[Senate Hearing 110-296]
[From the U.S. Government Publishing Office]
S. Hrg. 110-296
THE HEALTHY FAMILIES ACT: SAFEGUARDING AMERICANS' LIVELIHOOD, FAMILIES
AND HEALTH WITH PAID SICK DAYS
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
ON
EXAMINING THE HEALTHY FAMILIES ACT, FOCUSING ON SAFEGUARDING AMERICANS'
LIVELIHOOD, FAMILIES, AND HEALTH WITH PAID SICK DAYS
__________
FEBRUARY 13, 2007
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
senate
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
EDWARD M. KENNEDY, Massachusetts, Chairman
CHRISTOPHER J. DODD, Connecticut MICHAEL B. ENZI, Wyoming,
TOM HARKIN, Iowa JUDD GREGG, New Hampshire
BARBARA A. MIKULSKI, Maryland LAMAR ALEXANDER, Tennessee
JEFF BINGAMAN, New Mexico RICHARD BURR, North Carolina
PATTY MURRAY, Washington JOHNNY ISAKSON, Georgia
JACK REED, Rhode Island LISA MURKOWSKI, Alaska
HILLARY RODHAM CLINTON, New York ORRIN G. HATCH, Utah
BARACK OBAMA, Illinois PAT ROBERTS, Kansas
BERNARD SANDERS (I), Vermont WAYNE ALLARD, Colorado
SHERROD BROWN, Ohio TOM COBURN, M.D., Oklahoma
J. Michael Myers, Staff Director and Chief Counsel
Katherine Brunett McGuire, Minority Staff Director
(ii)
C O N T E N T S
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STATEMENTS
TUESDAY, FEBRUARY 13, 2007
Page
Kennedy, Hon. Edward M., Chairman, Committee on Health,
Education, Labor, and Pensions, opening statement.............. 1
Prepared statement........................................... 3
Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming,
opening statement.............................................. 4
Prepared statement........................................... 6
Ness, Debra, President, National Partnership for Women and
Families, Washington, DC....................................... 10
Prepared statement........................................... 12
Heymann, Jody, M.D., Ph.D., Professor at McGill University,
Director, McGill Institute for Health and Social Policy and
Project on Global Working Families, Montreal, Quebec........... 16
Prepared statement........................................... 17
Hartmann, Heidi, Ph.D., President, Institute for Women's Policy
Research, Washington, DC....................................... 23
Prepared statement........................................... 25
Bhatia, Rajiv, M.D., MPH, Director of Occupational and
Environmental Health for the San Francisco Department of Public
Health and Assistant Clinical Professor of Medicine at
University of California at San Francisco, San Francisco, CA... 34
Prepared statement........................................... 36
King, G. Roger, Partner, Jones Day, Columbus, OH................. 38
Prepared statement........................................... 41
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.:
Harkin, Hon. Tom, a U.S. Senator from the State of Iowa,
prepared statement......................................... 62
Clinton, Hon. Hillary Rodham, a U.S. Senator from the State
of New York, prepared statement............................ 63
Brown, Hon. Sherrod, a U.S. Senator from the State of Ohio,
prepared statement......................................... 64
Dancing Deer Baking Co....................................... 64
Medical Legal Partnership for Children....................... 65
Children's Hospital Boston................................... 66
Jeff Levi, Ph.D., Executive Director, Trust for America's
Health (TFAH).............................................. 67
Response to questions of Senator Kennedy by:
Deborah Ness............................................. 67
Jody Heymann, M.D., Ph.D................................. 75
Rajiv Bhatia, M.D., MPH.................................. 82
(iii)
Response to questions of Senator Enzi by:
Debra Ness............................................... 71
Jody Heymann, M.D., Ph.D................................. 80
Rajiv Bhatia, M.D., MPH.................................. 83
G. Roger King............................................ 84
Response to questions of Senator Coburn by:
Jody Heymann, M.D., Ph.D................................. 81
Rajiv Bhatia, M.D., MPH.................................. 84
G. Roger King............................................ 85
Questions of Senator Kennedy to Heidi Hartmann, Ph.D......... 87
THE HEALTHY FAMILIES ACT: SAFEGUARDING AMERICANS' LIVELIHOOD, FAMILIES
AND HEALTH WITH PAID SICK DAYS
----------
TUESDAY, FEBRUARY 13, 2007
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The committee met, pursuant to notice, at 10:07 a.m. in
Room SD-430, Dirksen Senate Office Building, Hon. Edward M.
Kennedy, chairman of the committee, presiding.
Present: Senators Kennedy, Sanders, Brown, Enzi, Isakson,
and Allard.
Opening Statement of Senator Kennedy
The Chairman. We'll get--this is off the record or you can
put it on. We'll get started in just a few minutes. We have--
Senator Enzi and I had the report from the Aspen Commission. It
was Governor Thompson and Governor Barnes on the No Child Left
Behind and we had a conference with our House colleagues and a
number of members of the press and they were somewhat slow
arriving. They had all the members of the commissions. Many had
traveled far distances so we were a few moments tardy but
Senator Enzi will be here momentarily and we'll get started.
I'm very grateful for all of your presence here.
We received good news that we're not going to be
interrupted by votes. We'll have until 2:30 this afternoon. I
think we can finish by then. You might not be able to get out
of here with the snow. That's something that New England does
and people from Wyoming but we'll get started in just a very
few moments. I'm very appreciative. We've got an excellent
panel here.
We'll come to order. Senator Enzi and Senator Isakson, I
just reminded our panel that we were necessarily delayed to
receive really excellent recommendations of the Aspen
Commission on the No Child Left Behind. We welcome the
opportunity now to move ahead on this very important issue.
Each of us knows what it means to be sick. We all had to
miss occasional days of work because of illness and every
parent knows what it is like to care for a sick child. As a
Member of Congress, we don't lose our pay or risk our jobs if
we stay home when illness strikes but millions of Americans
aren't so fortunate. Half of the private sector workers in the
United States do not have paid sick days. Seventy percent don't
have paid sick days they can use to care for family members.
You can't take a day off to recover from the flu. They can't
leave work to care for a child who is running a fever.
This lack of protection is particularly difficult for women
and children. Women have moved into the workforce in record
numbers. They continue to take primary responsibility for their
children's health. Nearly 80 percent of mothers say they are
solely responsible for their children's medical care.
We're talking about hardworking people, like Stephanie
Scott and Elnora Collins who are here today. Stephanie is a
full-time teacher at a day care center. She and her colleagues,
who have been at her workplace for years, have no sick days.
Elnora is a 67-year-old home care worker who is caring for two
granddaughters. She has no paid sick days. She tells us, one
time I was sick, I threw up at a client's house. She loves
caring for older citizens but she needs time off to care for
her own health.
Children need their parents to have paid sick days. I have
a letter from four pediatricians, the Boston Medical Center in
the South End Community Health Center that I'll include in the
record.
[The material referred to can be found in additional
materials.]
The Chairman. But briefly, they say, ``We strongly support
the Healthy Families Act because we believe it could be one of
the most powerful treatments we have for children. By
supporting the Healthy Families Act, you're supporting
minimizing expensive hospital stays for children and getting
parents back to work more quickly.'' If we truly care about
families, we must change our policies. We need laws that let
working men and women be responsible parents, too.
The lack of paid sick days is not just a family issue. It's
also a public health issue. Sick people go to work or sick
children go to school. They infect co-workers or fellow workers
and the public. In fact, many workers who have constant contact
with the public have no paid sick days. Eighty-five percent of
food service workers and 55 percent of workers in the retail
industry are denied that benefit.
Thirty percent of health care workers can't take paid time
off when they are ill. Paid sick days are the obvious solution
to prevent the spread of illnesses and reduce medical costs.
They would result in significant savings to our economy and our
health care system. That's why employers support paid sick
days, too.
Dancing Deer Bakery, a small business in my hometown of
Boston says a national paid sick day law creates a level
playing field for all businesses. We hope that a bill will move
through the Chambers, beyond the President's desk. Paid sick
days should be a non-partisan issue. A healthy nation is a
productive nation.
Paid sick days for workers is a vital step to address
health needs. That's why I'm re-introducing the Healthy
Families Act to provide the seven paid sick days to workers
each year.
