks, Hispanics, Stephen Smith, Globe Staff, August 

18, 2009, http://www.boston.com/news/local/massachusetts/articles/2009/08/18/cases—of— 

swine—flu—higher—among—bostons—blacks—hispanics?mode=PF 17 U.S. Bureau of Labor Statistics, Economic News Release, Employment Situation Summary, 

Nov. 6, 2009, http://data.bls.gov/cgibin/print.pl/news.release/empsit.nr0.htm 18 Center for American Progress, www.americanprogress.org/issues/2009/03/econ—snapshot— 

0309.html, March 2009 19 Angus Reid Strategies for Mansfield Communications online survey of 1,028 workers, conducted 9/10—9/12/09. Margin of error: +/¥3.1% points. 20 Ari Houser and Mary Jo Gibson, AARP Public Policy Institute, ‘‘Valuing the Invaluable: The 

Economic Value of Family Caregiving, 2008 Update.’’ 21 Jane Gross, ‘‘Study Finds Higher Costs for Caregivers of Elderly,’’ New York Times, 11/19/ 

07. 22 Employment Policy Foundation 2002. ‘‘Employee Turnover—A Critical Human Resource 

Benchmark.’’ HR Benchmarks (December 3): 1-5. 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. 24 Next test: Flu 101, Suzanne Ziegler, Minneapolis Star Tribune, September 23, 2009 

www.startribune.com/lifestyle/health/60463767.html?elr=KArksi8cyaiUo8cyaiUiD3aPc:— 

Yyc:aUU 25Sick Time: Employers Gear Up for Swine Flu, Betsy McKay and Dana Mattioli, Wall Street 

Journal, November 2, 2009 

http://online.wsj.com/article/SB20001424052748704746304574508110025260366.html 

Chairman MILLER. Thank you. 

Thank you very much, all of you, for your testimony. As you can 

see, there is a fair amount of interest on the committee, so we are 

going to have to be brief here, but we will try to give everybody 

an opportunity to ask questions. 

Dr. Schuchat and Dr. Benjamin, I have been looking at this legislation. As we drafted this legislation, the idea is that when we look 

at school policies, it seems to be—and workplace policies—you are 

trying to provide some circuit breaker within that space to stop the 

H1N1 from spreading. I mean is that what we are trying to do 

when we close the school or we try to get parents to keep their kids 

at home or have workers go home—that is the purpose, the public 

health purpose here? 

Dr. Schuchat. You know, there is a direct benefit for people in 

an office slowing the spread. I think we learned from the spring 

that closing schools for a week was extremely disruptive to communities and society and the children. 

And with a focus on keeping ill people out of the schools or out 

of the workplace, it was a much less disruptive approach, but important to reduce the spread to others and give people time to heal. 

But we knew that keeping kids home, even for that 3 to 5 days 

that might be necessary meant a parent often needed to stay home 

with them and had a ripple effect. 

Chairman MILLER. So a school policy is a little bit dependent 

upon the parental policy at the workplace. 

Dr. Schuchat. Yes, absolutely. 

Chairman MILLER. Yes. Yes. 

Dr. Benjamin? 

Dr. Benjamin. Yes, I would agree with that. They are really 

interdependent. And, you know, we know clearly that you can slow 
29 

the spread of the disease, lots of models that have shown that. But 

if you think about it, it is kind of common sense as well. 

Chairman MILLER. Mr. Clarke, let me ask you something. For 

the somewhere around 40 to 60 million people who don’t have paid 

leave policy, your concern is that for your employers, who may 

have a comparable policy, that they be allowed to use that comparable policy in place of this, whether it is called paid sick leave 

or paid time off or whatever combination that is, that you don’t 

want to see this as additive to that? You want to see this if an employer gives you 7 days of paid time off or 10 days of paid time off, 

you could use that. If they allow you to borrow from the future, you 

could do that. You want to stay within those policies that your employers have. Is that correct? 

Mr. CLARKE. Well, primarily, yes, on the paid time off argument—— 

Chairman MILLER. Whether we—yes. 

Mr. CLARKE. Yes. And the issue with paid time off is there is no 

day in that bucket called ‘‘sick days.’’ 

Chairman MILLER. No, I understand that. 

Mr. CLARKE. Right. 

Chairman MILLER. So you want that—I am not asking you to endorse the policy. I am not stretching here too far. 

Mr. CLARKE. Okay. 

Chairman MILLER. You would ask that that be made compatible, 

that that currently, I assume, under the theory of paid time off is 

that the employee can choose the purposes for which they want to 

use that that time—in theory, right? 

Mr. CLARKE. Yes. 

Chairman MILLER. So you don’t want to label those times or lay 

on top of that additional days. 

Mr. CLARKE. That is true. 

Chairman MILLER. What do we do for the people that there is no 

policy? 

Mr. CLARKE. Well, I agree with that first point that, you are 

right, we want these to coordinate well and not overlap, and, sir, 

on the issues with the two bills that are at issue here today is that 

the safe harbor provisions do not accomplish that. 

Chairman MILLER. Okay. 

Mr. CLARKE. So there is a serious issue with that there. 

On your other point, the numbers that are bandied around we 

certainly don’t accept. We don’t believe they are supported by numbers that we collect ourselves. 

Chairman MILLER. I know, but the Bureau of Labor Statistics 

collects these, and they are used by all the other organizations. 

Mr. CLARKE. Exactly. The—— 

Chairman MILLER. I mean you are taking information in North 

Carolina. 

Mr. CLARKE. Well, the reason we don’t accept the numbers are 

that those—and I have looked at these studies—often they very 

narrowly define paid leave. They won’t get credit for time off unless 

it is called paid sick leave. That is going to take a PTO account 

that has no day called paid sick leave and put them in the category 

of no sick days provided. Those sorts of issues exaggerate the problem. I am not saying there is no problem. 
30 

Chairman MILLER. Let me just—I got to move, because my colleagues are going to beat me up here. 

Ms. NESS, on this question of if you have a paid time off policy 

of X number of days, do you have a problem with this being compatible with that or that being safe harbored? 

Ms. NESS. No, the Healthy Families Act is crafted so that if a 

work—— 

Chairman MILLER. Right. 

Ms. NESS [continuing]. If the workplace or employer already has 

in place a policy that would allow people to use 7 days as paid sick 

days, that would be acceptable. They would not have to change 

their policy. 

Chairman MILLER. Okay. And then what do we do with those 

who don’t have that policy? 

Ms. NESS. Well, that is why we need the Healthy Families Act. 

And, if anything, I think those Bureau of Labor Statistics numbers 

actually underestimate the number of folks who lack paid sick 

days, because they often count in those numbers folks who are on 

the job and the employer generally provides paid sick days, but 

there are job tenure requirements that prevent people from being 

able to use paid sick days for periods of months, or up to a year 

in some cases. 

Chairman MILLER. They may exclude part-time workers in that 

policy or it may exclude—— 

Ms. NESS. Part-time workers—— 

Chairman MILLER [continuing]. One level of workers and not others? 

Ms. NESS. Part-time workers are the least likely to have paid 

sick days. I think the number is something like 15 percent of parttime workers have paid sick days. 

Chairman MILLER. Thank you. 

Mrs. McMorris Rodgers? 

Mrs. MCMORRIS RODGERS. Good morning, everyone. 

And I want to thank the chairman and the ranking member for 

holding this hearing. 

I also want to thank all of our witnesses for being here. 

I just wanted to make a few observations before I get to my question. Over the last several months we have heard a great deal 

about the H1N1 pandemic, from the shortage of vaccines to more 

than 22 million individuals affected by the disease, 90 percent of 

whom are under the age of 65. 

As a mom, there is not an issue that is more important to me 

than ensuring that my son is healthy, but the statistics also revealed the potential for serious strains on our nation’s businesses. 

It strains employers and employees alike. And for the most part, 

businesses have been one step ahead, implementing policies that 

promote healthy work environments, such as telecommuting, job 

sharing, paid time off. In fact, according to the Department of 

Labor, 83 percent of businesses in the private sector offer their employees access to paid leave, which can be used for illness or injury 

or situations such as H1N1 flu. 

Despite these innovations, several bills have been introduced to 

respond to the emergency, including more mandates on small businesses. In a stagnant economy with unemployment at its highest 
31 

level since 1983 and productivity inching along, we need to ensure 

that the response provides the flexibility that employers and employees need, flexibility that ensures employees can take care of 

themselves and their families and flexibility that allows businesses 

to remain productive. 

With this in mind, I would like each of the witnesses to comment. What does mandated paid sick leave offer share what I that 

a flexible workplace program doesn’t? Shouldn’t both employers 

and employees decide what is best for them, not Congress? 

Dr. Schuchat. As a public health expert, what our goal is is to 

make it easy for employees to do the right thing, the healthy thing 

for them and the best thing for the workplace. And so our focus has 

been to look at the evidence and determine what is the best thing. 

And we have found that staying home for 24 hours after you are 

sick with the flu, after the fever has gone, makes the most sense. 

It is a balance of making sure you are better and reducing the 

chance you are going to infect other people. And so whatever will 

make it easy for people to do the right thing is really what we are 

promoting. Thank you. 

Dr. Benjamin. I think the idea of having flexible policies is great, 

as long as there are not barriers. In other words the employee gets 

to say, ‘‘I am the one that is sick,’’ you don’t have to get permission 

to stay home, and that the processes to verify your illness are reasonable. In my job we allow people to be out for 3 days before even 

beginning to discuss whether or not they need to bring a doctor’s 

note in, for example. 

Mrs. MCMORRIS RODGERS. Okay, okay. Good. Thanks. 

Mr. CLARKE. Well, to respond to your question, I certainly come 

at this from a glass is close to full perspective, and so when I hear 

mandates and read the mandates of these two bills, I see four 

things. I see that mandates would hurt employers that have good 

and flexible benefits and hurt those employees that enjoy that flexibility, particularly in the PTO circumstance. 

I believe they hurt employees who would like to use those days 

for other purposes. I believe that it hurts small employers with 

costs that they may not be able to bear. We are talking about 3 

percent of payroll here on this seven-day mandate. 

And I believe it hurts job creation with small employers. I don’t 

think we can overlook the fact that as it gets more expensive to 

hire and to retain, you get less hiring and retention. 

Mrs. MCMORRIS RODGERS. Okay. Thank you. 

Ms. NESS. I think that policies that afford workers the flexibility 

to use the time as paid sick days are terrific, and the Healthy Families Act is drafted in a way to allow those policies to stand. 

I think the numbers, though, speak for themselves. Too many 

workers—we are talking millions of workers—don’t have that kind 

of flexibility. And I would argue that it is more costly to employers 

not to provide this leave than it is to provide it. 

And again, I am coming fresh from this event releasing this socalled ‘‘Raising the Global Floor,’’ which looked at the 190 countries 

in the world that are part of the U.N. And of those, 163 provide 

paid sick days. The U.S. is among those that don’t. Of the 15 most 

economically competitive nations in the world, the U.S. is the only 

one that does not provide paid sick days. That book, after 8 years 
32 

of research, does a very, very good job of showing that these kinds 

of policies do not negatively impact economic competitiveness or job 

creation. 

Mrs. MCMORRIS RODGERS. Well, I thank everyone for their comments. I just believe as much as we can focus on flexibility for both 

employers and employees, that it is a win-win. And we need to be 

encouraging those policies that make it possible, that will keep our 

businesses competitive and make sure that employees have a job, 

too. 

Chairman MILLER. Thank you. 

Mr. Kildee? 

Mr. KILDEE. Thank you, Mr. Chairman. 

Let me address this to the panel, and any of you may answer, 

if you can. Has there been any study on the difference in the cost 

of having the sick continue to come to work with their accompanying inefficiency and the possibility of infecting others or staying away from work while recuperating? Has there been any study 

at all indicating the financial or fiscal aspects of doing one or the 

other? 

Dr. Benjamin, do you have any comment on that? 

Dr. Benjamin. I am not aware of such a study, but I am not sure 

you can get such a study through an institution or review board. 

Mr. KILDEE. Okay. 

Dr. Benjamin. I just remind you that in a small percentage of 

cases, influenza is a fatal disease, so the cost certainly in terms of 

dollars is interesting, but the cost in terms of human terms is tragic. 

Mr. KILDEE. Right. We recognize that as more than a fiscal 

thing, but even on that alone, there might be some measurable way 

of finding whether staying at home and not infecting others or coming to work with your inefficiency and infecting others, that might 

be even a fiscal—— 

Doctor? 

