The cost of denying paid sick leave

COVID-19 Policy Analysis: As our nation confronts the COVID-19 pandemic, OK Policy will be analyzing state and federal policies that impact our state and its residents during this national health emergency. These posts reflect the most current information available at publication, and we will update or publish follow-ups as new information becomes available.

NOTE: OK Policy is not a state agency and we cannot assist in applying for state services or provide legal advice.

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The current public health emergency makes it clear that paid leave, including paid sick leave, is a critical benefit of employment. The lack of paid sick leave is problematic even during the best of times, and it can be catastrophic during the worst times. Though the Families First Coronavirus Response Act does include two weeks of paid sick leave for some workers, it won’t cover everyone. Employers with more than 500 workers will not be required to provide paid sick leave, and small businesses and health care providers may also be exempted. While this paid leave is good for the workers who will be covered, it is also temporary. It will only be available once. We need a permanent solution. This post below was originally published in December 2017, and has been updated for publication.

Am I too sick to work? Can I take the day off? For many Oklahomans, the answer to these questions is usually “no.” Private employers are not required to offer paid sick leave to their employees in Oklahoma. And yet, sick leave will be needed by almost all workers at some time – to recover from an illness or to care for a sick child or family member. Denying workers paid sick leave creates big costs for all of us. 

The individual cost of being sick

We all get sick, and that shouldn’t put us at risk of losing needed pay or losing our job. Unfortunately, it often means just that. One in four workers employed in the private sector do not receive paid sick leave, meaning that a sick day is a day without pay. And the workers least likely to have access to paid sick leave are also those who can least afford to lose a day’s pay. Only 30 percent of private-sector employees in the bottom 10 percent of earners have access to paid sick leave (compared to 93 percent of workers in the top 10 percent of earners). An hourly worker making minimum wage in Oklahoma could lose 20 percent of their weekly income by taking one sick day. Two sick days could cost 10 percent of their income for the whole month.

For all too many low-income workers, taking sick leave without pay can make it impossible to cover basic expenses for the month. Even worse, it may lead to dismissal or discipline at work – Oklahoma is an at-will employment state, so workers can be fired for any reason, including taking a day off to deal with an illness. For workers who are already struggling to make ends meet, either possibility is dangerous. This means many low-wage workers will continue to go to work despite their illness. This applies to sick children as well – they may be sent to school so their parent can go to work. This is unnecessary, and it’s unhealthy.

The public cost of working sick

Going to work while sick is not just bad for the sick person – it is bad for their co-workers and their community as well. Contagious diseases are more likely to spread when sick workers cannot stay home. The only situation that is comparable to our current health emergency is the 2009 H1N1 flu outbreak. At that time, almost 26 million employed Americans age 18 and older may have been infected. It is estimated that infected people going to work resulted in seven million additional cases of the disease. This spread of contagious disease is especially likely in the accommodation and food service industries, yet only 45 percent of workers in this industry have access to paid sick leave. More than half of food service workers say they “always” or “frequently” go to work while they are sick. This can have serious negative consequences for public health. In 2005, a single restaurant worker at a sandwich shop in Michigan spread norovirus to over 100 customers. During a widespread outbreak of illness, like we’re currently experiencing, paid sick leave becomes even more important. Workers who are sick, or have been exposed to the coronavirus and may become sick, must be able to stay home for perhaps two to three weeks without putting their financial health at risk. 

Paid sick leave policies will also need to be more flexible in a public health emergency. Many people will need to stay home even if they are not sick because of social distancing or because their workplace has closed to help slow the spread of illness. Those circumstances should also qualify for paid sick leave – you are absent from work due to a community health threat. This kind of temporary flexibility is possible when sick leave policies are already in place. States and localities with pre-existing paid sick leave policies have been able to institute temporary adjustments to those policies to allow workers to receive sick pay during this public health emergency, even if they themselves are not sick. 

Paid sick leave for employees can certainly help to contain the spread of contagious diseases, but it also improves overall public health outcomes. Workers with access to paid leave are more likely to receive regular medical care. This can help prevent more serious health problems that require additional time off. If they do get sick, the episode should be shortened because they received care. Employees without paid leave are more likely to delay care. When they do seek care, they are more likely to visit an emergency room that is open all hours but more expensive, instead of a physician’s office that has lower costs but limited hours. This creates an additional financial burden for sick, low-income workers and for the community. These non-emergency visits to the ER increase wait times and increase the cost of health care for us all.

We all need paid sick leave

In the United States, 11 states and the District of Columbia already require, or will soon require, employers to offer paid sick leave to employees. A large majority of Americans believe it should be the standard everywhere. Paid sick leave is good for the public and good for business. Businesses in states and cities that have adopted paid sick leave policies report lower employee turnover, higher employee morale, and improved job satisfaction. Studies have also shown that sick leave policies lead to increased profits for businesses that adopt them. Businesses benefit when workers have time to care for their health. All Oklahomans need paid sick leave, and not just during a public health crisis.


Courtney Cullison worked for OK Policy from 2017 to 2020 as a policy analyst focused on issues of economic opportunity and financial security. Before coming to OK Policy, Courtney worked in higher education, holding faculty positions at the University of Texas at Tyler and at Connors State College in eastern Oklahoma. A native Oklahoman, she received an Honors B.A. in Political Science from Oklahoma State University, and an M.A. and Ph.D. with emphasis in congressional politics and public policy from the University of Oklahoma. While at OU, Courtney was a fellow at the Carl Albert Congressional Research and Studies Center. As a professor she taught classes in American politics, public policy, and research methods and conducted original research with a focus on the relationship between representatives and the constituents they serve.

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