We are very mindful on our committee that this is the
committee that had the Family Medical Leave bill. Leaders were
my good friend, Senator Dodd. Five years of hearings before we
finally passed that. And I know that has unpaid family medical
leave and Senator Dodd is really leading in trying to make sure
we make some progress in that area. Senator Murray on our
committee as well, has a more modest approach, particularly to
provide time off for parents work with teachers, in terms of
the educational kind of component. And she is enormously
committed. Others have different ideas. We hope we'll be able
to find the common ground and get some work done in this area.
[The prepared statement of Senator Kennedy follows:]
Prepared Statement of Senator Kennedy
Each of us knows what it means to be sick. We've all had to
miss occasional days of work because of illness. Every parent
knows what it's like to care for a sick child.
As members of Congress, we don't lose our pay or risk our
jobs if we stay home when illness strikes. But millions of
Americans aren't so fortunate.
Half of private-sector workers in the United States do not
have paid sick days. Seventy percent don't have paid sick days
they can use to care for family members. They can't take a day
off to recover from the flu. They can't leave work to care for
a child who is running a fever.
Among workers in the lowest income quarter, 80 percent do
not have the ability to take time off for an illness without
losing their pay or even their jobs.
This lack of protection is particularly difficult for women
and children. Women have moved into the workforce in record
numbers, but they continue to take primary responsibility for
their children's health. Nearly 80 percent of mothers say they
are solely responsible for their children's medical care.
We're talking about hard-working people like Stephanie
Scott and Elnora Collins, who are here today. Stephanie is a
full-time teacher at a day-care center. She and colleagues who
have been at her workplace for years have no sick days. Elnora
is a 67-year-old home care worker who is caring for two
granddaughters. She has no paid sick days. She tells us, ``One
time I was so sick, I threw up at a client's house.'' She loves
caring for older citizens, but she needs time off to care for
her own health.
We're talking about children like Jennetta Allen of
Georgia. She says,
``Once when I was little I got real sick at school. I
waited and waited but Mom never came. . . . When my Mom
finally made it home she was crying more than I was.
She told me her boss would not let her leave. My Mom
was fired because her boss thought I might get sick
again!''
Children need their parents to have paid sick days. I have
here a letter from four pediatricians who work at Boston
Medical Center and the South End Community Health Center. I
will include this letter in the record, but, briefly, they say:
``We strongly support the Healthy Families Act
because we believe [it] could be one of the most
powerful treatments we have for children. By supporting
the Healthy Families Act, you support minimizing
expensive hospital stays for children, and getting
parents back to work more quickly.''
If we truly care about families, we have to change our
policies. We need workplace laws that let working men and women
be responsible parents too.
The lack of paid sick days is not just a family issue--it's
also a public health issue. When sick people go to work or sick
children go to school, they infect coworkers or fellow students
and the public.
In fact, a high proportion of workers who have constant
contact with the public have no paid sick days--85 percent of
food service workers and 55 percent of workers in the retail
industry are denied that benefit. Thirty percent of health care
workers can't take paid time off when they're ill.
Paid sick days are the obvious solution to prevent the
spread of illnesses and reduce medical costs. Every day we see
stories in the paper of stomach illnesses breaking out in
restaurants or on cruise ships. We learn of flu outbreaks
leading to hospitalization of the elderly. These diseases are
very contagious, but their spread can be minimized if sick
people stay at home.
Paid sick days also give people the opportunity to obtain
medical treatment for illnesses or chronic medical conditions.
We all know that preventive care helps reduce medical costs.
For all these reasons, paid sick days would result in
significant savings to our economy and our healthcare system.
That's why employers support paid sick days too. Dancing
Deer Bakery, a small business in my hometown of Boston,
Massachusetts, has written a statement that I will include in
the record, saying that:
``A national paid-sick-days law creates a level
playing field for all businesses. . . . We hope that a
bill will move through both Chambers and be on the
President's desk. Paid sick days should be a non-
partisan issue. A healthy nation is a productive
nation.''
Paid sick days for workers is a vital step to address
health needs. That's why I'll be re-introducing the Healthy
Families Act--to provide 7 paid sick days to workers each year.
We must also move to take steps to deal with other family
and work issues. We need to protect workers who seek greater
flexibility in the workplace. We need to expand family and
medical leave--an issue which Senator Dodd has led for many
years. We need to provide affordable child care, such as
Senator Murray's bill to allow time off for parents to attend
teacher conferences.
The world and the workforce are changing, and our laws have
to catch up. I look forward to hearing from our witnesses today
about how we can move forward and make paid sick days our
national law.
The Chairman. I recognize Senator Enzi.
Opening Statement of Senator Enzi
Senator Enzi. Thank you, Mr. Chairman, I ask that my
prepared statement be a part of the record and included.
The Chairman. It will be so included.
Senator Enzi. Normally I would begin by thanking the
Chairman for holding this important hearing but I've been
through a whole range of emotions on this and had a lot of
difficulty with that statement until I read the testimony. I
agree with the testimony that is to be presented. When paid
sick leave is provided, it makes a tremendous mental impression
on people and helps them out with their daily lives.
One of my concerns is, if we make that a law, is it then
the same category and the same incentive that it is when it's
done voluntarily? We've been holding roundtables and I know
that from an informational standpoint and statistical
standpoint that doing it this way is adequate. There are a lot
of other opinions that I would have like to have had brought
into the mix and we're very limited in a hearing situation to
do that.
But I don't want the public to think that business people
just sit around and say, what do you think Congress would like
us to do on paid sick leave or vacations or any of the other
employee benefits that they have to wrestle with--and I say
wrestle with because I've been one of those small businessmen.
We do it to be sure that we have employees, as effective
employees as possible, as consistent of employees as possible
and we grapple with how to do it and how to beat the
competition on it. You have to be a little better than the
other guy in order to get the employee that you want. And
consequently, across this nation, of those who do provide paid
sick leave, there is a huge variety of ways of doing that and a
huge variety in number of days of doing that. I've actually
read the bill and I've made a lot of comments in the margin on
it and this dictates a way that some, maybe even a majority of
businessmen are providing paid sick leave but it isn't the only
ways that they're doing it and isn't the only amount of time
and there is a variety between how many days a week people work
and how many days sick leave there are and ease of calculation
and ease of record keeping is very important, particularly to
small businessmen.
Now I noticed that this excludes businesses of 15 or
smaller. I'm not sure why it doesn't exclude businesses of 50
or smaller so that it complies with the Family Medical Leave
Act. That seems to be the standard we've established for ultra-
small businesses and ones that would have difficulty with
processing it. I know when I was in the shoe business, we
started with half a day per month for sick leave. Now that only
comes to 6 days a year. We also found out that quite often what
that was, as in addition to their paid vacation because a lot
of times, they were sick when they needed to go somewhere. Some
of my accounting practices, I found that was also helpful and
recommended to a couple of people that most of the accidents
that they had where people took workers comp, which was a paid
time off, happened usually the day before hunting season and
they ought to consider giving hunting season off as a paid
vacation for their people and it would make a difference. You
know and you run into the guy that just got back from an elk
hunting trip and say, I thought you were off with an injury.
Well, I was off from an injury. I said what did you do? And he
said, well I went elk hunting. I said, how did you get into the
backcountry? Well, I hiked. How did you get your elk out? I
backpacked it. And he was out for a back injury. So there are
different circumstances and the businessman has to deal with
that and try to figure out how he can make his employees as
comfortable as possible with the benefits that he is able to
afford.
Oh, yes. Afford. That does play a major role in it. There
are a lot of things that small businessmen would do for their
employees if they could afford it. When we're mandating paid
days off, we're mandating that they pay for it. It's an
unfunded mandate from the Federal Government. We're not saying
if you will give your people time off, we're going to allow
that as an additional tax credit because when you let somebody
off, you have to fill that position in a small business. It
isn't like you had an extra position. If you had an extra
position, you'd have fired the person. So it's a necessary
position and quite often, it's not necessary all of the year
but you pay them in the times that the work is really slow so
that you have them during the times that it's really busy,
although that is time that often they get sick.