Dr. Schuchat. Yes, there have been studies of the economic toll 

of influenza that have looked at, you know, the loss of work, the 

loss of productivity, the seeking medical care, and so forth. And it 

is many, many billions of dollars that is lost through the annual 

seasonal flu. A pandemic would then cause a lot more economic 

loss. So I am not thinking of a particular study that added on that 

the cost of a few days off, but certainly, the business loss of influenza substantial. 

Mr. KILDEE. This is a corollary of that. Last Saturday I went 

through the schedule of the week and saw we were having this 

hearing, and then went to Mass on Sunday. And the priest is a 

pretty good businessman, too, plus a very good priest, and he said, 

‘‘Listen, I hear sneezing and hacking and coughing out there. Let 

me say this. First of all, if you are doing that, don’t take the common cup. Don’t shake ‘‘peace be with you’’ with your neighbor after 

you, you know, sneeze into your hand. And why don’t you stay at 

home? Don’t come to Mass. Miss Mass. That is the loving thing to 

do, not to come to Mass. Stay home. No matter what they told you 

in the third grade, stay home.’’ 

So I mean we have to be realistic. There is a problem you cause 

socially when you bring your infection with you into work, and 
33 

while there are moral aspects to this also, so morally it is better 

to stay at home and miss Mass then go to Mass and spread the 

influenza, but there is, I am sure, a fiscal measure there that it 

would be interesting to study. But I will leave it at that and thank 

you very much. 

And thank you, Mr. Chairman. 

Chairman MILLER. Mr. Roe? 

Mr. ROE. Thank you. 

Just for my good friend about Mass, I usually do a cough count 

during silent prayer at church, and when it is too high, I try to get 

out of there, if I can. 

I guess I have unique perspective of all this, being a physician 

and also running a small medical practice. In our practice we do 

have personal days, which you were talking about, so our folks can 

choose whatever they want to use them for. It is not specifically labeled. And I hate to lose that flexibility. They are able to use them 

if they are ill or if they have something with their child at school 

that they want to go to or anything they want to use it for. I think 

that would be a step back. 

As Congresswoman McMorris Rodgers just said, small businesses 

are struggling right now, and what I would do to encourage—and 

just a comment from you all—to encourage small businesses is to 

look for a tax break for those that would provide that, because 

right now, if I can get up and go to my medical practice, nothing 

happened. There was no revenue produced. 

And in all due respect, Dr. Benjamin, you have a certain amount 

that is appropriated that you manage each year. In a small business they have no revenue until they produce a service or goods. 

And when those goods and services are produced, then they have 

revenue to pay out. And when they lose that, through whether it 

is illness or injury, so a business is motivated to keep healthy 

workers and to keep them on. We all know that. I mean I know 

from my own practice that I want educated, healthy people. 

And certainly as you pointed out, the turnover is very costly, 

whether it is a police department or fire department or medical office where you have to retrain people. So I think if we look at this, 

just to comment, and certainly, Mr. Clarke, you on a tax break for 

someone to encourage them to do that as opposed to a penalty. 

Mr. CLARKE. Certainly. If I was asked about alternatives to either the HFA or EICA, it would be to look at things like that. It 

would be to look at incentives for smaller employers, particularly 

those employers where the lack of paid sick time may be more percentage-wise evident that an incentive based system would be preferable. I would certainly agree with that. 

Dr. Benjamin. Let me just step and push back a little bit. Actually, you know, even though APHA is a nonprofit, we are really a 

business. We have about a $16 million revenue stream, and we 

publish the ‘‘American Journal of Public Health,’’ and we have a 

small book publishing company. 

But let me revert back to my ER doc days. When I was an emergency physician, which is how I spent most of my clinical days, if 

I didn’t work, I didn’t get paid. And we have millions of practitioners just like you. And when you are practicing, if you didn’t 
34 

have a partner, your business really came to a stop. So I personally 

have some sensitivity to the concept of not having paid sick leaves. 

Now, you know, as you know, that meant I worked more shifts 

when I came back. But many people in our country don’t have that 

option to be able to do that, and that is why I am a strong supporter of paid sick leave. 

Mr. ROE. Would you think about a tax break for small businesses 

that are struggling right now instead of another mandate to them 

to provide a benefit they don’t have the revenue for? Would you 

look at that? 

Dr. Benjamin. Well, I think that there are many innovative ways 

for Congress to figure out how to fund this and support and 

incentivize businesses, you know, to do that. You know, I am certainly not a tax expert. But if it would serve that principle—in 

other words, allow businesses to be flexible, offer the benefit, the 

real issue, as you know, is how do you pay for it? 

Mr. ROE. I think one of the—exactly—I think one of the things, 

too, is to not take that flexibility away from our employees, is that 

they are able to pick. I mean they are sick, they can stay out. You 

don’t want somebody with the flu at work and infecting everybody 

else at work. That is just common sense, as everybody knows that. 

But that person should—if they want to use their personal day 

for that or need to use their personal day for that, they can. Or if 

they need to use their personal day to be with a sick parent in a 

hospital or a child’s play at school, that is what I would like to see 

happen. 

Dr. Benjamin. I don’t think anyone is disagreeing with the flexibility issue, you know, as long as the barriers—or that the system 

is constructed in such a way that it functionally looks like sick 

leave, acts like sick leave, so that it is accessible, truly accessible 

to the employee. I don’t think anyone would disagree with you, sir. 

Mr. ROE. I want to thank the panel. 

It is an excellent panel, Mr. Chairman, you have assembled 

today. Thank you. 

Chairman MILLER. Thank you. 

Mr. Andrews? 

Mr. ANDREWS. Thank you, Mr. Chairman. 

Mr. CLARKE, in looking at H.R. 3991, the Emergency Influenza 

Containment Act, I appreciate the fact I think you have made some 

very constructive suggestions as to how some of the definitions 

might be tightened up, but I want to come back to the core of that 

legislative proposal. 

If a person went to work today and was coughing and sneezing, 

and their immediate supervisor with authority over them said, ‘‘I 

am very concerned that you have H1N1. Go home. Come back in 

5 days, and we are going to dock your pay for the next 5 days,’’ 

do you think that the employer should be allowed to do that? 

Mr. CLARKE. Well, I will answer your question, because I think 

people should answer questions that are put to them. Do I think 

they should be allowed? Yes. Do I think it is good policy? No. Do 

I think it happens very often? No. What I see happening particularly in this H1N1 pandemic is that employers are even addressing 

issues that neither of these bills address. That is, when someone 

is out of paid sick leave, they are allowing them to take more. 
35 

Mr. ANDREWS. Well, I understand that. If I may, so someone is 

going to bear the cost of that 5 days missed work. You think it 

should be the employee, not the employer, right? 

Mr. CLARKE. I do not think it should be the employee, but do I 

think it is a matter of federal law to prevent that result? No. 

Mr. ANDREWS. Well, what other way could we prevent that result? 

Mr. CLARKE. Well, it is already prevented by the marketplace. 

There is such a high percentage of paid sick leave, vacation, personal days, other types of time off. 

Mr. ANDREWS. But what about for the 39 percent of private-sector employees who don’t have that protection by the marketplace? 

What about them? Do you think they should bear this cost, rather 

than the employer? 

Mr. CLARKE. Well, you know, this whole issue—and I am always 

interested in how this issue is framed—it is really not an all or 

nothing issue. You know, all people who are sick don’t stay home. 

All people who—— 

Mr. ANDREWS. No, no, I understand that, but in my hypothetical, 

this is the case, because the bill doesn’t say that everybody gets 

this paid leave. 

Mr. CLARKE. Right. 

Mr. ANDREWS. It says if your employer instructs you to, directs 

you to go home, you get the paid leave. So under these facts, this 

is a situation where a person has been told that they have no 

choice but to go home and be docked the 5 days’ worth of pay. You 

think that the employee should bear that cost. 

Mr. CLARKE. I do not think that employee should bear that 

cost—— 

Mr. ANDREWS. So what is the alternative? 

Mr. CLARKE. My answer is I don’t think it should be a matter 

of federal law to prevent that result in isolated situations. 

Mr. ANDREWS. But how should we prevent it? How should we 

prevent it? 

Mr. CLARKE. Well, you prevent it in ways that are creatively prevented at the workplace now. I mentioned a very large food processor—you would recognize their name—that provides no paid sick 

leave. Instead, they are providing 6 months of short-term disability 

paid leave in the instance of the medium term illness. 

Mr. ANDREWS. But do you think that is typical of the 39 percent 

of private-sector employees who don’t have this protection, or atypical? 

Mr. CLARKE. No, I think that is an atypical example, but I think 

it is typical to have creative results. 

Mr. ANDREWS. But what about the more typical example, then, 

where an employer doesn’t offer that sort of cafeteria plan of leave? 

How should we avoid this cost being imposed on the employee? 

Mr. CLARKE. All right, well, on some level, again, to answer your 

question and to be upfront with you, on some level, the only way 

to have no example like that occur is to get very, very specific and 

mandatory on all levels of leave. And I doubt that as a country that 

we want to do that. 

Mr. ANDREWS. Well, but of course, this isn’t about all levels of 

leave. This is about this condition where a person has been di-
36 

rected to miss work and to be docked their pay, right? This is not 

about universal paid leave. This is about a very specific fact pattern, where the employer holds the authority to tell someone they 

have to miss this time off. 

And, you know, the cost is borne by someone, right? There are 

three choices. It can be borne by the taxpayers. It can be borne by 

the employer or borne by the employee. 

Mr. CLARKE. Right. 

Mr. ANDREWS. Do you think it should be borne by the employee? 

Mr. CLARKE. I don’t think it should be. My answer when I said 

yes was as to the federal mandate to cure it. 

Mr. ANDREWS. But can you give us—I understand that, but can 

you tell me how we can avoid the employee bearing that cost, if we 

don’t have a law that says this? 

Mr. CLARKE. Well, the creative ways that we discussed, I think, 

a little bit earlier around incentives, around even perhaps, I think, 

in HFA the bill has a study provision. Maybe let us do that study 

before the bill was passed and find out the true scope of the problem, find out really how many examples there are like this. 

Mr. ANDREWS. I understand it. I think you and I would both 

agree that while people are waiting for this study to get done, and 

they miss 5 days’ work and don’t make their rent payment or can’t 

buy their groceries, that is not very satisfactory. 

I don’t want to see this cost imposed on small businesses arbitrarily, but this is a situation where the employer has made an 

election to say, ‘‘I want you—I am telling you to go home. I am telling you to go home. You can’t come to work today.’’ And I don’t 

think that is fair. 

Chairman MILLER. Mr. Thompson? 

Mr. THOMPSON. Thank you, Mr. Chairman. Mr. Chairman, I 

would like to ask unanimous consent to submit a letter for the 

record. 

[The information follows:] 
37 
38 

Mr. THOMPSON. As a member of the House Small Business Committee in addition to my responsibilities here in Education and 

Labor, I have an additional responsibility to do my best to ensure 

the proposals we are looking at today take into consideration the 

needs of our nation’s small businesses who employ so many Americans and the American workforce. 

On September 9, 2009, the Committee on Small Business had a 

hearing on the impact of H1N1 influenza virus on small firms, and 

we learned, as suspected, that small business owners are making 

strides to keep workplaces healthy during the flu season. The witnesses testified that they are crafting flexible work and employee 

schedules, as Mr. Clarke made reference to some of those that he 
39 

has observed, that—and are doing their best to address the H1N1 

outbreak. 

An employee should have the freedom to negotiate benefit structure that works best for them. And some employers who currently 

offer paid vacation may not be able to afford to do so if they are 

required to offer paid H1N1 leave. At a time when our nation’s unemployment rate is 10.2 percent, we should help small businesses 

increase employment. 

This letter was also signed by the ranking member of the Small 

Business Committee and addresses some of these issues. As the 

committee moves forward, we need to take into account small businesses’ unique needs and ensure that we don’t create policies 

where, however well intentioned, they may have an adverse effect 

on our nation’s economic engine. 

I appreciate the panel coming today. I had some specific questions. 

Mr. CLARKE, in your testimony you mentioned a number of unanswered questions regarding the Emergency Influenza Containment 

Act. What in your view are the most important of those unanswered questions? 

Mr. CLARKE. Well, they are largely definitional. What does it 

mean to suggest or direct? I mean this is what happens in reality 

in workplaces. People have conversations. People typically are 

friends. People are concerned about each other. And his supervisor 

has a conversation with someone who appears to be ill or getting 

ill. Is that suggesting or directing? 

The significant problem, though, is just like it is with HFA, is 

what is the impact on the paid time off plans? And what is going 

to be the impact of the mandate on employer flexibility, because 

just like HFA, there is a specific safe harbor there saying if you 

provide this mandated benefit in another way, it is not additive? 

But that mandated benefit has so many strings and issues in it 

that most employers would not be in compliance with that today, 

so it would either be additive or it would have to replace an existing benefit. 