But you have to pay the person and then you have to pay the
person that replaces them or you fill in for them yourself. I'm
aware of a guy in my home town that owns three restaurants and
he keeps adding more people to his staff but if I want to find
him, I can go to one of those three restaurants and he'll be
waiting tables because he didn't have enough people that day.
Now when he does that, he still has to spend the night doing
the stuff that he would have done during the daytime, even
though he tries to pay additional people to do it. So these
things aren't quite as easy as they sound.
It would really be nice to give everybody the same amount
of paid leave that the Federal Government gets. Affording it is
the difficulty. It would be nice to do the paid vacation the
same way. Do you know why we don't just prescribe all of those
things? I do know why we don't prescribe all of those things.
We haven't figured a way for the small businessman to afford
it. So I do look forward to the testimony. I appreciate the
effort that went into it. I do have probably more questions
than we can cover during the time that will be allotted on it
and I hope all of you will respond to those questions as well
because that information will be extremely helpful to us in
whatever kind of a solution we can come up with.
Thank you.
[The prepared statement of Senator Enzi follows:]
Prepared Statement of Senator Enzi
I want to thank the chairman for holding this hearing and I
also want to thank the panel for their willingness to
participate in this important dialogue.
Anyone who works for a living is keenly aware of the time
demands that work imposes. The task of balancing work and
family life is never easy, and when illness compounds the
situation, the challenge becomes even greater. Most private
sector employers are acutely aware of this reality and
increasingly responsive to it.
In the most recent member benefit survey conducted by the
Society for Human Resource Management, 86 percent of the
respondents reported that their companies provided paid sick
leave either under a separate sick leave program, or as part of
a general paid time off plan. More than 80 percent also
indicated that they provide both short-term and long-term
disability insurance coverage. In addition, an increasing
number utilize even more creative approaches such as paid time
off, and sick leave banks, or pools.
The more broadly-based National Compensation Survey reveals
that on an overall national basis 68 percent of full-time
employees have access to paid sick leave programs at work.
Most employers make these provisions both because they know
that a healthy workforce benefits their business; and, because
they know that in a competitive labor market, such as the one
we have right now, they must address this issue to attract and
retain quality employees.
Today, the average cost of employee benefits for all
employers in the private sector is nearly $7.50 an hour.
Average benefits now comprise nearly 30 percent of total
payroll costs. That number has been increasing over the years,
and such numbers support the importance that most employers
attach to providing meaningful benefit packages, including
provisions for illness-related absences, for their employees.
Despite these facts, however, some employees do not have
paid sick leave available to them at their place of work
because many of these individuals are part-time employees and
many work for smaller employers. Those small employers very
often face the same cost squeeze and financial pressures that
their own employees face. Many business owners view their
employees as their own extended family. That is a fact that we
need to always keep in mind as we discuss either wages or
benefits and small business. We also must be aware that any
additional requirements we place on small business may be the
imposition of an unfunded employer mandate.
Some estimates suggest that approximately 55 million
private sector workers are without access to paid sick leave.
The Health Families Act, as proposed, would extend paid sick
leave benefits to all of those individuals except those that
work for establishments with fewer than 15 employees which
would cover roughly 45 million employees. The legislation
requires up to 56 hours of paid sick time per employee.
Currently, the average hourly wage is right around $17.00
per hour for non-supervisory, non-farm employees. Thus, the
average cost exposure of the proposed legislation for each
full-time employee is nearly $1,000. Even if we adjust the pool
of the approximately 45 million workers to include part-time
employees who have pro-rata entitlements, the cost exposure
here is clearly in the tens of billions of dollars.
To extend this type of leave requirement to businesses, as
is contemplated by the Healthy Families Act, would be little
more than an unfunded mandate on small businesses throughout
the country. In addition, this legislation represents only
direct labor cost, and does not account for a myriad of other
indirect costs. The money necessary to pay those increased
costs must come from somewhere.
Proponents of this legislation argue that the huge cost of
this legislation would be offset by productivity savings gained
from eliminating ``presenteeism'' which is called by some
individuals the practice of less than healthy individuals
coming to work. Presenteeism ``losses'' are, at best, highly
speculative and subjective. Moreover, private sector human
resource systems have traditionally shown the ability to adapt
to economic reality. Put another way, businesses do not require
Federal mandates to instruct them how to operate more
efficiently, productively and profitably.
No matter how desirable a particular goal may be, one
cannot simply dismiss the costs involved as unimportant or
inconsequential. Here, the costs are decidedly not
inconsequential, particularly for smaller businesses. The pool
of available labor dollars is not infinite, and when we mandate
their expenditure for a specific purpose, we always run the
risk of unintended consequence. A dollar that must be spent
here, often results in a dollar that will not be spent
elsewhere. Imagine the irony for an employee who is granted
sick leave under this bill, but whose employer decides to
eliminate or reduce health plan benefits.
If the end result this bill seeks is indeed healthier
families, then I would also like to invite every member of this
committee to work with me on small business health plan
legislation. That initiative will make America's working
families healthier by allowing small businesses and
associations to band together and buy into health plan coverage
at better rates. Surely as we are rating the ``To Do'' list of
the 110th Congress, increasing the number of insured Americans
ranks higher than giving people days off who may not even have
a health care provider to go to. I know if I were one of the 46
million uninsured Americans, I would think so.
Obviously, increased benefits, like increased wages, enjoys
universal popularity. However, we cannot even contemplate
mandating such benefits in an economic or policy vacuum.
We also need to bear in mind that Washington does not
always have a monopoly on good ideas; and that whenever we act
prescriptively, we also decrease flexibility and creativity.
What works in one place of business may not work in another;
and, what we inflexibly mandate may not be best for all.
I also believe that our consideration of this legislative
proposal must be informed by our experience with similar
legislative initiatives. As some of you may recall last
Congress, the HELP Committee held a roundtable discussion on
the Family and Medical Leave Act. During the course of that
roundtable we learned about many of the practical issues and
problems associated with implementing that legislation. I'd
also note that the Department of Labor has recently solicited
information from the public about many of these same issues.
The Healthy Families Act--as it was introduced in the last
Congress--while not an FMLA proposal, does import some of the
practical problems associated with FMLA that have been
repeatedly brought to our attention. Among those issues have
been the practical problems associated with unanticipated, or
intermittent leave; the issues associated with suspected abuse
of leave entitlements, medical verification and privacy
concerns, the existence of vague legislative terms and
definitions, the issues related to the appropriate increments
in which leave can be taken, and the incidence and costs of
leave-related litigation.
These are not isolated or minor concerns. These concerns
have not been raised in support of any claim that FMLA should
be repealed. Quite to the contrary, virtually all the employers
that have raised these concerns support FMLA, however, they
believe it must be clarified in several important, real-world
respects. In a wide variety of instances this legislation
borrows from FMLA, and imports, and even expands, many of these
same real concerns to the proposed legislation. An appropriate
first step would seem to be meaningfully addressing these very
real issues in the context of our current laws before simply
repeating them in new ones.
Unfortunately, a review of this legislation replicates many
of the practical problems we have witnessed with FMLA, and
makes them even worse. The legislation lacks definitional
precision, adequate safeguards against abuse, and due
recognition of, or provisions to counter, its disruptive impact
on affected businesses. The legislative language is extremely
open-ended as to arguably create a Federal mandate of 56 hours
of paid time off to be used as an employee wishes, and in such
increments as the employee wishes.
While I share the Chairman's concern for working families I
am also concerned for the businesses, particularly the small
businesses, which employ them. I also appreciate that as both a
policy matter and a personal matter the achievement of an
appropriate balance between work and family is a matter of
great importance. However, these are complex problems and
complex problems very often defy simple or universal solutions.
I think we need to recognize this as we move forward, and also
recognize that as simple and attractive as it may appear, we
cannot solve all problems through legislative fiat without any
regard to those that must pay the cost of the mandates we
impose.
Mr. Chairman, thank you for holding this hearing today. I
look forward to hearing from all of our panelists and look to
see how we can help employees and their families to be healthy
while providing the flexibility and stability for our Nation's
small businesses to build and grow their businesses with the
goal towards hiring more workers.
The Chairman. Thank you very much, Senator Enzi. The panel.
We have Debra Ness, who is the President of the National
Partnership for Women and Families. Before assuming her current
role, she served as the Executive Vice President of the
National Partnership for 13 years. Ness has played a leading
role in positioning the organization as a powerful, effective
advocate for today's women and families.
Dr. Jody Heymann is a founding Director of the Institutes
for Health and Social Policy at McGill, an institution
dedicated to research of public policy. She is also a founding
Director of the project of global working families at Harvard;
first research program to comprehensively examine the condition
of working families in the United States and around the world.
She has recently published, Forgotten Families: Ending the
Growing Crisis, confronting children and working parents in the
global economy.
Heidi Hartmann is President of the Institute of Women's
Policy Research, scientific research organization to meet the
need for women-centered policy oriented research. She is also a
Research Professor at the George Washington University and a
recipient of the McCarthy Fellowship Award for her work in the
field of women and economics. She is Vice Chair of the National
Council of Women's Organizations.
Dr. Rajiv Bhatia is the Director of Occupational and
Environmental Health, San Francisco Department of Public Health
and Assistant Clinical Professor of Medicine at the University
of California at San Francisco. He teaches public health at UC-
Berkley.
Mr. G. Roger King, a Partner of Jones Day Law Firm, San
Diego. He specialized in representing employers under Federal
labor law. He was labor counsel for Senator Taft in 1971 to
1973, Senate Committee, 1973 to 1975, also a Captain in the
U.S. Air Force, Judge Advocate, 1972 to 1973. And I had the
chance to say hello and he remembered being a part of this
committee working with Senator Javits and others, going back a
long time. So welcome back to the committee.
We'll start. Debra Ness, please.
STATEMENT OF DEBRA NESS, PRESIDENT, NATIONAL PARTNERSHIP FOR
WOMEN AND FAMILIES, WASHINGTON, DC.
Ms. Ness. Good morning. Good morning, Chairman Kennedy,
Senator Enzi, Senator Isakson. Thank you very much for this
opportunity to testify.
I'm Debra Ness, President of the National Partnership for
Women & Families. We are a non-profit, nonpartisan organization
that for more than 35 years has been working on issues
important to women and families.
I am here to testify in support of the Healthy Families
Act, a groundbreaking piece of legislation to guarantee workers
7 paid sick days annually to recover from their own illness or
care for a sick family member. Congress should waste no time
passing this bill.
The reason is simple. Chances are, each of us will get sick
or need to care for a sick family member some time this year.
But not all of us have the option of taking time off to get
better. In the United States today, nearly half of all private
sector workers do not have a single paid sick day and the
situation is even more grim for low-income workers, three
quarters of whom have no paid sick days.
In fact, 86 million hardworking Americans do not have a
single paid sick day that they can use to care for a sick child
or a sick family member.
I'd like to put a face on some of those statistics. Let me
tell the story of Robbie Bickerstaff. Her son was hit by a car
but he didn't want to call his mom because he was afraid she
would lose her job. When Robbie found out, she of course left
work to take her son to the emergency room where the doctors
were able to treat him and set his broken arm. Fortunately,
Robbie's son was okay but unfortunately, he was right to worry
about his mom's job. Bickerstaff was fired for leaving her job
that day.
Let me tell you the story of Connie Smith, who worked for 3
years at a fast-food restaurant without ever taking a single
sick day until one day, she got the stomach flu. After vomiting
at the restaurant, she told her boss that she simply had to go
home. His response? He ordered her to finish her shift, which
ended at 4 a.m. So she did. She continued to work, handling
food and exposing every customer she served to her illness.
Currently there is no State or Federal law that ensures
that workers have paid sick days when they need them. Senators,
you can change that by passing this bill. The National
Partnership is leading a very broad coalition in support of the
Healthy Families Act, a coalition that includes children's,
civil rights, women's, disability, faith-based, community
groups as well as labor unions, health advocates, and leading
researchers at top institutions. It includes organizations like
9to5, ACORN, the Leadership Conference on Civil Rights, AFL-
CIO, and the U.S. Conference of Catholic Bishops. We are all
very different organizations but we've come together to support
this bill because millions of Americans are being forced to
choose between taking care of a sick child or family member and
losing a day's pay or even losing their job. In a nation that
values families, no worker should have to make this impossible
choice.
Paid sick days are particularly important to women, since
women, for the most part, are still the primary caregivers for
their families. Half of working moms report having to miss work
when a child gets sick and half of those moms also lose pay,
which can be a significant financial blow for families at any
income level.
Paid sick days are also critically important to the well
being of children. Children recover from illness faster when
their parents care for them and having access to paid sick days
also increases the likelihood that working parents can take
their children for preventive care and well child visits that
can help keep them healthy.
Paid sick days are also good for the public health. Our
government, the CDC urges us to stay home from work, to keep
our children out of school and daycare when they are sick but
workers without paid sick days don't have that option and we
all suffer as a result.
Paid sick days are also good for our economy. Studies show
that presentism--employees' practice of coming to work even
though they are sick costs our national economy $180 billion in
lost productivity annually.
Cost-benefit analysis shows that if workers had just 7 paid
sick days a year, our economy would experience a net annual
savings of $8.2 billion due to reduced turnover, higher
productivity and reduction in the spread of contagious illness
in the workplace.
I could go on. Paid sick days are good for low-wage
workers, for older workers, for seniors, for caregivers. Paid
sick days are important to all of us and poll and after poll
has found tremendous public support for paid sick days and
proposals like the Healthy Families Act.
Momentum is building and the National Partnership is
working with organizations across the country. Paid sick day
bills have been or will soon be introduced in cities and State
legislatures from coast to coast. These State and local
initiatives are important but we need more. Americans need paid
sick days and it shouldn't matter what city or what State they
live in.
This debate is really about what we value as a nation.
We're very good at talking about family values but we need to
do more than talk. If we truly care about the health, the well-
being and the economic security of our families, then we must
enact the Healthy Families Act.
Thank you.
[The prepared statement of Ms. Ness follows:]
Prepared Statement of Debra L. Ness
Good morning. Chairman Kennedy, Senator Enzi, and members of the
committee, thank you for the opportunity to testify here today. I am
Debra Ness, President of the National Partnership for Women & Families,
a non-profit, nonpartisan advocacy organization with more than 35 years
of experience promoting fairness in the workplace, access to quality
health care, and policies that help women and men meet the competing
demands of work and family.
I am here to testify in support of the Healthy Families Act, a
groundbreaking piece of legislation to guarantee workers 7 paid sick
days annually to recover from their own illness or care for a sick
family member. Congress should waste no time in passing this bill,
which is tremendously important to people all across our country.
The reason is simple. Chances are each of us will get sick or need
to care for a sick family member this year. But not all of us have the
option to take time off from work to get better. In the United States
today, nearly half (48 percent) of private sector workers do not have a
single paid sick day to use for themselves or to care for a family
member.\1\ The situation is even more grim for low-income workers:
three in four (76 percent) have no paid sick days at all.\2\ And 86
million hard-working Americans do not have a single paid sick day they
can use to care for a sick child.\3\
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\1\ Vicky Lovell, No Time to be Sick: Why Everyone Suffers When
Workers Don't Have Paid Sick Leave, Institute for Women's Policy
Research, May 2004.
\2\ Lovell, No Time to be Sick.
\3\ Lovell, No Time to be Sick.
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Let's put a face on some of those statistics:
Robbie Bickerstaff was fired after leaving work to take
her son, who had been hit by a car, to the emergency room so doctors
could set his broken arm. Her son understood the risk and refrained
from calling her after the accident, because he did not want her to
lose her job. It turns out that he was right to worry.
In 3 years working at a fast-food restaurant, Connie Smith
never took a sick day--until she got the stomach flu. After vomiting at
the restaurant, she told her supervisor that she simply had to go home.
He ordered her to finish her shift, which ended at 4 a.m. She did,
exposing every customer she served to the flu.
Donetta Renee Parish reported to work at a Washington, DC.
grocery store with a severe ear infection because she could not afford
to take unpaid leave. She was later written up for missing work when
she stayed home to care for her 2\1/2\-year-old son who had had a
seizure.