Small employers, if I may say, small employers provide paid sick 

leave. The surveys, they show up as providing paid sick leave as 

much, really, as larger employers do. The difference is that small 

employers tend as a group not to have defined policies on every 

issue, or really even on any issue in some cases. 

So some of them have concerns about handbooks and policy 

manuals and things like that, and they are very much more in the 

moment. And that really is to employees’ benefit during a pandemic like this that is recognized nationally, that has got very good 

science behind it, that is in the news, and really in our experience 

encourages small employers to do more than you might find in a 

written and sort of hard coded policy at a medium or larger size 

site. 

Mr. THOMPSON. The supporters of another bill that we have 

heard discussed this morning, the Healthy Families Act, suggest 

that the bill is targeted at those employers who do not offer paid 

sick leave and claim that employers who do not offer paid sick 

leave currently would not be affected by the legislation. Is that how 

you read the bill? And if not, how would you read it? 
40 

Mr. CLARKE. I read the bill’s mandate to say that if you provide 

these sick days in this way with these conditions with these 

carryovers with these prerogatives with these notice provisions 

with all these particular details, and you also provide 7 days otherwise, you don’t have to add it. 

However, I really cannot think in my mind of an employer that 

has a sick pay plan that meets the current safe harbor. So an employer that is going to have to open up their plan to try to comply 

with that safe harbor is going to have to—he will, I believe, open 

up a broad look at their paid time off policies and try to balance 

the cost with what is being added in their minds. 

Mr. THOMPSON. Okay. Thank you. 

I yield back, Mr. Chairman. 

Chairman MILLER. Mr. Hare? 

Mr. HARE. Thank you, Mr. Chairman. 

I would like to direct the committee’s attention to written testimony that was submitted to the committee by Melanie Disher from 

my home state of Illinois. And Melanie is a food service worker at 

Plainfield North High School and is an employee of Sodexo, a private company contracted by the school to provide cafeteria services. 

She is a shining example of someone who can’t afford to take sick 

days and has to work while ill, potentially exposing children and 

other staff members to germs. Melanie’s situation is indicative of 

the problem all across the country, especially among those who are 

considered low-wage or part-time workers. Workers deserve the resources necessary to not only protect their health, but the health 

of their co-workers and as in Melanie’s case, schoolchildren. 

The Centers for Disease Control recommends that individuals experiencing flu-like symptoms stay home, but for too many workers 

staying at home means the loss of vital income, marks against 

their work record, or other negative implications. Having paid sick 

leave not only ensures that sick individuals can recover, but also 

stems the incidence of infection, protecting the safety of at-risk 

populations. 

With that, Mr. Clarke, the CDC estimates that sick workers can 

infect one in 10 of their colleagues. Doesn’t this fact clearly point 

to the need to ensure that workers are guaranteed paid sick leave, 

especially if the people they interact with are part of an at-risk 

group, such as children? I would think that if you had young kids 

in school and you knew that the food service workers were going 

there ill and that your child would be exposed to this, I think that 

would be a pretty scary situation as a parent. 

Mr. CLARKE. Yes, I have to certainly sympathize with that last 

comment as a parent and as a fellow human being on this planet, 

but my response is that the glass is over 80 percent full, and that 

is going to be a fairly rare circumstance or one that is occurring 

primarily in part-time employment. 

Part-time employment typically does in this country not carry 

very many pay benefits. About half the employers provide a paid 

benefit in the part-time environment. Part-time is very common in 

food service and hospitality. I mean it is likely—I don’t know—that 

that individual is part-time. And I would hope that her employer 

would give her and provide her a paid benefit proportionate to the 

hours that she works. 
41 

Mr. HARE. Just two things, Mr. Clarke. You know, I have heard 

you mention 80 percent full several times in your testimony today, 

and I appreciate your being here, but as Chairman Andrews pointed out, what about these 39 percent of people who don’t have it? 

And we are in a recession. We have got 10.2 percent of people who 

aren’t working. Many of these are single parents. 

Mr. CLARKE. Right. 

Mr. HARE. They are going to work. They are sick. They are in 

food service. They may be serving us. I remember we had a hearing 

on this before, and I asked the panel across the board and said, 

‘‘How many of you would order a tenderloin if you knew that the 

person serving it to you was coughing and sneezing all over the 

place?’’ And nobody raised their hand. 

My concern is for these people who don’t have it. And what do 

we do to give it? It would just seem to me that especially if the employer is telling them, ‘‘Look, you are coughing and I don’t like the 

way—you have got to go home.’’ And they should. I don’t want 

them, you know, want them infecting people. 

But they are not going to get anything out of this. And for many 

of them, that is the difference between being able to pay for health 

care, being able to put groceries, being able to buy prescriptions to 

get better. I just don’t know what we would do with those 39 percent of people. And that is an awful lot of people out there. 

Mr. CLARKE. Right, and I certainly appreciate that concern. I 

think the answer really goes to what pool there you are looking at 

when you come up with that percentage number. I am not going 

to say there is no one in this country that works for a living that 

has no paid time off and might suffer one of the consequences that 

you or the other congressmen mentioned. My point is that the pool 

is much, much smaller than those statistics present. And let me 

give an example of why that is. 

Someone mentioned that 93 percent figure that the Bureau of 

Labor Statistics from the USDOL published in February of 2009, 

that 93 percent of full-time employees receive paid sick leave. Now, 

they got to that number by accumulating vacation, sick, personal 

and similar kinds of paid leave. And they accumulated that and 

called it all sick leave. 

If you want to do a study that says I am only going to count you 

as receiving sick leave if you have a piece of paper in front of you 

that says you get X days of sick leave, you are going to increase 

the pool of people who do not have paid sick leave, in your mind. 

I mean there is a fundamental issue there. I don’t know where the 

exact number is. You know, these things vary within ranges. But 

there are two fundamental different foundations there in those surveys. 

Mr. HARE. Well, I will just conclude by saying this. In the factory 

that I used to work at, which was an organized factory, there was 

no paid sick leave. If you are sick, and most of the time when I 

was—I worked there 13 years—I just came to work, because I had 

a couple of young kids that I had to provide for. And when you are 

working piecework, you are pushing all day long just trying to 

make ends meet. 

And we couldn’t borrow from any account. We couldn’t borrow 

from our vacation. We couldn’t borrow. And we had no personal 
42 

leave, so, you know, I have been there and done that, and I just 

hope that this bill passes, because for those people who don’t have 

it, we clearly have to provide it. And I thank you. 

Thank you, Mr. Chairman. 

Chairman MILLER. Thank you. 

Mr. Courtney? Mr. Courtney, might I ask you to yield for 30 seconds? 

Mr. COURTNEY. I would be happy to. 

Chairman MILLER. That 93 percent figure, Mr. Clarke, was manufacturing employers, right? 

Mr. CLARKE. No, Mr. Chairman, that was overall. Actually, manufacturing was 96 percent. 

Chairman MILLER. It was overall. Okay. 

Mr. CLARKE. Manufacturing had the highest percentage of paid 

sick leave of any other sector in the country. 

Chairman MILLER. Check the record on that. 

Okay. Mr. Courtney? 

Mr. COURTNEY. Thank you, Mr. Chairman. 

Ms. NESS, I would like to sort of review with you a little bit the 

differences between H.R. 3991 and the Healthy Families Act, because I mean one of the concerns I frankly have about 3991 is that 

the trigger for sick pay under that proposal is really an employer 

decision. In other words, the employee, the way I read it, almost 

has to present himself or herself at the workplace, and then the 

employer makes the decision that, ‘‘Okay. It is time for you to go 

home.’’ 

I mean there is really no scenario in this language that really 

started that somebody wakes up that morning and just says, you 

know, ‘‘I don’t think I should go to work.’’ To comply with Dr. 

Schuchat’s, you know, goal, which is to make it easy for the employee, I am a little concerned at just about the way this is structured, and I don’t know if you want to comment on that. 

Dr. Schuchat. Yes, we share that concern. And I see that as a 

starting point that we need to improve on. I think there are some 

very core principles to make emergency legislation meaningful. I 

think it has to be job protected. It has to be paid. And I think it 

has to be at the employee’s discretion. 

The employee has to be able to call in and say, ‘‘I am too sick 

to come to work.’’ Otherwise, we are defeating the purpose of trying 

to reduce the amount of contagion spread by sick workers going 

into the workplace. We also believe that the leave needs to be usable not just for the person who is ill, but also if that person is taking care of an ill family member, like a sick child that needs to be 

kept home from school. 

Mr. COURTNEY. I mean again, as—and I am also just sort of trying to visualize other scenarios where if somebody is at work 

coughing—they are in a factory floor or office where there are other 

people around—that person gets sent home, and then the rest of 

the staff is sitting there thinking, ‘‘Well, I was there when that person was coughing.’’ The structure of this, really, I just find it somewhat questionable. 

Dr. Schuchat. It becomes even more problematic when you think 

about the kinds of workers that we are talking about, who tend not 

to have paid leave. They are the folks who are interacting with the 
43 

public on a regular basis, so a lot of these are childcare workers. 

They are nursing home workers. They are food service workers. 

They are workers in public accommodations, in hotels and retail. 

So they are the very folks who are interacting the most with the 

public, who you really don’t want to have coming to work sick. 

Mr. COURTNEY. Whereas the Healthy Families Act, I mean, really again doesn’t tie the who decides to the employer, it creates just 

basically several more broad-based sick leave benefits, which allows the worker with a doctor’s note or whatever to qualify for the 

sick leave. And, you know, again, I am not trying to be proud, you 

know, difficult here, but it just seems like that provides a path that 

achieves what the public health officials are saying is really the 

goal here, which is to make it easier for workers to not spread 

H1N1. 

Ms. NESS. Correct. And we look forward to working with the 

committee to build those core principles into any emergency legislation that would go forward. 

Mr. COURTNEY. I don’t know if, Dr. Schuchat or Dr. Benjamin, 

you want to comment on this sort of employer trigger that is in 

3991. 

Dr. Schuchat. I mean from a public health perspective the best 

thing is not to go to work or school when you are sick, to be able 

to not do that. We have actually also recommended that if you are 

not really ill, we don’t want you to actually go to a doctor’s just to 

get a doctor’s note, because that can clog up the health care system. 

And so some of the outreach that has been done to the business 

community has been about, you know, flexibility about that, so that 

we don’t overburden the health care system in order to—you know, 

for people who wouldn’t otherwise have to go there. 

Mr. COURTNEY. Dr. Benjamin? 

Dr. Benjamin. I will just agree with Ms. Ness’ perspective on 

that. I think that is accurate. Do you want to encourage people not 

to come and work? Incentives should be to stay home when you are 

sick. 

Mr. COURTNEY. All right. Thank you. 

And as far as, I guess, Ms. Ness, if someone is home and is able 

to work from home with, you know, telecommuting, I mean there 

really should be some accommodation, hopefully. I mean we are living in a world where that is becoming more common. I mean I 

don’t know if you have any comments about whether that should 

be incorporated. 

Ms. NESS. Well, I think we are all for flexibility. I think it has 

its limitations when you are talking about workers, for example, 

who are hotel workers, for example, or somebody who is a short 

order cook or—I mean there are some jobs that you can’t do flexibly 

from home. So certainly, we are very enthusiastic supporters of 

flexibility, but there are millions of workers for whom flexibility is 

not an option. 

Mr. COURTNEY. Thank you. 

I yield back. 

Chairman MILLER. Mrs. Biggert? 

Mrs. BIGGERT. Thank you, Mr. Chairman. 
44 

Rear Admiral Schuchat, I have a couple of questions about the 

vaccines and particularly the H1N1. I know that you—in your testimony you said that the vaccine is targeted, you know, the available doses, in priorities such as, you know, pregnant women, children and people that care for children. 

But it seems like what has happened, and we had a change in 

how the vaccines are delivered, and just going around and seeing 

so many places where they say they have the vaccine, and then you 

will see these huge, huge, long lines of people waiting for several 

hours and, you know, holding their children. And it didn’t seem to 

be the best way that should be given out, particularly even getting 

the people together that have the potential of being sick. 

How was the policy determined how they would be distributed? 

And did it work? 

Dr. Schuchat. The recommendations for who ought to be vaccinated when supplies are relatively scarce came from CDC’s advisory committee on immunization practices. It is a science-based 

committee, and they came up with these five that ought to be vaccinated before others. 

The vaccine is coming from five different manufacturers, and it 

is going to the central distributor that CDC manages. States and 

large cities order vaccine proportionate to their population and 

have it shipped from that central distributor to the sites that they 

designate. There is state and local authority in directing those 

sources. 