Currently, no State or Federal law ensures that workers have paid
sick days when they need them. You can change that by passing this
bill. The National Partnership is leading a coalition in support of the
Healthy Families Act--a coalition that includes children's, civil
rights, women's, disability, faith-based, community and anti-poverty
groups as well as labor unions, health agencies and leading researchers
at top academic institutions. It includes 9to5, ACORN, the Leadership
Conference on Civil Rights, AFL-CIO, National Organization for Women,
and numerous other large, well-respected organizations. We have come
together in support of this bill because millions of Americans are
being forced to choose between taking care of a sick child or family
member and losing a day's pay--or even losing a job. In a nation that
values families, no worker should have to make this impossible choice.
Americans want to be responsible workers and be able to care for
their families. In 78 percent of today's families, both parents work
for pay--and the typical couple in America now works close to 90 hours
per week. But our policies lag desperately behind--and families are
struggling as a result. We can and must do better--and we will, if we
truly value families.
Coalitions are working in cities and States across this country to
pass measures similar to the Healthy Families Act, and they are making
progress. But we urgently need a national standard. America needs you
to make passage of the Healthy Families Act a priority for this
Congress.
lack of paid sick days hits low-wage workers hardest
When a low-wage worker gets sick, or needs to take care of a sick
child or take an elderly parent to a medical appointment, he or she is
faced with an impossible choice: lose a day of pay and possibly even
your job, or take the time you need to take care of your family. Half
of low-wage working parents report losing pay to stay home and care for
a sick child or being forced to leave children home alone.\4\ In the
wealthiest Nation in the world, these are choices no parent should have
to make.
---------------------------------------------------------------------------
\4\ Jody Heymann, Forgotten Families, Oxford University Press,
2006.
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Low-wage workers typically have little or no savings to fall back
on when they need time off but have no paid sick days. For example, a
recent survey of New York residents found that 71 percent of low-income
workers report having less than $500 in savings, and 52 percent of
those workers report having less than $100 in savings.\5\ When sick
workers have little savings, they are especially vulnerable to extreme
financial crises and even bankruptcy. One study found that nearly 2
million Americans experience medical bankruptcy annually, even though
75 percent of those surveyed had health insurance at the onset of
illness. Respondents reported that illness and medical bills were the
cause of 46.2 percent of their personal bankruptcies.\6\
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\5\ Community Service Society and Lake Snell Perry & Associates,
The Unheard Third 2005: Bringing the Voices of Low-Income New Yorkers
to the Policy Debate, 2005.
\6\ David Himmelstein, Elizabeth Warren, Deborah Thorne, and
Steffie Woolhandler, Illness and Injury As Contributors to Bankruptcy,
Health Affairs Market Watch, 2 February 2005.
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paid sick days are good for children
Children inevitably get sick. On average, school-age children miss
at least 3 school days per year due to health issues, and younger
children have even higher rates of illness.\7\ Providing workers with
paid sick days that can be used to care for a sick child has a positive
impact on children's health. Studies show that children recover from
illness faster when their parents care for them,\8\ and that having
paid time off is a primary factor in a parent's decision to stay home
when a child is sick.\9\ Having access to paid sick days also increases
the likelihood that working parents can take children for the
preventive care and well-child visits that can help keep kids from
getting sick or forestall more serious illness.
---------------------------------------------------------------------------
\7\ Vicky Lovell, No Time to be Sick.
\8\ S.J. Heymann, Alison Earle, and Brian Egleston, 1996, as cited
in Lovell, Paid Sick Days Improve Public Health by Reducing the Spread
of Disease, Institute for Women's Policy Research, 2006.
\9\ Jody Heymann, The Widening Gap.
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paid sick days help workers care for older relatives
Many workers today care for an older relative, and many more will
be caring for them in the near future as Baby Boomers age. In 2000,
12.6 percent of the population was over 65 years old; by 2030,
Americans over age 65 will comprise 20 percent of the population.\10\
Studies have shown that more than a third of Americans (35 percent),
both women and men, have significant eldercare responsibilities, and
many are forced to reduce their work hours or take time off to provide
care.\11\ Providing access to family-flexible sick leave is a critical
strategy for helping working families deal with the needs of their
aging relatives.
---------------------------------------------------------------------------
\10\ Department of Health and Human Services, Administration on
Aging, Statistics on the Aging Population, 2006.
\11\ Families and Work Institute, Highlights of the 2002 National
Study of the Changing Workforce, 2002.
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women are disproportionately impacted by the lack of paid sick days
The lack of paid sick days has a significant impact on working
women, and is particularly threatening to women's economic security.
Women are still predominantly responsible for family caretaking. Many
working women have children, and one in three has additional caretaking
responsibilities for an elderly relative, a person with a disability,
or a special need child.\12\
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\12\ Jody Heymann, The Widening Gap: Why America's Working Families
Are in Jeopardy--and What Can Be Done About It, Basic Books, 2000.
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Staggering statistics demonstrate the hardship that can be
associated with women's caretaking responsibilities: half of working
mothers miss work when a child comes down with a common illness.\13\
Many of these women--two-thirds of low-
income mothers and one-third of middle and upper income mothers\14\--
lose pay to care for their sick children. That is a significant
financial blow for many low- and moderate-income women and their
families.
---------------------------------------------------------------------------
\13\ Kaiser Family Foundation, Women Work and Family Health: A
Balancing Act, Issue Brief, April 2003.
\14\ Kaiser Family Foundation, Women, Work and Family Health: A
Balancing Act.
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Because women are more likely to work part-time (or full-time by
cobbling together more than one part-time position), they are less
likely to have paid sick days. Only 16 percent of part-time workers
have paid sick days, compared to 60 percent of full-time workers.\15\
Accommodation and food service industry workers, the majority of whom
are women (53 percent) have almost no paid sick time.\16\ Women also
are disproportionately represented among low-wage workers, the
population least likely to have access to paid sick days: 59 percent of
minimum wage workers are women.\17\
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\15\ Vicky Lovell, No Time to be Sick.
\16\ Lovell, No Time to be Sick.
\17\ Economic Policy Institute, Minimum Wage Issue Guide, http://
www.epi.org/content.cfml/issueguides_minwage, 2007.
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Further, women's dual commitments to work and family can negatively
affect their career paths and income stability if they lack paid sick
days they can use to care for family members. One study found that
being female doubles the chance of experiencing job loss because of
family illness.\18\
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\18\ Spilerman and Schrank, Responses to the Intrusion of Family
Responses in the Workplace, Research in Social Stratification and
Mobility, 10, 27-61, 1991.
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older workers need paid sick days, too
Roughly half of Americans 65 years or older participate in the
labor force,\19\ and this number is expected to increase as the number
of older Americans increases and more workers delay retirement for
economic or other reasons. Many of these workers will require time away
from work to care for their own health or to care for an older spouse
or other family member.
---------------------------------------------------------------------------
\19\ AARP Public Policy Institute, Update on the Aged 55+ Worker,
2005.
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establishing a minimum standard of paid sick days is good for public
health
Paid sick days are essential to ensuring that workers don't have to
risk their own or the public's health because they can't afford to take
a sick day. The U.S. Centers for Disease Control and Prevention (CDC)
strongly urges us to stay home from work, school, and social gatherings
when we are sick and, not surprisingly, the CDC encourages parents to
keep sick children home from school and daycare to avoid the spread of
illness.\20\ But workers without paid sick days don't have the option
to do so, and we all suffer as a result.
---------------------------------------------------------------------------
\20\ Centers for Disease Control and Prevention, http://
www.cdc.gov/flu/symptoms.htm and http://www.cdc.gov/flu/professionals/
infectioncontrol/childcaresettings.htm.
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Workers in direct contact with the public every day are the least
likely to have paid sick days. Eighty-six percent of food and public
accommodation workers have no paid sick days, and most workers in child
care centers, retail, and nursing homes also lack paid sick days.\21\
Nobody wants a sick worker sneezing in their food, passing illness at
the store, or infecting children and seniors. We want sick children to
recover at home and not infect other children at school or in daycare.
We are all at risk when workers cannot stay home when they are sick or
need to care for a sick child or family member.
---------------------------------------------------------------------------
\21\ Lovell, No Time to be Sick.
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Giving workers paid sick days makes it possible for them to seek
the medical help they or a family member needs. It also removes a key
barrier to health care access, making it possible for them to seek
preventive care. Preventive care is key to improving workers' overall
health and decreasing the number of avoidable hospitalizations, thus
decreasing health care costs. Many people with chronic illnesses such
as asthma or diabetes could avoid hospitalization if they were able to
attend outpatient visits to manage their conditions.
paid sick days are good for the u.s. economy
Providing paid sick days for workers produces benefits beyond those
that accrue to individual workers, children and seniors, or even our
national public health. Healthy workers are critical to a productive
and vibrant economy. Employers and our economy would benefit
substantially if workers had 7 paid sick days annually.
Sick workers in the workplace inevitably hurt more than they help.
All workers who have no paid sick days go to work sick and spread
illness to colleagues, lowering the overall productivity of the
workplace. More than half (56 percent) of human resources executives
report that ``presenteeism''--employees' practice of coming to work
even though they are sick--is a problem in their companies.\22\ Studies
have shown that presenteeism costs our national economy $180 billion in
lost productivity annually.\23\ When workers are guaranteed a minimum
number of paid sick days, employers benefit as healthier workers are
more productive and the spread of illness in the workplace is reduced.
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\22\ CCH Incorporated, 2006 CCH Unscheduled Absence Survey, October
2006.
\23\ Ron Goetzal et al., Health Absence, Disability, and
Presenteeism Cost Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers, Journal of Occupational and
Environmental Medicine, April 2004.
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Employers reap the savings from reduced turnover as well. Turnover-
related costs (which include advertising for, interviewing, and
training replacements) are substantial, generally far greater than the
cost of providing paid sick time to retain existing workers. A cost-
benefit analysis of the Healthy Families Act demonstrates that if
workers had just 7 paid sick days per year, our national economy would
experience a net savings of $8.2 billion per year due to reduced
turnover, higher productivity, and reduction in the spread of contagion
in the workplace.\24\
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\24\ Vicky Lovell, Valuing Good Health: An Estimate of Costs and
Savings for the Healthy Families Act, Institute of Women's Policy
Research, 2005.
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The United States lags far behind the rest of the world in
providing paid leave benefits. A recent study by Dr. Jody Heymann of
Harvard and McGill Universities highlights just how far the United
States lags behind other nations including those with some of the
strongest economies in the world: at least 145 nations provide paid
leave for short- or long-term illnesses, and 127 of those nations
guarantee a week or more of paid sick days per year to their workforce.
The benefits of paid leave are provided to workers in every one of the
top 10 most economically competitive nations in the world, with the
glaring exception of the United States.\25\
---------------------------------------------------------------------------
\25\ Jody Heymann, Alison Earle, and Jeffrey Hayes, Project on
Global Working Families, The Work, Family, and Equity Index: How Does
the United States Measure Up?, 2007.
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Also of note, just last fall the World Economic Forum announced its
annual economic rankings, and the United States had fallen from first
to sixth.\26\ The nations ranked above the United States all guarantee
some paid sick time to their workers.
---------------------------------------------------------------------------
\26\ Steven Pearlstein, No Longer No. 1, and No Wonder, The
Washington Post, Sept. 27, 2006, D10.
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We are familiar with the arguments against establishing minimum
labor standards that provide workers paid sick days, because we heard
them all in the fight to enact the FMLA. We are convinced that they are
specious scare tactics; there are simply no objective studies that
conclude that giving workers good working conditions leads to job loss
or that these protections are in any way linked to higher unemployment
rates.\27\ The statistics, and the experience of other economic power-
house nations, clearly demonstrate that these arguments are not based
in reality.
---------------------------------------------------------------------------
\27\ Jody Heymann, Alison Earle, and Jeffrey Hayes, Project on
Global Working Families, The Work, Family, and Equity Index: How Does
the United States Measure Up?, 2007.
---------------------------------------------------------------------------
the public overwhelmingly supports paid sick days
The likelihood of being sick--or of having a child who will get
sick--does not depend on whether you live in a blue or a red or a
purple State, so establishing a minimum standard of paid sick days
deserves bipartisan support. Poll after poll has found tremendous
support for paid sick days and proposals like the Healthy Families Act.
For example, 7 in 10 New York City residents across income lines
believe there should be a law that requires employers to provide full-
time workers at least 7 days of paid sick time annually.\28\ Nine out
of ten Maryland voters believe that every full-time worker should have
paid sick days. Similarly, 85 percent of respondents in a national poll
support the use of paid sick days to care for children and parents who
are ill.\29\ A recent poll by the National Council for Research on
Women showed that women are five times more likely to vote for a
candidate who favors guaranteed paid sick days.\30\
---------------------------------------------------------------------------
\28\ Community Service Society and Lake Snell Perry & Associates,
The Unheard Third 2005: Bringing the Voices of Low-Income New Yorkers
to the Policy Debate, 2005.
\29\ Job Opportunities Task Force and Gonzales Research & Marketing
Strategies, Statewide Survey, 2006.
\30\ The National Council of Research on Women Poll, 2006.
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conclusion
This debate is really about what we value in this Nation. If we
want strong families and a strong economy, if we care about the health,
well-being and economic security of our families, we will waste no time
in passing the Healthy Families Act.
Guaranteeing access to paid sick days is the next step in the
effort to put our desperately outdated workplaces back in sync with the
realities of families. Paid sick days are the next minimum labor
standard the Nation needs.
Momentum is building. The National Partnership for Women & Families
is working with concerned citizens around the country who are pressing
for paid sick days. San Francisco voters overwhelmingly approved the
country's first paid sick days ordinance in November. Thus far in 2007,
paid sick days bills have been introduced in legislatures in
Connecticut, Florida, Maine and Massachusetts and will be introduced in
the District of Columbia, Maryland, Minnesota, Montana, Vermont,
Wisconsin, and the city of Madison in coming months. These initiatives
are important, but we need even more. Every American needs paid sick
days. The time has come to enact a law that provides paid sick days for
all workers: the Healthy Families Act.
Mr. Chairman, members of the committee, I thank you for the
opportunity to participate in this important discussion.
The Chairman. Thank you.
Dr. Heymann.
STATEMENT OF JODY HEYMANN, M.D., Ph.D., PROFESSOR AT MCGILL
UNIVERSITY, DIRECTOR, MCGILL INSTITUTE FOR HEALTH AND SOCIAL
POLICY AND PROJECT ON GLOBAL WORKING FAMILIES, MONTREAL, QUEBEC
Dr. Heymann. Good morning. There we go. That's a little
better. Good morning, Senator Enzi, Senator Isakson and
Chairman Kennedy. Thank you for inviting me here to testify
today.
My name is Jody Heymann. I am the Director of the Institute
for Health and Social Policy at McGill, Founding Director of
the Project on Global Working Families at Harvard, and on the
faculty of both universities. I am trained as a pediatrician
and a policy analyst and for over a decade and a half, I have
led systematic studies involving over 10,000 working Americans
as well as studies involving over 55,000 families in the global
economy.
I am here today to say that the Healthy Families Act would
make an enormous difference to working Americans. When we asked
people across the country, in a representative sample from
coast to coast, what was the single most important reason that
they had to disrupt work to care for a family member, it was
health. That was true for Americans from 25- to 75-years old,
for men and women across every geographic region. Yet, nearly
half of private sector workers currently have no paid sick days
at all and an even larger percentage lack the ability to take
days off to care for sick family members.
Sick days matter to employees. They matter because they
lead to faster recovery from illnesses and employees being less
likely to spread their illnesses to those they work with. They
also matter because people are more likely not to lose jobs. In
fact, in the national study we did, having a health problem
increased by 50 percent the likelihood of job loss among low-
wage mothers. This matters to the middle class as well. The
single factor that made the biggest difference in keeping your
job if you got sick was paid sick days. Among nurses across the
country, two and a half times as likely to keep your job if you
had paid sick days once you got sick. So it matters to
employees and it matters to their families.
What are the basic facts about families? A majority of
working Americans are caring for children, the elderly or
disabled. Seventy percent of mothers with children under 18 are
in the workforce. A third of working Americans are caring for
somebody over 65 and two out of seven have at least one member
in their family with disabilities.