We know that 34 states have already carried out school located 

clinics to reach large numbers of children, that virtually all states 

have directed doses to hospitals for health care workers and highrisk populations. Most states have sent some alloquets to providers’ 

offices to reach the high-risk people there. Some have also started, 

I believe—I think 14 states have started to provide some doses to 

the retail pharmacy venues that can reach additional people. Some 

have gone to employer clinics. 

The states and the cities are directing the vaccine doses in the 

ways that they believe are the most effective to reach the priority 

groups. We know that the vast majority of vaccine has gone for the 

high-risk population, but that they have been doing mass clinics. 

I think everyone wishes there weren’t long lines, that it were 

easier for people, particularly pregnant women, parents of young 

children, to easily get their loved ones vaccinated. And with a limited supply, it has been challenging, but it is getting better each 

day. 

Mrs. BIGGERT. Well, did your advisory committee give any information on how they would have given this out? It seems to me that 

if you have got different groups and priorities, that the way to do 

it would have been through the pediatrician or a doctor’s office. 

And as I recall, that usually seems to be the starting point for distribution. And was this a change from all the states? Or how does 

that happen? 

Dr. Schuchat. The doctors’ offices are the key component. One of 

the challenging things about vaccinating during a pandemic is how 

busy the doctors’ offices have been, particularly the pediatricians’ 

offices. We know that in the spring in New York City, doctors, pediatricians, were actually having to cancel their well child visits, 
45 

which is where they give out vaccines. So this was much more of 

a flexible approach, often trying to find, you know, lots of doctors’ 

offices, but also as a venue. 

One critical piece is that doctors who care for pregnant women 

rarely get vaccines, and we have really had to push hard to get obstetricians to sign up for vaccine. In some states it has been a great 

response. In others it has been a little trickier. So local health departments, hospitals and others are really pitching in where the 

provider community might not have been able to fill the need. 

But certainly, providers are among the large numbers that are 

getting vaccine and using it. Of course, some people don’t have providers, and so there are these other venues so that they would be 

able to be vaccinated. 

Mrs. BIGGERT. Well, it seems that there has been short supply. 

Would you be able to meet the need for this before everyone gets 

sick? 

Dr. Schuchat. The demand has been tremendous for vaccine. 

This differs from some other countries, where the public is a little 

more skeptical of the need for vaccine and the value of it. But demand has been very high. Supply is getting better, but it is not 

there yet, and our goal every day is to use the supply that is there 

as effectively as possible. 

We hope that in the weeks ahead it is going to get better, but 

demand is very high right now, and it is difficult to say when the 

lines will be shorter, when it would just be easier for people who 

have been recommended to be vaccinated, to be able to be. 

Mrs. BIGGERT. Well, if you have it to do over again, would there 

be any difference in the way that you would approach the distribution? 

Dr. Schuchat. I think that the central distribution and the state 

and local authority have been very important in us reaching as 

many people as we have reached. I think doing it over again, the 

messaging and expectation setting could have been much better, 

that I think people thought we would be in much better shape by 

now and are very frustrated. And I wish that we had communicated in a way that made it easier for people to know that it was 

going to be tough. 

Mrs. BIGGERT. Thank you. 

Yield back. 

Chairman MILLER. Mr. Tonko? 

Mr. TONKO. Thank you, Mr. Chair. 

Ms. NESS, you in your testimony cited the fact that several companies have expanded their policies, their sick leave policies in response to the H1N1 virus. And then I think it was three companies—— 

Chairman MILLER. Mr. Tonko, could you pull your microphone 

up to you a little bit? 

Mr. TONKO. Three companies that you mentioned in the testimony had done so. Do you know how these companies have fared 

in comparison to other companies in terms of controlling or keeping 

their workforce healthy? 

Ms. NESS. I don’t have data on how they have fared, and I think 

those actions are relatively recent. So we would be happy to try to 
46 

get back to you on that, but I think it points out the need for us 

to take action. 

In such a tight and competitive economic environment, I think 

leveling the playing field here and encouraging all employers to do 

the right thing would probably make it easier in this environment 

for employers to all take the steps that we need them to take right 

now. 

Mr. TONKO. And, Dr. Schuchat, you talked about bringing together CDC and the Department of Education so as to allow for 

state and local agencies to calibrate their message and provide 

guidance. Would you recommend similar systems be available to 

tailor, perhaps, the needs in our business community for their 

workforces? 

Dr. Schuchat. You know, we have been working with business as 

well. The public health connections with the Department of Commerce, Department of Labor, and so forth have been extensive, and 

also Homeland Security, about continuity of business. We have also 

done a lot of outreach with the U.S. Chamber of Commerce, the 

Business Group on Health and others. 

I think critical for a pandemic response is good communication 

and partnership. And the partnership with education has been incredible. It has really been extremely strong. I think the education 

sector felt that pandemic the strongest in the spring and all 

through the summer worked very hard to ready the schools. It has 

been a great success, because the disruption to the school system 

has been much lower. USDA stepped up and made sure that there 

were school lunches for some of the kids where schools did have to 

be closed. 

We have done much better this fall than we did in the spring responding, and with the business community I think we have been 

trying, but we could always do better. 

Mr. TONKO. Where do you think the improvements can come 

with the business community? I hear this, you know, summer outcome with the school systems. Where could we improve with the 

business community? 

Dr. Schuchat. You know, I think one feature that has been nice 

with education has been our tracking system. We have been monitoring school dismissals and really had a metric of the success of 

the interventions, that we had the new guidance, and so forth. 

It may be that we don’t yet have the right metrics to understand 

how we are doing with business, but it is also a less centralized 

universe, you know, in terms of the partnership. So I am sure that 

this committee would have good ideas of about how we could 

strengthen the work, but we have been paying a lot of attention to 

it. 

Mr. TONKO. Then, Mr. Clarke, with the paid time off situation 

and the flexibility factor that you keep mentioning, while that may 

seem to be a workable solution for employees and employers, what 

about situations where the available time is used too—and then, 

for instance, someone could have used that time for a vacation earlier this year? 

What happens when, from a public health policy perspective, 

when an individual is sick at the workplace, is required to go home, 
47 

or is ordered to go home with no available time, given that flexibility? 

Mr. CLARKE. Right. No, I really appreciate that point, and I 

think that is the point that we miss in most of this discussion. We 

missed it in the HFA. We miss it in the EICA. We don’t address 

what happens when you didn’t have basic plan that did meet the 

safe harbor. You are now out of sick time. What happens next? 

And what I got to complement the surgeon general’s office, the 

CDC, what has happened in the employer community is there is 

such a deep awareness of what is going on with this pandemic, 

with this flu, that so many employers are thinking about just exactly what you asked and doing things like I mentioned—that is, 

adding extra days to the bank or coming up with other ways— 

‘‘Look, come in on another day, a day you weren’t normally scheduled. Come in then and make up that time. Let us get you paid 

that way’’—all sorts of creative ways either just to give the time, 

the paid time to them, or to have a way to make it up. 

But those issues are being addressed in the marketplace, are 

really not addressed in these two bills. 

Mr. TONKO. And if the worker is absent from work or ordered to 

be absent from work, with that lack of flexibility remaining because 

time has been used, the economics of it, who—you know, are you 

suggesting that the business would pay them if they came in to 

make up that time? 

Mr. CLARKE. I am suggesting that many are telling me that is 

their current plan. I don’t know, certainly, the percentage exactly 

that will do that. What I can tell you is there is a growing awareness of that need, a growing awareness of the medical facts, a 

growing awareness of the fact that this is a very contagious flu, a 

growing awareness of all these factors, and employers are reacting 

to that. 

I am not suggesting every employer is in every situation. What 

I am suggesting to you is that they are listening, they care about 

it. These human resource professionals that we work with every 

day are on top of this. If we run a tele-seminar for our members, 

it is way oversubscribed in 2 days. If we have a webinar, it is well 

subscribed. These companies are on top of it and care about their 

employees. 

Chairman MILLER. Mr. Guthrie? 

The gentleman’s time has expired. 

Mr. Guthrie? 

You don’t have—oh, maybe 1 minute? 

Mr. GUTHRIE. One quick question. 

Chairman MILLER. Okay, one quick one. 

Mr. GUTHRIE. On the safe harbor in the bill, and this is for Mr. 

Clarke, if the employer requires notice of medical certification or 

call-in procedures, the use of paid sick leave, does it appear to you 

that the bill’s safe harbor not apply? 

Mr. CLARKE. It appears to me the safe harbor would not apply. 

These safe harbors have very specific provisions, and if they are 

not all checked in the right way, then there is no safe harbor. 

Chairman MILLER. Thank you. 

Ms. Chu? 
48 

Ms. CHU. Ms. Ness, you talk about the fact that there are 15 cities and states that have considered paid sick day laws and that you 

are involved in about 25 campaigns across the nation on paid sick 

leave. I know that there could be local initiatives with regard to 

paid sick leave, but why in this case is it a point to have a federal 

standard? 

Ms. NESS. Well, mainly because right now there are only three 

localities in this country where there is a standard: San Francisco, 

Washington, D.C., and Milwaukee, which is actually being contested at the moment. And we are talking about millions of workers who need this basic workplace protection, and a patchwork approach isn’t going to help to many millions of those workers. 

We need a basic labor standard, and the arguments that we hear 

today about why we can’t do this now are the same arguments we 

have heard every time we move to put in place a workplace protection like this. And the evidence always shows that most of the 

claims about negative impact on business and negative impact on 

jobs never really materialized. We have good evidence that shows 

that this makes sense both for workers and for businesses, and we 

have reached the point where we need to act. 

I would like to just highlight this with the one reference to my 

earlier testimony, which is that communities of color and low-income communities are particularly hard hit by the lack of this protection. And there is some evidence now that the rate of H1N1 in 

those communities is higher. The rate of hospitalization in those 

communities is higher. 

If you think about it, it makes sense. People who don’t have paid 

sick days can’t stay home, can’t take care of themselves, can’t get 

care. They get sicker. They are sick longer, et cetera. 

Ms. CHU. Dr. Schuchat, could you address why there should be 

a federal standard, if we are to do such a thing? 

Dr. Schuchat. No, as a public health expert, our—and my colleagues and I at CDC are just keen that it is easy for people to do 

the right thing. And we have issued guidance from the federal level 

to help employers, schools, health care workers and others know 

what the best science suggests. And that suggests that staying 

home when you are sick for 24 hours after the fever has broken is 

the best medical advice. It helps you get better, but it helps you 

from infecting other people, so this is really our approach, you 

know. 

As a center director at CDC, I have about 800 people who work 

for me, and I have a very committed workforce that wants to come 

into work. It is very fortunate that my workforce has benefits that 

let them stay home when they are sick and that they do that kind 

of work that lets them telecommute, so it is just—I think our goal 

is just to make it easy for people to do the right thing and not infect their co-workers. 

Ms. CHU. Ms. Ness, I was chair of an underground economy task 

force when I was in the legislature in California, and I know that 

it is very difficult to enforce the standards, even very basic things 

such as minimum wage. How could we ensure that once we pass 

this law that it could be enforced? How could we ensure that there 

would not be employers that would just send employees home and 

then just stop their pay? 
49 

Ms. NESS. Well, given that this is emergency legislation, there 

would need to be very rapid response. And with an emergency response to gearing up for the right kind of enforcement, we believe 

there needs to be call centers where people can call for help to understand and also to report when the law is not being followed. 

We think the Department of Labor would need to set up some 

rapid response teams to make sure, given the emergency nature of 

this legislation, that we have got the right enforcement in place. 

And there needs to be real education both for employers and employees. 

Ms. CHU. Dr. Schuchat, I wanted to—you talked about enforcement—I want to raise an issue that happened in my district. There 

was a tragedy that occurred with a woman named Monica Rodriguez, who was pregnant and went to a hospital, and she was 

coughing. They just sent her home with cough syrup. She went to 

another hospital 2 days later and was admitted into the intensive 

care, and it turned out she did have H1N1, and she died, as well 

as her unborn child. 

It seems crystal clear what the guidelines are with regard to 

pregnant women with severe flu-like systems. Can you tell me 

what kind of enforcement mechanisms there are for hospitals to actually follow these guidelines? 

Dr. Schuchat. Yes, we have really been intensifying our outreach 

to the obstetric community, to the health care community. There is 

just a long-term tradition of reluctance among pregnant women 

and their caregivers to give the medicines. There is a fear that, you 

know, we don’t know if this is a safe approach. There have been 

some misunderstandings about the lab tests and their accuracy. 

We have really been working hard to get the message out that 

a woman who is pregnant who has got a fever and cough really 

needs to be given antiviral medicines. They can be lifesaving. This 

is not just something to pooh-pooh and something we want women 

to know, to take very seriously, and their doctors. We have done 

a lot of outreach much more intensively over the past couple of 

months as disease has increased and just trying to hope that we 

can decrease that kind of terrible story. 