Let's just take the case of children which we began to hear
about from Debra and look at it a little bit more. When there
are no paid sick days available, we know what happens. Children
are sent to daycare sick with contagious diseases that spread
to other kids. They are left home alone. They are often unable
to see physicians for diagnosis or needed medications and end
up with emergencies and conditions that worsen.
When paid sick days are available and this is the important
statistic to remember, families are five times as likely to be
able to care for their children when they're sick.
Now it matters to adult care as well. When adults receive
support from family members when they are sick, they have
better health outcomes from major illnesses like heart attacks
and strokes and those same working Americans that we asked
across the country, who did you need to care for when they got
sick? Well, 42 percent reported it was their children. The rest
were reporting a wide range of family members, which is why I
commend the fact that this act is written to incorporate the
fact that you can be caring for aunts or uncles, grandchildren
as well as your own children's spouses who are in desperate
need of help.
Businesses benefit at the same time and that's why I'm glad
it's been raised, the issue of what are the economic
consequences? Businesses benefit from limiting the spread of
infectious diseases in the workplace, from lowering job
turnover rates, from lower recruitment and training costs,
lower presentism costs and we base this on having spoken with
businesses across the country.
Importantly, we know the United States can compete while
doing this. We've done a study of the countries around the
world and who is offering paid sick days. One hundred and
forty-five countries offer paid sick days. In at least 100 of
these countries, it begins on the first day you are sick.
Unless we think 7 days is too many, in 100 of these countries,
it's for a month or more.
Now, the world business leaders in the world economic forum
have ranked the most competitive economies around the world and
every single one of the 20 most competitive economies with the
exception of the United States, guarantees paid sick days. In
fact, guaranteeing paid sick days makes you more competitive
and we have rigorous analyses showing that.
As for unemployment, which is a question that has been
raised, there is absolutely no relationship between national
unemployment or employment levels and offering paid sick days.
So in conclusion, can the United States afford to provide
paid sick days and still compete in the global economy? Most of
the world already has legislation guaranteeing paid sick days.
All the competitive economies do. I have faith that U.S.
companies are just as strong and compete as well with it. Will
it make a difference to the health of American children and
adults alike in need? Absolutely. It will make a great
difference and particularly to those in greatest need, low-
income families who are the most likely to lack it. Thank you
for having me here.
[The prepared statement of Dr. Heymann follows:]
Prepared Statement of Jody Heymann, M.D., Ph.D.
Good morning, Chairman Kennedy, Senator Enzi, and members of the
committee. My name is Jody Heymann. I am the Director of the Institute
for Health and Social Policy at McGill University, Founding Director of
the Project on Global Working Families at Harvard University, and on
the faculty at both McGill and Harvard Universities. For the past
decade and a half, I have led a research team at Harvard and now at
both McGill and Harvard, which focuses on understanding the conditions
working families face in America and in a globalized economy, and what
can be done to improve the conditions of working adults, their
children, their elderly parents, and other family members.
Trained as a pediatrician and a policy analyst, I began this work
when it became clear from individual families that the conditions
parents faced in the workplace and in their communities in the United
States were having a dramatic effect on the health of American
children. Over the past decade and a half, I have led systematic
studies involving over 10,000 Americans--from every State and across
all income and demographic groups--as well as studies involving over
55,000 families in the global economy, and have examined public
policies across the United States and across 180 other economies we
interact and compete with.
Thank you for inviting me here to testify today. I am here to urge
you to support the Healthy Families Act. The Healthy Families Act will
make a crucial difference to the health and livelihoods of American
adults and their families. The provisions in the act are readily
feasible and affordable while competing in the global economy.
working families in america
The clear majority of working Americans care for children,
disabled, or elderly adults.\1\ According to the Bureau of Labor
Statistics, 70 percent of mothers with children under 18 are in the
workforce.\2\ At the same time, the National Study of the Changing
Workforce found that between 25 percent and 35 percent of working
Americans are currently providing care for someone over 65.\3\
According to the Census Bureau, 2 in every 7 families report having at
least one member with disabilities.\4\ While both men and women provide
important care, women are still much more likely than men to assume
primary caregiving responsibilities for family members of all ages.\5\
\6\ \7\
While the majority of working Americans are caring for family
members--children, spouses or partners, parents, grandchildren, and
grandparents--the United States does not have most of the basic
protections the rest of the world can count on. While the United States
compares well to many other countries in having policies that ensure an
equitable right to work for all racial and ethnic groups, regardless of
gender, age or disability, the United States lags far behind the rest
of the world when it comes to most policies protecting working
families. Just to cite a few examples, 168 countries offer guaranteed
leave with income to women in connection with childbirth; 66 countries
ensure that fathers either receive paid paternity leave or have a right
to paid parental leave; 107 countries protect working women's right to
breastfeed; 137 countries mandate paid annual leave; and 145 countries
provide paid sick days or leave for short- or long-term illnesses. The
United States does not guarantee any of these yet.\8\
And in the absence of legislation, the private sector has not
filled the gap. Nearly half of private sector workers have no paid sick
days at all. An even larger percentage lack the ability to take days
off to care for sick family members.\9\ While many families cannot
reliably count on paid sick days, working poor families are at the
highest risk. Our research team found that 76 percent of low-income
working parents did not consistently have paid sick days over a 5-year
period.\10\
why sick days are such an important place to start
The research group I lead carried out an important study to learn
from working Americans about their greatest needs when it comes to
caring for family members. We interviewed a representative sample of
Americans across the country every day for a week to learn about work
disruptions they experienced in order to meet the needs of family
members. The greatest needs were in two areas: caring for the health of
family members and meeting school or child care needs. Meeting the
health needs of family members was a top priority for working Americans
from 25- to 75-years old in our study, for men and women, and for
people across every geographic region. It is important to note that the
need to care for children accounted for only 42 percent of work
disruptions that were related to family. Fifteen percent were to care
for parents, 12 percent to care for spouses or partners, 7 percent for
grandchildren, and 24 percent for other family members.\11\ Because of
the range of family needs, I fully support the definition of family
coverage in the Healthy Families Act; it accurately reflects the needs
and commitments of American families.
sick days' impact on the health of working americans and their families
When you look at the evidence on the importance to child and adult
health of having family members involved in their care, then it should
not be a surprise that this is a top priority for Americans. Parental
availability is vital for ensuring children's physical health. Children
sent to daycare sick with contagious diseases exacerbate the higher
rate of observed infections in daycare centers,\12\ \13\ \14\ \15\
including higher rates of respiratory and gastrointestinal
infections.\16\ \17\ \18\ Children left home alone may be unable to see
physicians for diagnoses, needed medications, or emergency help if
their conditions worsen. Furthermore, parental care may be important
for children even when substitute sick child care is available. Studies
of hospitalized children have shown that sick children have shorter
recovery periods, better vital signs, and fewer symptoms when their
parents share in their care.\19\ \20\ \21\ \22\ The presence of parents
has also been found to shorten children's hospital stays by 31
percent.\23\ Without paid sick days, working parents have little choice
but to send their sick children to day care or school, have young
children stay home alone, or miss needed meetings with doctors with
potentially serious health consequences.