Ms. CHU. Thank you. 

I yield back. 

Chairman MILLER. Ms. Fudge? 

Ms. FUDGE. Thank you, Mr. Chairman. 

I thank all of you for being here today. 

Mr. CLARKE, in your testimony, and correct me if I maybe didn’t 

read this properly, but in your testimony, your written testimony, 

you appear to have looked rather closely at employees that in general have relatively high wages and more flexible workplaces. Did 

you have the opportunity at all to analyze the legislation from the 

perspective of individuals in industries or occupations earning less 

income or in less flexible workplaces? 

Mr. CLARKE. Well, yes. Our membership literally goes from workplaces with two employees to, in one case, probably 20,000 employees, and half of our membership is under 100 employees, so that 

is a partial answer. But what I am really—— 

Ms. FUDGE. No, I am looking at the incomes of the employees. 
50 

Mr. CLARKE. Oh, yes. Oh, yes. And, oh, gee, widely, widely variable. This is a, you know—— 

Ms. FUDGE. No, no, no. That is not my question. I understand 

that it is very variable, but in your testimony you basically look at 

people who make a lot of money, who make more than the norm. 

Mr. CLARKE. Oh, no, no. I wouldn’t say that at all. We have a 

lot of processing facilities, a lot of, you know, low-end manufacturing, a lot of roles—hospitality, food service, hospital, bank, office 

work that is not highly paid at all. Where I am going with that is 

that I think our mix represents the market fairly well. 

But where I am going with this is that, again, neither of these 

bills reached down below the 15-employee threshold. I am not, certainly, advocating that you change the threshold. I just think we 

need to recognize that a disproportionate percentage of the issues 

we have discussed today likely come from the under 15-employee 

group. And it is also the toughest group to put a mandate on economically. So I think that is an important point to make. 

Ms. FUDGE. Well, I am not making that point. My point is in 

your testimony you really do look at people who are in manufacturing who make more than the norm, and you did not really, in 

my opinion, look at those who are in lower income brackets and 

those who are in less flexible workplaces. 

Ms. NESS, you talked a bit about using some kind of a Web site 

or hotline or telephone line to report retaliation or the discrimination that is based upon employees taking time off. Do you really 

think that the telephone hotline or Web site are enough to encourage workers to take time off in the face of possible retaliation or 

discrimination by their employers? And do you have any other recommendations that we may be able to use to minimize that? 

Ms. NESS. No, I don’t think that by itself is enough. I think it 

is a tool, particularly if we are talking about emergency legislation 

that we are trying to get up and running quickly. It is a tool to 

both answer questions and also to report problems. 

But there needs to be serious resources allocated within the Department of Labor to do the proper enforcement. They need all the 

tools they need to be able to do the data collection to make sure 

that employers are doing the right thing, and they need to do serious education of both the employers and the employees. 

I think enforcement should be combined with strong education, 

but if we are talking about emergency legislation, there probably 

needs to be some very quick rapid response in a telephone hotline 

to facilitate, not as a substitute for, rapid enforcement. 

Ms. FUDGE. Thank you. 

And I just want to say for the record, Mr. Chairman, that understand I didn’t run a small business, but as the mayor of a city, I 

had more than 250 employees in a small city. We had the kinds 

of programs you are talking. We had sick leave. We had vacation 

time. We had personal days, et cetera. 

If I had allowed to people to just take a vacation day when they 

felt sick, with no prior warning or to just use the time any way 

they wanted to use it, I couldn’t get the trash picked up, I couldn’t 

get the firefighters out, I couldn’t get the police department out. So 

it really is very different. 
51 

It is very different to say that there is a pool and they can just 

use it any way they want to. In theory that sounds good, but in 

practice it does not work. So I just want to say that for the record, 

Mr. Chairman. Thank you. I yield back. 

Chairman MILLER. Mr. Loebsack? 

Mr. LOEBSACK. Thank you, Mr. Chairman. 

Thanks to all of you on the panel. And as a representative from 

Iowa, I am very appreciative of the fact—I wasn’t in here the whole 

time, but I think everyone has said H1N1 and has not used the 

less formal term for this, so thank you very much for using H1N1. 

Dr. Schuchat, I tried to write down some of the numbers that you 

gave us. Did you say that so far 48.5 million doses have been distributed? Is that correct? 

Dr. Schuchat. As of today, 48.5 million doses have become available for the states to order. 

Mr. LOEBSACK. Okay. Do we know how many of them have actually been distributed and actually been taken? 

Dr. Schuchat. We know that the states are doing a very good job 

ordering their doses, and, you know, within a day or so that the 

doses are shipped out to them. 

We are carrying out coverage surveys, so we will have a better 

sense of the proportion of the population that has received the vaccine. Our preliminary data suggest that it is going to the high risk 

people right now, but I think later this week we are hoping to get 

those numbers cleared up and be able to release them, at least the 

early coverage data. 

Mr. LOEBSACK. The reason I asked—it sounds like this is a very 

complicated outreach program. It is very complicated. I would like 

to see a little chart, if you will, sir, you know, laying out the highrisk populations, laying out what the CDC does, and then at the 

state and local level, who is responsible for what essentially. But 

do you have any estimate as to the number of doses that will eventually have to be distributed and taken by individuals? 

Dr. Schuchat. It is extremely difficult to come up with that number. One of the things that we know is the number in the population group, the 159 million in these five groups that we have targeted, does not equate to the number of doses that we need. 

We know that we never have 100 percent uptake of any intervention. With seasonal flu about 100 million people get it each year— 

the vaccine. And we recommend it for about 253 million people. We 

think the demand is greater for the H1N1 vaccine than for seasonal flu in usual years, but we don’t know exactly where that 

sweet spot will be when we are finally able to reach—achieve— 

really to meet the demand. 

One thing that has happened is that area-to-area and week-byweek, demand can change. So we are working really hard now to 

use every dose we get. And what will happen over the weeks ahead 

with demand, whether it will increase further or decrease, we don’t 

know. We are certainly planning to try to have more vaccine than 

the demand, but when we will get to that point I don’t know. 

Mr. LOEBSACK. All right. And you do have a system in place 

where you can be tracking all this, obviously, in the feedback, 

and—— 
52 

Dr. Schuchat. That is right. We have a national H1N1 influenza 

survey that is being carried out. And then we are also 

supplementing the behavior risk factor surveillance system, which 

would give us state specific coverage data and also will let us see 

how are we doing in pregnant women, how are we doing in health 

care workers, in children, and so forth, so that we can get a little 

bit more granular data. 

And perhaps in the future we will be able to learn a little bit 

about where did we do very well and where did we not do as well. 

The system works based on state and local direction of the programs, and we are really trying to find best practices and share 

them quickly. 

Mr. LOEBSACK. So you are getting feedback all the time. You are 

refining the system all the time. So I mean the goal, obviously, is 

to get these—the vaccine doses—to as many people who need them 

as possible, so all along the way you are trying to refine the—— 

Dr. Schuchat. That is right. I think the spirit is continuous quality improvement, not waiting for 2 years from now to figure out 

what is the best way to go. 

Mr. LOEBSACK. Right. 

Dr. Schuchat. And I can say that at the state and local level, 

day-by-day they are improving. You know, some of those long lines 

we saw, the next day the health departments were handing out 

numbers and figuring out, okay, we got 2,000 doses, 2,500 people 

in line, giving the last 500 people early notice that you are not 

going to make it today, but if you come back tomorrow, we will put 

you up at the head. 

Mr. LOEBSACK. Okay. Thank you. 

Ms. NESS, a quick question about—did I hear you say that there 

is a correlation essentially between income level and number of 

paid sick leave—sick days? Is that correct? 

Ms. NESS. Yes, what I said is that low-income workers, workers 

in low-wage positions, are less likely to have these kinds of job protections. 

Mr. LOEBSACK. Can you elaborate on that? I mean how strong is 

that correlation? I don’t know if you have an R for me or any kind 

of a statistic for us. 

Ms. NESS. We know that if you look at all workers, for all private 

sector workers it is approximately half that don’t have paid sick 

days. But if you look at low-wage workers, we are talking four out 

of five. 

Mr. LOEBSACK. Okay. 

Ms. NESS. Another way to think about it is 22 percent of food 

service or public accommodations workers—folks, for example, who 

work in hotels—have paid sick days—only 22 percent. That is sort 

of less than a quarter of the workforce would apply to nursing 

home workers and child care workers as well. 

Mr. LOEBSACK. Okay. Thank you. 

Thank you, Mr. Chairman. 

Chairman MILLER. Thank you. 

Dr. Benjamin, I think we have to excuse you, I am told, so—that 

you have another commitment. So thank you very much for your 

time. If we have questions, we will follow up with you in writing, 

if that is all right. 
53 

Dr. Benjamin. Yes, sir. Thank you very much. 

Chairman MILLER. Thank you very much for your time. 

Mr. Payne? 

Mr. PAYNE. Thank you. 

Actually, as we in New Jersey are very concerned as other parts 

in our—now, the first death of H1N1 in New Jersey occurred in my 

district, West Orange. And currently, we have had 22 deaths so far. 

We have had nearly 800,000 doses provided, about 40 percent of 

what our needs are in the state. So we are still lagging behind. 

And, of course, we have certainly a preference to pregnant women 

and young children. 

And let me just ask you, Doctor, has the question of pregnant 

women been answered yet? Initially, there was a question of 

whether they should take it, whether they shouldn’t take it. And, 

of course, the early doses we know were in pregnant women, therefore, the need being there. However, the question of whether it was 

safe enough—how has that been worked out? 

Dr. Schuchat. Based on everything that we know right now, the 

risk of H1N1 disease in pregnancy greatly exceeds any hypothetical 

risk from the vaccine. NIH has carried out a clinical trial in pregnant women, and the initial results suggest very good immune response from the vaccine, suggesting it will work really well, and no 

red flags in terms of safety. 

There is an effort to commitment to follow up the women in that 

trial long-term and their babies, and then also nationally to do 

some monitoring in pregnancy. There haven’t been any red flags at 

this point in the use of vaccine in pregnant women, but we do continue to get these very sad stories of women who are really in critical care, on life support, and sadly, many of them having died. 

So we know that this is a bad disease in pregnancy, and the vaccine is made exactly the same way as seasonal flu vaccine, which 

is used in lots of pregnant women and has a very good safety track 

record. 

Mr. PAYNE. Ms. Ness, you mentioned in your testimony that several cities—the District of Columbia, San Francisco, Milwaukee— 

provide paid sick leave and by ordinance. I wonder if—have these 

cities found that the employer mandates is a great burden on employers? And are employers in those cities complaining about workers abusing this privilege? 

Ms. NESS. Well, San Francisco is the one city that has been in 

place long enough for us to actually take a look. And the results 

have been very encouraging. In fact, there was some research done 

to look at job creation, and it turned out that job creation in the 

city of San Francisco was actually higher since this mandate than 

in the surrounding areas that did not have the guaranteed paid 

sick days. 

Mr. PAYNE. Thank you. 

Mr. CLARKE, in your Capital Associations Industries, what type 

of industries basically are there? I was out, and you might have 

mentioned it. Are they manufacturing—primarily manufacturing, 

right? 

Mr. CLARKE. Well, at our founding back in the 1960s, it was primarily manufacturing. Today it is about 32 percent manufacturing. 

We really represent the broad spectrum of the business community. 
54 

Mr. PAYNE. Okay. And, of course, as you have heard previously, 

I guess, there is always a lot of concern about particularly those— 

and, you know, our society is sort of—things, you know, sort of upside down—those who have the, in my opinion, some of the more 

important positions—food service, caring for the elderly, caring for 

children, and it is quite a few people in that category, of course, 

tend to be the lowest paid. 

And when you are low paid, you certainly are not expecting to 

have robust employee benefits. And so, you know, I am looking at 

that at 80—mine was 80 percent full, too, but it is empty now— 

your 80 percent glass that you keep saying about how good things 

are for four-fifths of the people. You therefore assume that that last 

20 percent, that unfilled glass, is primarily filled with those folks 

who are working with the elderly, working at, you know, homes for 

geriatrics, food service workers. 

How do you kind of, you know, figure out, even if it is just a 20 

percent, isn’t this kind of an important 20 percent that is not covered, and that you still contend that a person should be responsible 

for their own sick leave, since in many instances these places do 

not provide them? How do you reconcile all that? 

Mr. CLARKE. Well, sure. The food service industry is not, you 

know, all monolith. There are some large, very large companies 

that play in that space. They are going to have a different set of 

benefits, perhaps a different view toward all types of paid leave. A 

very small player, a very local individual, a caterer, for example— 

not to pick on caterers—might not have that level of sophistication 

or economic wherewithal, so it is, you know, I think it is difficult 

to take an industry and say that industry would not have this benefit. 

I think the comment I would make is that the industries you 

mentioned tend to have a higher proportion of people that work 

part-time, and that about half of the time part-time employees, 

even in those industries that you named, are accumulating sick 

days, but simply at a lower rate proportionate to the hours that 

they work. 

Chairman MILLER. Ms. Woolsey? 

Ms. WOOLSEY. Thank you, Mr. Chairman, for holding this hearing, because it is not only important, it is timely right now. 

Our witnesses have pointed out that H1N1 has now spread to 46 

states and that it is certainly a serious threat to public health, particularly when workers come to work sick, because they can’t afford 

to do otherwise. Ultimately, I believe we need to pass Representative DeLauro’s Healthy Families Act so that all workers have paid 

sick days and job protections when they need to care for themselves 

and their families. 

But to face our current crisis this emergency legislation is needed. I think we need to tweak it here and there, but that is why I 

co-sponsored the Emergency Influenza Containment Act that was 

introduced by Chairman Miller, which, by the way, I hope everybody is aware—we keep talking about small business—this legislation exempts small employers, and actually over 80 percent of our 

workers in 2005, annually, were employed by small businesses that 

employed under 20 employees. So small employers are pretty well 
55 

exempted from this, and that’s 80 percent of our workforce right 

then and there. 

But the goal is a good start, Mr. Chairman, and it certainly addresses an emergency situation. 

Ms. NESS, I really agree with a lot of what you said in your testimony about strong job protection and employees needing to have 

discretion on whether—really, both of you said that, and so did Dr. 

Benjamin—that it really should not just be left up to the employer. 

And so here is my question, because I don’t want to repeat everything everybody has said. If there is a question, if we need to have 

verification, or if the employer doesn’t believe the employee, who is 

the tiebreaker on this? What would you suggest that we have just 

to make sure that employers don’t feel like they are being taking 

advantage of and that employers don’t take advantage of their employees. 

Ms. NESS. Right, right. Well, as we know, many employers successfully manage paid days policies today, so it is not like this is 

something groundbreaking a new. And I think there is a large body 

of experience we can draw on. But that Healthy Families Act does 

allow employers to request a medical certification after a three-day 

period. That is a protection that was built into the legislation. 

I also would say, you know, we hear all the time about concerns 

that employees might misuse this. The data show that when employees do have paid sick days, about half of all employees don’t 

use them. And when you look specifically at employees that have 

a minimum of seven paid sick days, the average amount that employees take is around 2.5 days. 

Ms. WOOLSEY. And would you like to take it one step further? 

Female employees take their sick time off for their families. 

Ms. NESS. Yes, I mean we feel very strongly that any kind of 

paid sick leave legislation needs to make sure that it is family 

flexible. And we tend to think particularly now with the H1N1 epidemic about children needing care. 

But we are also facing a tsunami of caregiving challenges in this 

country as our population ages. And it is expected that over the 

next couple of years half of the workforce will be caregivers. And 

so these issues, while we have an emergency situation right now 

with H1N1, these caregiving challenges are not going away. They 

are only going to get worse. 

Ms. WOOLSEY. Taking care of not only their own children, but 

their parents. 

Ms. NESS. That is right. And for women in particular, women 

who are in particular in the baby boomer generation right now are 

being hit from every direction. They are not only still taking care 

of the younger generation, they are increasingly taking care of elders, who are living longer and also living sicker, so their health 

care needs are more complex. 

And because of the rapid increase in chronic conditions, they are 

also grappling with their own health care conditions. So for women, 

the need for there to be some basic minimum number of paid sick 

days is tremendous. 

Ms. WOOLSEY. Dr. Schuchat, do you have any comments on 

verification? 
56 

Dr. Schuchat. You know, I can say that in the midst of this particular pandemic, we have focused on ways to decrease the pressure on the health care system, both to have people not clog up the 

emergency departments with relatively mild illness and to have to 

discourage people or employers from visiting the doctors just to get 

a note, because that can actually tie up very scarce resources. 

So I think we have urged flexible release policies and also the 

temporary release from that need to get the note because of the 

negative impact it would have on the health care system. 

Ms. WOOLSEY. Thank you. 

Ms. HIRONO. Thank you, Mr. Chairman. 

Several of my colleagues have already taken note of the fact that 

H.R. 3991 is it is up to the employers to kick off this coverage requirement. My question to Mr. Clarke and Ms. Ness is do you 

think in the real world that this would therefore result in many 

employers not asking their employees to stay home because they 

are sick? 

Mr. CLARKE. You know, I would hope not. I would hope not. 

Though, if you do assume, if you do come from the point of view 

that there are employers that want to minimize every expense, 

don’t want to provide an employee anything, either because they 

can’t or they just won’t, if you categorize a group of employers that 

way, then it is easy to say, well, that group with that mindset is 

not going to suggest or direct. I think that is a conclusion that you 

can make about this hypothetical group of employers. 

Ms. HIRONO. Ms. Ness? 

Ms. NESS. Well, I would like to think that all employers would 

do the right thing, but the numbers right now show that they don’t. 

And so I believe it is important that we not leave it to employers’ 

discretion as to whether or not somebody should stay home if they 

are sick or to be able to say you must come in even though you 

are sick. I do think it is important for that to be at the employees’ 

discretion, even though I would like to think that most employers 

behave in a very humane way. 

Ms. HIRONO. Ms. Ness, you mentioned San Francisco’s mandate. 

Is that at the employees’ decision to—— 

Ms. NESS. Yes, it is. 

Ms. HIRONO [continuing]. Require coverage? 

Ms. NESS. In all three cities it was an employee decision. 

Ms. HIRONO. Mr. Clarke, would your objection to this bill be even 

greater if it was changed to—on H.R. 3991 that if we were to 

change that to employee’s action as opposed to the employer’s control? 

Mr. CLARKE. Yes, I think unilateral, non-communicative, don’t 

have to speak to you for 3 days, don’t have to report what I am 

doing for 2 days is a very, very unworkable right to give an employee base. Yes, I think that would be very difficult. 

Ms. HIRONO. Although apparently San Francisco has done this 

and the world has not come to an end there. 

Mr. CLARKE. Some may debate you on that one. 

Ms. HIRONO. Thank you very much. 

I yield back. 

Chairman MILLER. Would the gentlewoman yield for a second? 

Let me just—— 
57 

Ms. HIRONO. Yes. 

Chairman MILLER. Mr. Clarke, you suggest that—I think you are 

probably correct in most instances that there probably is relatively 

a few number of employers that just view any of these things as 

antithetical to whether it is their profitability, their survivability, 

however they judge the outcomes of their businesses. 

But then if that is a very low number, and in the greater emphasis that you are talking about, employers are willing to trust employees for 7 days to say, ‘‘I have got to take care of my kid or I 

am going to stay home, I am sick’’ or whatever the situation is, 

that we don’t assume that those people are gaming the system. 

Is this essential to have what is viewed as sort of a employer protection at the employer discretion in the bill at all? I mean are we 

still talking—are we really focusing on such a small number of employers that the safeguard really is sort of not real? 

Mr. CLARKE. Well, hypothetically, that could be the case, except 

that the way the bill is written about the other things around the 

safe harbor, the other things that have to be in place, if it was 

purely an issue of does employer-based discretion make a mandated leave more palatable to the employer? Well, yes. But when 

you layer that around with the barest details that have to be in 

place, that really blunts that advantage. 

Chairman MILLER. All right. It is a beginning. Thank you. 

Mrs. Davis is next. 

Mrs. DAVIS. Thank you, Mr. Chairman. 

And, Dr. Schuchat, first you mentioned that you were able to 

track schools to have information about how they are doing, the 

number of students that are absent, et cetera, and the reason for 

that. Is there a database set up so that businesses can respond? 

I am thinking of really the restaurants in my district, for example, and I think the people who are working part-time and are facing the public—there are many, many professions, occupations that 

are doing that—but particularly in the restaurant business, I think 

this is a real concern, and a lot of them have more than 25 or 100 

employers. I mean is there a way to actually track what is happening in that area? 

Dr. Schuchat. No, I am not aware of a systematic tracking. It 

may be that Department of Commerce or Department of Labor has 

something that we are not collaborating on. We have been doing 

some general surveys or polls with some universities to understand 

the impact that the pandemic is having on different sectors. 

We did one—or Harvard did one, I think, this summer that 

looked at employers and their policies. It was before the increase 

in disease in the fall, and so whether—we will need to check and 

see if there is anything ongoing or that might be done that would 

look at those matters. 

Mrs. DAVIS. Yes, it seems like there might be a fairly simple way 

of doing that and allowing them to kind of report those numbers, 

because if in fact it is spreading faster in that industry as opposed 

to other industries, I don’t know. 

Do you know, Mr. Clarke? Any thoughts about that at all from 

your constituency? 

Mr. CLARKE. I do not. I think the doctor would be a lot more 

qualified on that point. 
58 

Mrs. DAVIS. Okay. Thank you. 

And then in terms of the information that they receive, small 

businesses don’t—you know, they are so busy just making payroll 

that they don’t have a lot of time to be checking and seeing what 

kind of information is out there. How are we getting that information out to them? What resources are they able to use? And, you 

know, are they using it? 

Dr. Schuchat. There has been an active outreach effort. The 

Commerce Department, HH, U.S. Chamber of Commerce have been 

trying to get information out, not just to the larger businesses, but 

to the small businesses. 

We partner with the Small Business Administration on some of 

that, looking at those Web and other venues to reach people. Particularly as we issued new guidance, we wanted to make sure it 

was broadly received. And the state partners and some of those organizations have really helped with that locally. 

Mrs. DAVIS. Great. 

Mr. CLARKE. Representative Davis, if I might say, the communication has been terrific. 

Mrs. DAVIS. Oh, okay. 

Mr. CLARKE. The Internet has just made it so accessible. I think 

any employer that touches any business-oriented organization has 

received multiple messages and links and assets regarding H1N1. 

And I doubt that I have been in a place in the past month that 

didn’t have good practice guidelines hanging on every wall in that 

employer’s place. 

Mrs. DAVIS. Well, thank you. 

Mr. Chairman, I think this is an important issue. There certainly 

are challenges. I don’t think everybody acknowledges that there 

can be some misuse of some of this, but on the other hand, you 

know, the alternative is not a good one either. I mean that is life 

and death issues for people, and so I think we need to try and figure out how best to deal with it. 

Thank you, Mr. Chairman. 

Chairman MILLER. Mrs. McCarthy? 

Mrs. MCCARTHY. Thank you, Mr. Chairman. 

Mr. CLARKE, could you define what a small business is? 

Mr. CLARKE. Well, I think the SBA definition is under 100 employees, I believe, but it is really in the eye of the beholder. I have 

met people with 30 employees that think they are medium-size, 

and I have met people with 200 that call themselves small. 

Mrs. MCCARTHY. Actually, the number goes much higher. Some 

areas would say small businesses are 400 and under, but basically, 

what we are talking about an awful lot of our part-time workers. 

If you work for a large corporation, yet they have a lot of retail 

stores, and most of the women that work in those retail stores are 

part-timers, none of them get health care. They get minimum 

wage, just about. 

But the other thing that I was interested in—you kept talking 

about short-term sick leave. That is a policy that the employee can 

buy? Or does the employer offer that? 

Mr. CLARKE. The example I gave was a large food processor that 

provides that free of charge to the employee base, to the hourly em-
59 

ployees, and that provides up to 6 months of short-term disability 

wage replacement during an illness lasting up to 6 months. 

Mrs. MCCARTHY. Do you know that with taking short-term insurance that if you came down with a virus or anything else, you 

would be turned down for any kind of large health care policy that 

you might want to go into later down the road that—because they 

have preemption, as far as pre-existing conditions? 

I mean that is one of the problems with the short-term. If you 

use that short-term, whether it is a college student getting a bridge 

between short-term and full-term, they have quite a bit in there as 

far as saying that if you have a pre-existing condition, which we 

know could be almost anything, they could be turned down for fulltime insurance. 

So would it not be true that for some of the stores or people that 

you represent, it could be a shortcut, because they would not be 

able to get full-time health care insurance for their employees? 

Mr. CLARKE. Well, I am really not aware of the facts you state, 

and I can’t dispute them. What I can say is that I have never seen 

an employee enter an STD, or short-term disability policy, whether 

that was insured or whether that was paid by the employer’s 

checkbook, which most of them are—— 

Mrs. MCCARTHY. I will be honest with you. I would think that 

most employers don’t even know that some of the health care provisions that they give their employees—and I am not saying they are 

doing this on purpose—I am just saying that if an employee has 

any kind of an illness, any kind of a disease, they can be—high 

blood pressure—so we are talking about—Ms. Ness was actually 

talking about it—if you have underserved communities, the majority, unfortunately, have high blood pressure. They have diabetes. 

They have other illnesses that could actually be controlled as a 

chronic care, but they would be denied health care. And I think 

that is one of the reasons that we are fighting for stopping pre-conditions. 

Ms. NESS, could you follow up on that as far as large corporations, but individual stores, which are mostly run by women, or 

work there? 

Ms. NESS. Well, I think you are underscoring the fact that 

women are the majority of part-time workers, and those part-time 

workers tend not to have any benefits. And so sometimes you have 

an employer that is offering decent full-time benefits, but they are 

not available to the part-time benefits. 

Many of the women in those very low-wage jobs are stringing together more than one job in order to make ends meet to support 

their family. For those women, not having any benefits is—it ripples through every aspect of their lives. They not only don’t have 

time off when they are sick, they don’t have health insurance, and 

they don’t have any ability to take care of their children when their 

children get sick. 

And, you know, we often say that a lot of these women are just 

one sick kid away from losing their job, one sick kid away from unemployment. There really is no safety net or any protections for 

them. 

Mrs. MCCARTHY. I know one of my colleagues brought it up a little bit earlier, but when we see how this virus spread so rapidly— 
60 

we saw it in our schools; we have seen it in some of our nursing 

homes where there are a lot of part-time workers, especially workers that are only from the underserved area—and yet, you know, 

we keep talking about the costs of not having someone go home. 

I know in my office—and we are lucky; we are the federal government; we don’t have pre-existing conditions, as far as that 

goes—maybe I am a little paranoid about it, but on every desk we 

have some, you know, to clean your hands when you come in. Our 

business, we shake hands constantly with everybody. 

But the cost of when the flu hits the office, the cost of it spreading, because not only is it in the office, depending on how they 

transfer to go to work—New York City, the largest cities, you are 

talking about trains and subways, you are talking about buses— 

could you expand on that, Doctor? 

Dr. Schuchat. Yes, our recommendations are that people not only 

stay home from work or school when they are sick, but they stay 

home, that they are not just—that kids who are sick not, you know, 

not go to school, but then go off and hang out with their friends. 

The idea there is to limit spread. 

There have been economic analyses of the cost of seasonal influenza on society in terms of both lost work and the impact on spread 

and so forth, and it is many, many billions of dollars each year that 

we spend on that disease, even when it is not causing excessive 

rates like we are having now with this pandemic, which is striking 

more a younger working age population than would seasonal flu in 

terms of the severe complications. 

Mrs. MCCARTHY. Thank you. 

Chairman MILLER. Mr. Scott? 

Mr. SCOTT. Thank you, Mr. Chairman. 

I want to thank our witnesses. 

Ms. NESS, we exempt businesses with with less than 15 employees. Most employers with more than that would have some kind of 

sick leave. Do you have any idea of how many people this bill 

would actually cover? 

Ms. NESS. NO, I need to get back to you on those numbers. 

Mr. SCOTT. Dr. Schuchat, from a public health policy perspective, 

what effect—you kind of talked a little bit of this in response to the 

last question—what effect would this have on preventing an epidemic? It is not limited to epidemics, and presumably we are trying 

to prevent them from happening. And on all the kinds of things 

that we can do to prevent epidemics, where would this bill fall in 

a priority list? 

Dr. Schuchat. Well, we think that the ability to slow the spread 

of infectious diseases like flu is important in terms of that they picture a disease. With a pandemic in particular, we are trying to 

slow the spread, but in order to, you know, benefit people who 

won’t get infected, but also to decrease the pressure on the health 

care system, which may, you know, have errors if there are too 

many people sick at the same time, and also to buy more time for 

vaccine production so that we can protect more people from ever 

getting sick. 

So the idea, you know, since the spring that we have been pushing—stay home when you are sick; keep your children home when 

they are sick—is in order to reduce illness and really delay the im-
61 

pact that we have on these other sectors. So it is a very important 

feature, particularly in an area where there is scarce vaccine. 

Mr. SCOTT. With all the exemptions and what kind of effect 

would you expect the passage of this bill to produce? What effect? 

Dr. Schuchat. I can just speak to the public health side that, you 

know, our sense is that when it is easier for people to make 

healthy choices, they are more likely to, and that that is in the 

public interest. 

Mr. SCOTT. Mr. Clarke, in terms of enforcement, is there any reason to believe that it would be harder to enforce this act than the 

minimum wage bill under the fair labor standards? Is the enforcement mechanism—yes, can you comment on the enforcement mechanism? 

Mr. CLARKE. Yes. Yes, I could make two comments. I think it 

was mentioned earlier that the minimum wage law has such broad 

application for the workplace—you know, employers well under 15 

employees would be covered by minimum wage. And it is, in my 

opinion, a under enforced law. You know, I have been around workplaces for 26 years, and I think it is a very difficult task for any 

government agency to get to every workplace and address every 

conceivable issue, be it minor be it major, so I think that is a very 

difficult task. 

I think what makes it even more difficult to enforce a new emergency act like this is that it is new, that it will not be, for some 

extended period of time, well understood in its detail, will not for 

some period of time be, because it has got such a short enactment 

date on it, well complied with, I think, universally. Those things 

take time. 

Mr. SCOTT. Well, in terms of enforcement, wouldn’t you expect 

the enforcement to take place when there are complaints? And you 

wouldn’t expect federal workers to be running around trying to 

visit all the employers. They would wait for somebody to complain. 

Mr. CLARKE. That is true. Most complaints of minimum wage, 

and I would expect it of this statute, would be based on employee 

complaint. 

Mr. SCOTT. And finally, Dr. Schuchat, could you give us an idea 

of what the rate of production of the vaccine is now? 

Dr. Schuchat. Yes, as of today there are 48.5 million doses available for the states to order. We are working hard with them—— 

Mr. SCOTT. All right, wait a minute—for the states to order? 

Dr. Schuchat. That is right. That means that—— 

Mr. SCOTT. Does that include the ones they have already ordered? 

Dr. Schuchat. It includes what they have already ordered. It is 

a cumulative total. And each morning the states receive an allocation number, you know, that subtracts what they have already ordered and tells them you have got so many new doses or old doses. 

This is how many you can order from today. They put in their orders every day, and the orders are submitted to the central distributor and shipped the next day. 

So we have been working hard with the manufacturers to try to 

be able to look at the next several weeks’ estimates and are hoping 

to be able to share that more publicly very soon. As you know, it 

has been very difficult to predict what the yields would be. And the 
62 

past, you know, 2 months really we were not where we wanted to 

be since we started immunizing. 

This past week we missed the projection by about three million 

doses. Next week we—the current week we believe will be better, 

but it has really been very challenging. 

Mr. SCOTT. How many doses a week are you producing? 

Dr. Schuchat. It has ranged. You know, the first week or 2 was 

about 2.5 million, and then we hit, I think, 11 million doses a week 

a couple of weeks ago. Last week we only got about 5 million doses. 

Mr. SCOTT. Why is it not continuing to increase? 

Dr. Schuchat. What happens—right—what happens is there is a 

certain part of this that was due to the slow-growing virus and just 

that low yields that many of the manufacturers were getting. Most 

of them have been able to find better growing viruses and are getting higher yields. 

And the very last stages of production involve testing individual 

lots. And what happened last week and, I believe, has happened 

certain weeks is that that very last test stage you can’t predict 

whether everything was going to pass the testing or need to be further looked at. And so some of the lower results were because lots 

could not be released. 

Some of the other decrease was due to delayed shipment because 

of the bad weather in parts of the country, that the doses didn’t 

actually reach our central distributor on Friday. They reached it on 

Saturday because of the storm. And so, you know, this is a dayby-day thing, and even when the manufacturers really are on top 

of everything, their predictions need to incorporate some of these 

last-minute things that they wouldn’t know the week before. 

Mr. SCOTT. Thank you, Mr. Chairman. 

Chairman MILLER. Just quickly, in the absence of this legislation, people are obviously going to make decisions about staying 

home or not. And I guess the question is can they be fired for that 

in the workplace? And I assume the answer is today, yes, you could 

be. I assume, Ms. Ness and Mr. Clarke, you would not agree with 

that policy. 

Mr. CLARKE. No. No, no one should be fired because they had to 

stay home because they were sick. Of course not. And there are 

laws in states that would prevent that. 

To take a federal law that prevents that, the salaried exempt 

statues, the wage and hour statutes for salaried exempt provide 

that you must provide a certain number of paid sick days. I mean 

that is already in place for salaried exempt and that you can’t be 

retaliated against for using your salaried exempt rights. 

And so, no, no one should be fired for that. I wouldn’t support 

that. 

Chairman MILLER. But there is a universe of people out there 

that in fact can be fired. I am not—I wouldn’t—I assume we would 

endorse a policy that says you can’t be fired for that reason, but 

there is a universe of people out there that clearly can be and are 

fired for missing a day of work for whatever reason. 

Mr. SCOTT. Mr. Chairman? 

Chairman MILLER. Mr. Scott? 
63 

Mr. SCOTT. There are some states that are employer employee at 

will, where there are really no rights at all—Virginia, for example. 

Is there any restraint in Virginia? You stay home, you get fired? 

Mr. CLARKE. In North Carolina? 

Mr. SCOTT. In Virginia. 

Mr. CLARKE. I can’t speak to Virginia. In North Carolina, yes, 

there are. And the reason I say there are is that illness—you know, 

employers are very careful. I run into this all the time. Employers 

are very careful to not get into discussions with employees about 

the details of an illness, because they can easily take you to discussion around disability, which can easily take you to a violation on 

our state disability act or the federal disability act. 

So, you know, this whole area is—while maybe perhaps not technically regulated in a sense, the chairman cites—— 

Chairman MILLER. The safest policy would be not to discuss anything, but to fire you. 

Mr. CLARKE. That doesn’t look like—— 

Chairman MILLER. That is not the outcome we are looking for. 

Ms. NESS, do you want to comment? 

Ms. NESS. Yes, I just want to say you are absolutely right. There 

are people—— 

Chairman MILLER. Your mic is not on. 

Ms. NESS. Sorry. You are absolutely right. There are folks who 

can be fired, and that is why we need the Healthy Families Act as 

a basic standard to prevent that from happening. 

Chairman MILLER. Mr. Thompson, anything before we—— 

Mr. THOMPSON. I just want to thank the panel for the information provided and just to say, you know, certainly, having worked 

in the Emergency Medical Service as a volunteer, prevention— 

what we invest in prevention—goes far beyond, you know, finding 

a cure and addressing all the issues we have here. 

So, certainly, Admiral, I share your frustration in terms of the 

amount of—I mean we knew this was coming. We saw the first 

signs of it back in the spring, and so I share your frustration on 

the amount of vaccines that are available. I certainly would think 

that one of the things—and I am not looking for a response, but 

to encourage that after we go through the health risk, that maybe 

financial risk is on that list of vaccinations, working partnerships. 

I will be interested in working more with this on the Small Business Committee as well, at looking how we can work with our 

small businesses with partnerships to help protect the people and 

keep them, because this hearing is not about—I mean this is about 

H1N1, so—and that is certainly a specific thing that we should 

look into doing our best to prevent as well. 

Chairman MILLER. Thank you all very much for your testimony. 

I hope that we can continue to work with you as we develop this 

legislation. 

And I would ask unanimous consent to enter into the record not 

the—the letter that you requested, right, but signed? I didn’t respond to your request at that time. And also a letter—written testimony—from Melanie Disher, Sodexo food service worker, Plainfield 

North High School, Illinois, and which I think was read into. 

And without objection, members will have 14 days to submit 

their additional testimony. 
64 

Thank you so much for your time. It has been lengthy, but I 

think very helpful to the committee. 

Thank you to the CDC for everything that you are doing in our 

general population. Thank you. 

[Additional submissions of Mr. Kline follow:] 

November 17, 2009. 

Hon. GEORGE MILLER, Chairman; Hon. JOHN KLINE, Ranking Member, 

Committee on Education and Labor, U.S. House of Representatives, 2181 Rayburn 

House Office Building, Washington, DC. 

DEAR CHAIRMAN MILLER AND RANKING MEMBER KLINE: We write today in reference to the recently introduced Emergency Influenza Containment Act (H.R. 

3991). While we share your goal of protecting the health of the American workforce 

and minimizing the spread of the H1N1 virus and other contagious illnesses, we 

must oppose H.R. 3991 as it is currently drafted. The bill’s vague provisions would 

significantly impair employers’ existing paid leave programs and initiatives, thus 

creating a convoluted and unworkable mandate impacting businesses of all sizes. 

As you know, many employers have developed, or are in the process of developing, 

continuity plans in response to the current H1N1 outbreak. These plans include the 

full range of workplace flexibility options, including telecommuting, job sharing, 

schedule changes, shift swapping and paid time off for the employee’s own illness 

or to care for ill family members. In addition, the vast majority of employers, more 

than 80 percent, already provide employees with paid time off that may be used as 

sick leave. The rigid requirements of H.R. 3991 threaten employers’ ability to flexibly and creatively design programs that meet the unique needs and constraints of 

that employer and its employees. Moreover, the legislation fails to adequately recognize and clearly exempt from any mandated paid leave requirement employers that 

are already providing paid leave that may be used for sick leave to its employees. 

As our economy begins to recover from the most severe recession since the Great 

Depression, businesses need to maintain flexibility in order to survive, grow and 

provide jobs in the face of ongoing challenges, including the potential impact of contagious illnesses such as H1N1. A one-size-fits-all paid leave mandate that is applied to the broad, diverse industries that make up our nation’s marketplace would 

negatively impact all employers, including small businesses, and limit our ability to 

retain and create new jobs. 

The attached document outlines in more detail the important concerns we have 

about the Emergency Influenza Containment Act. We look forward to working with 

the Committee to address our shared goal of maintaining a healthy and productive 

workforce while ensuring the job retention and job creation that will ultimately 

bring us out of this recession. 

Sincerely, 

AMERICAN BAKERS ASSOCIATION, 

AMERICAN HOTEL & LODGING ASSOCIATION, 

ASSOCIATED BUILDERS AND CONTRACTORS, 

ASSOCIATION OF EQUIPMENT MANUFACTURERS, 

AMERICAN FOUNDRY SOCIETY, 

ASSOCIATED GENERAL CONTRACTORS, 

COLLEGE AND UNIVERSITY PROFESSIONAL FOR HUMAN RESOURCES, 

FOOD MARKETING INSTITUTE, 

HR POLICY ASSOCIATION, 

INDEPENDENT ELECTRICAL CONTRACTORS, 

INTERNATIONAL FOODSERVICE DISTRIBUTORS ASSOCIATION, 

INTERNATIONAL FRANCHISE ASSOCIATION, 

NORTH AMERICAN DIE CASTING ASSOCIATION, 

NATIONAL ASSOCIATION OF HOME BUILDERS, 

NATIONAL ASSOCIATION OF WHOLESALER-DISTRIBUTORS, 

NATIONAL CLUB ASSOCIATION, 

NATIONAL FEDERATION OF INDEPENDENT BUSINESS, 

NATIONAL RETAIL FEDERATION, 

NATIONAL ROOFING CONTRACTORS ASSOCIATION, 

NATIONAL SMALL BUSINESS ASSOCIATION, 

PLUMBING-HEATING-COOLING CONTRACTORS—NATIONAL ASSOCIATION, 

PRINTING INDUSTRIES OF AMERICA, 

RETAIL INDUSTRY LEADERS ASSOCIATION, 

SMALL BUSINESS & ENTREPRENEURSHIP COUNCIL, 

TREE CARE INDUSTRY ASSOCIATION. 
65 

Emergency Influenza Containment Act H.R. 3991 

Employer Action Triggers 

• The bill provides paid leave for workers who are ‘‘directed’’ or advised by their 

employer to leave work or not come into work because the employer ‘‘believes the 

employee has symptoms of a contagious illness, or has been in close contact with 

an individual who has’’ these symptoms. (See Sec. 3 (a), (b).) 

– This legislation does not define how the term ‘‘directed’’ should be defined. 

As a result, employers could have a range of conversations or contacts with 

their employees which might or might not rise to the level of a ‘‘direction’’. Preexisting guidance contained in employer policies could be construed to meet this 

definition therefore triggering employer payment obligations. 

– This legislation doesn’t define who can act as the employers. As written the 

determination could be made by a lower level supervisor that could be later revoked by someone with more authority. 

– The legislation leaves the determination of symptoms to the employers if they 

‘‘believe the employee has symptoms of a contagious illness.’’ The legislation 

lacks a clear threshold that would be sufficient to form this conclusion. Typically, most employers are not medical professionals, nor do they usually have 

such medical professionals on site to make this determination. 

– This bill lacks protections for employee privacy rights with regard to an employer determining whether an employee has been in close contact with an individual who has such symptoms. 

Employee Compensation 

• The bill calculates the rate of pay ‘‘based on the employee’s regular rate of pay 

and the number of hours the employee would otherwise be normally scheduled to 

work (sic)’’ (See Sec. 3 (c) (2) (a).) 

– This legislation does not address how overtime pay would be taken into account. 

– The hours an employee might normally be scheduled to work might not be 

fixed, or set for the time that the employee would be out. This legislation lacks 

the necessary guidance to make this determination. 

Employer Guidance 

• The Secretary is directed to issue guidelines to assist employers on these calculations, but no deadline for these guidelines is set, while the bill is supposed to 

take effect 15 days after enactment. (See Sec. 3 (c) (2) (b), Sec. 8.) 

– This legislation does not provide for the Secretary to issue implementing regulations to assist employers in fully understanding their obligations. The absence of regulations, and the notice and comment process to develop them, will 

mean that employers will be left to figure out how to implement this law on 

their own and heighten the risk that they will not be in compliance. 

Employer Termination of Leave 

• The bill allows an employer to indicate to the employee that it no longer ‘‘believes the employee * * * has symptoms of a contagious illness or poses a threat 

of contagion to other employees or to the public (sic)’’ (See Sec. 3 (c) (4).) 

As noted above, employers are not typically in the position of making such medical determinations. Nor would they be able to examine the employee once they are 

at home, or not at work. 

Impact on Current Policies and Requirements 

• The bill specifies that ‘‘nothing in this Act shall be construed to in any way to 

diminish the rights or benefits that an employee is entitled to’’ based on another 

federal, state or local law, collective bargaining agreement, or existing employer policy. (See Sec. 7.) 

• This provision lacks the necessary clarity to be effectively implemented. 

• One interpretation would be that it means an employer would have to restore 

any paid leave used as a result of them directing an employee to stay home so that 

in effect, an employer would have to add five days to what they are currently providing. 

• Another interpretation would be that an employer would not be able to adjust 

their current policy to reflect that paid leave they would have to provide under this 

bill, i.e. they could not reduce the amount of leave they provide from 10 days to five 

days. 

Sunset of Bill 

• This bill is supposed to sunset two years after enactment. (See Sec. 9.) 
66 

• There is no history of such a benefit being enacted and then being removed. 

There is no such thing as a temporary benefit, just as there is no such thing as a 

temporary tax. 

Definition of Illness 

• This bill defines a ‘‘contagious illness’’ as including ‘‘influenza-like-illnesses such 

as the novel H1N1 virus.’’ (See Sec. 10 (1).) 

– ‘‘Influenza-like-illnesses’’ is a very open ended phrase that could end up 

meaning many conditions. 

– This bill is described as responding only to the current epidemic of H1N1, 

however that illness is not the only condition for which leave would have to be 

paid. The current definition would result in an overly broad application. 

Definition of Covered Employers—Safe Harbor 

• This bill attempts to provide a safe harbor for employers that either do not employ 15 or more employees, or already meet its requirements. (See Sec. 10 (3) (A), 

(B).) 

– However, the bill does not take into account the growing trend by employers 

to provide Paid Time Off (PTO) plans. Under these plans employees are provided with paid leave without specifying the reason for its use. Such plans are 

becoming very popular as they relieve employers of the need to track multiple 

kinds of leave, and the reasons for the leave, and typically allow employees to 

receive the paid leave in compensation when they terminate employment. 

Under the current language, whether employers would be exempted if they offer 

a PTO style plan is not clear. 

– The bill does not make clear whether additional paid leave must be provided 

if an employee has already been provided leave, but has exhausted it by the 

time they need to be out under this bill. 

– The bill does not define the application of leave for employees that are contracted through an employment agency. 

– The bill does not specify how part time or temporary employees should be 

treated for purposes of the 15 employee threshold. 

– The language of (B) says that for an employer policy to qualify, it must not 

only provide five days of paid sick leave per 12 month period, but that this leave 

‘‘may be used at the employee’s discretion.’’ Such a requirement would disqualify many employer leave policies that would otherwise satisfy this safe harbor as employers frequently include a provision that leave be subject to notification, scheduling, or other requirements. The bill does not make clear if such requirements disqualify a leave policy from satisfying this safe harbor. 

November 17, 2009. 

Hon. GEORGE MILLER, Chairman; Hon. JOHN KLINE, Ranking Member, 

Committee on Education and Labor, U.S. House of Representatives, 2181 Rayburn 

House Office Building, Washington, DC. 

DEAR CHAIRMAN MILLER AND RANKING MEMBER KLINE: On behalf of the signed 

organizations and our contractors, subcontractors, material suppliers and employees 

across the nation, we would like to express our opposition to H.R. 3991, the Emergency Influenza Containment Act (EICA). Due to the adverse impact the bill will 

have on small business owners, as well as the counterproductive effect it will have 

on existing leave and benefit packages, we urge your opposition to this legislation. 

Employers offer compensation packages, including leave and other benefits, in 

order to recruit and retain the best employees. Our members are rightfully proud 

of the compensation packages they currently offer, as the benefits included in those 

packages are reflective of the realities of their industries, the preferences of employees and the premium business owners place on quality craftsmanship and a productive work environment. At the same time, the construction industry is facing unprecedented challenges, with an industry-wide unemployment rate of 18.7%, and 

construction employers attempting to create jobs are in no position to absorb another costly government mandate. 

The EICA would require businesses with 15 or more employees to provide their 

employees five days of paid sick leave every 12 months if the employer advises or 

directs an employee to leave or not come into work because it is believed that employee has a contagious illness, or has been in close proximity to an individual with 

a contagious illness. 

This legislation would become law 15 days after enactment, unfortunately without 

federal regulations, and would also sunset after two years. Federal regulations have 

a valuable place in interpreting federal statute, and without the input of a broad 
67 

segment of both regulators and the regulated community, it is hard to know exactly 

how to interpret the day-to-day situations that all employers may face. In H.R. 

3991, we are very concerned about several vague provisions that provide few answers, while raising many questions. 

First, it is unclear under the legislation what it means to advise or direct an employee to leave work or stay at home, and at what point the employer may recall 

that worker. Is an employer policy stating employees should stay at home when ill 

enough to constitute ‘‘advise or direct,’’ or must the employer specifically tell that 

employee not to come in? It is equally unclear when an employer may call an employee back to work, as employers can face liability based on what a fact finder may 

deem it believed with respect to an employee’s health or contagiousness. Next, the 

lack of regulatory guidelines will undoubtedly create situations where employers unwittingly fail to adhere to the vague nature of the new statute despite their best 

efforts to do so. Additionally, it is unclear how EICA will impact existing leave policies. This is especially troublesome considering that more than 80 percent of business owners currently offer paid leave of some kind. It is also especially difficult in 

construction to develop a comprehensive leave policy where a large segment of the 

industry is part-time, project-based or seasonal work. 

Finally, we would be remiss if we failed to address the larger problem with paid 

leave mandates, whether related to H1N1 or not. The economic hardships facing our 

nation have acutely impacted the construction industry. Our industry has seen historic highs in job losses, with more than 1.7 million construction workers without 

employment. At a time when employers are struggling to avoid layoffs and business 

closures, imposing paid leave mandates on employers is unwise policy that threatens jobs and the viability of many of the nation’s small businesses. 

As we have stated in the past, we remain ready to work with Congress in a constructive way to address the impact of current tax and regulatory policies on the 

ability of employers to offer the best benefits possible in the modern workplace. We 

look forward to having constructive discussions on these topics, but those conversations must begin with the recognition that onesize-fits-all mandates from Congress 

are a political rather than practical answer to a very complex issue. 

In the meantime, as the Committee considers H.R. 3991, we strongly encourage 

your opposition to this unnecessary and harmful legislation. 

Sincerely, 

AIR CONDITIONING CONTRACTORS OF AMERICA, 

ASSOCIATED BUILDERS AND CONTRACTORS, 

INDEPENDENT ELECTRICAL CONTRACTORS, 

NATIONAL ASSOCIATION OF HOME BUILDERS, 

NATIONAL ROOFING CONTRACTORS ASSOCIATION, 

PLUMBING-HEATING-COOLING CONTRACTORS—NATIONAL ASSOCIATION. 
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71 
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[Whereupon, at 12:18 p.m., the committee was adjourned.] 

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