At the same time, the proportion of adults having to meet the needs
of elderly and disabled adult family members while working is growing
and will continue to do so as the American population ages. The
percentage of the U.S. population made up of individuals aged 60 and
older is estimated to increase more than 1.5 times and the percentage
of the U.S. population made up of individuals aged 80 and older is
estimated to double by 2050.\24\ A wealth of research has shown that
when adults receive support from family members when sick, they have
substantially better health outcomes from conditions such as heart
attacks \25\ \26\ and strokes.\27\ An extensive body of research also
demonstrates that elderly individuals live longer when they have higher
levels of social support from friends and family members.\28\ \29\
The ability of workers to address their own health needs is equally
critical. Research has shown that taking the necessary time to rest and
recuperate when sick encourages a faster recovery \30\ and may prevent
minor health conditions from progressing into more serious illnesses
that require longer absences from work and more costly medical
treatment.\31\ \32\ \33\ If working adults are able to stay home when
they are sick, they are also less likely to spread their illness to
those they work with.\34\
Workplace policies are essential to the ability of working adults
to meet both their own health needs and the health needs of their
family members. Our research found that the largest determinant of
whether or not American parents can care for their children when they
get sick is the availability of paid sick days. We have found that
parents who have paid sick days are more than five times as likely to
be able to care for their children themselves when they get sick as
parents who do not have paid sick days.\35\ \36\
impact on the ability of americans to get jobs, keep jobs, and earn
a decent living
Without paid sick days, working families are placed at risk
economically, experiencing wage and job loss when they take time off to
provide care for family members.\37\ \38\ \39\ \40\ Alison Earle, a
senior member of our research group, and I conducted the most
comprehensive longitudinal study of working poor families and job loss
in the United States. We found that the ability of working poor mothers
to keep a job was dramatically affected by the health of the mother and
the health of her child, even after taking into account the mother's
years of education, her skills, and the local environment in which she
was looking for work. Having a health problem led to a 53 percent
increase in job loss among low-wage mothers and having a child with
health problems led to a 36 percent increase.\41\
We know paid sick days could make an enormous difference in the
ability of adults to return to work and keep their jobs. In a
subsequent study we carried out of nurses, most of whom were middle
class, having sick days made all the difference in their ability to
keep jobs after developing heart disease or having a heart attack. Of
all the working conditions studied, paid sick days were the only
benefit significantly associated with an increased likelihood of
returning to work; nurses with paid sick days were 2.6 times more
likely to return to work after a heart attack or angina.\42\
impact on businesses
Offering paid sick days has positive benefits for employers,
including limiting the spread of infectious diseases in the workplace
by letting employees stay home when sick.\43\ \44\ As just one example,
the spread of infectious disease at the workplace is the reason that
the U.S. Centers for Disease Control and Prevention recommended that
Americans with influenza--a disease that leads to 200,000
hospitalizations and over 36,000 deaths in an average year \45\--stay
home when they are sick.\46\ In health care and service settings,
providing sick days to employees also helps protect the health of
patients and customers. For example, one study found a decreased risk
of respiratory and gastrointestinal outbreaks among residents in
nursing homes that provide their employees with paid sick days.\47\
At the same time, workplaces with paid sick days experience lower
job turnover rates, leading to lower recruitment and training costs and
a higher level of productivity and decreased unnecessary
absenteeism.\48\ \49\ In addition, a recent study found that customer
satisfaction and commitment to service providers were lowest when
consumers viewed the employer as having a high rate of turnover.\50\
sick days are feasible and affordable
While there are clear economic benefits to paid sick days, it's a
natural question to ask whether the United States can mandate paid sick
days and still compete in the global economy. Having examined data on
the public policies for working families in 177 countries around the
world, we can answer this with a clear yes. One hundred and forty-five
countries guarantee paid sick days. In at least 100 countries, paid
sick days begin with the first day of illness.\51\
By global standards, the seven days proposed in the Healthy
Families Act is quite modest. One hundred and two countries guarantee 1
month or more of paid sick days.\52\
The World Economic Forum, which brings together the top business
leaders from around the world, has ranked the most competitive national
economies.\53\ All of the 20 most competitive countries, with the
exception of the United States, guarantee paid sick days, and 18 of
them provide 31 or more sick days with pay.\54\ In fact, we have
examined the relationship between national economic competitiveness and
paid sick days and leave. Those countries which are most economically
competitive are consistently more likely to guarantee paid sick days
and leave for employees' own health, for the care of children's health,
and to meet the health needs of other adult family members.\55\ It
makes sense. If you guarantee paid sick days, you have healthier
workers and a healthier next generation--both essential to competition.
Table 1.--Ten Most Competitive Economies and Their Sick Day Policies
----------------------------------------------------------------------------------------------------------------
Provides more than 10 paid
Country/Economy Ranking Any paid sick days? sick days
----------------------------------------------------------------------------------------------------------------
Switzerland.............................. 1 Yes......................... Yes
Finland.................................. 2 Yes......................... Yes
Sweden................................... 3 Yes......................... Yes
Denmark.................................. 4 Yes......................... Yes
Singapore................................ 5 Yes......................... Yes
United States............................ 6 No.......................... No
Japan.................................... 7 Yes......................... Yes
Germany.................................. 8 Yes......................... Yes
Netherlands.............................. 9 Yes......................... Yes
United Kingdom........................... 10 Yes......................... Yes
----------------------------------------------------------------------------------------------------------------
* Rankings are from the World Economic Forum's Global Competitiveness Report 2006 2007. Information on paid sick
days is taken from the Work, Family, & Equity Index, 2007.
conclusion
Finally, I'd like to speak for a moment on a personal note, as a
doctor and as a mother. When I cared for children as a doctor, like
other pediatricians, I relied entirely on the ability of parents to
provide care for their children. When I discharged a child from the
hospital after a serious asthma attack, the prescription and
instructions for care went with the mother and father--and on the
shoulders of parents rested whether the child would have a healthy
recovery or return within days to the emergency room. For parents whose
work let them take sick days to care for their children, whether after
an asthma attack, to get a routine vaccination, or to check that the
child met important developmental milestones, this was a fair
responsibility to place on their shoulders. But for too many American
parents, I've learned they have no chance to provide adequate care for
their children--no matter how desperately they want to--because they
are forced to choose between taking the needed hours to care for their
children's health and earning income that is essential to that care.
As a young mother, I stood outside my son's childcare center and
listened sadly to the experience of another parent. The childcare
center served medical school faculty and hospital workers from every
kind of job. The mother I spoke to had succeeded in leaving welfare for
work and had placed her children in childcare. Like many children
during their first year in childcare, hers were sick often with
respiratory infections and fevers high enough that they were not
allowed to go to the center. My children had the same hurdles, but I
could take leave from work. Her job offered no paid sick days. At the
end of the year, she was dismissed, unemployed, and falling deeper into
poverty because of the days she missed when her children were sick.
After a decade and a half of our research, confirmed over and over
again by the research of other groups, we know these experiences are
not the exception.
In short, the United States currently lags dramatically behind all
high-income countries, as well as many middle- and low-income countries
when it comes to paid sick days designed to protect the health of
working Americans and their families. Can the United States afford to
provide paid sick days and still compete in the global economy? The
answer is clearly yes. Most of the world already has legislation
guaranteeing paid sick days. All the most competitive economies do.
Will it make a difference to the health of American children and adults
alike in need of care? An enormous one, particularly for the health and
well-being of those in greatest need--low-income families and families
with a child or adult with frequent illnesses or a chronic health
condition.
The Healthy Families Act is superbly constructed to help meet the
essential needs of working adults and their families and at the same
time is readily achievable. Thank you again for holding these hearings
and for taking the time to move forward on these critically important
issues facing American working families. If I or my staff can be of
further help to you as you continue to deliberate on these issues,
please do not hesitate to contact us.
Endnotes
\1\ Heymann J. (2000). The Widening Gap: Why America's Working Families
are in Jeopardy and What Can Be Done about It. New York: Basic
Books.
\2\ U.S Bureau of Labor Statistics. (2006). Employment Characteristics
of Families in 2005. Washington, DC.: U.S. Dept. of Labor.
Available online at: http://www.bls.gov/news.release/pdf/famee.pdf.
\3\ Bond, J.T., C. Thompson, E. Galinksy & D. Prottas. (2002). The
National Study of the Changing Workforce. New York: Families and
Work Institute.
\4\ Wang Q. (2005). Disability and American Families: 2000. Washington,
D.C.: U.S. Census Bureau. Available online at: http://
www.census.gov/prod/2005pubs/censr-23.pdf.
\5\ Dalenberg, D., J. Fitzgerald, & J. Wicks. (2004). Direct valuation
of personal care by households. Population Research & Policy Review
23:73-89.
\6\ Bond, J.T., C. Thompson, E. Galinksy & D. Prottas. (2002). The
National Study of the Changing Workforce. New York: Families and
Work Institute.
\7\ Heymann J. (2000). The Widening Gap: Why America's Working Families
are in Jeopardy and What Can Be Done about It. New York: Basic
Books.
\8\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/
Montreal: Project on Global Working Families. Available online at:
http://www.mcgill.ca/files/ihsp/WFEIFinal
2007.pdf.
\9\ Lovell V. (2004) No Time to Be Sick: Why Everyone Suffers When
Workers Don't Have Paid Sick Leave. Washington, DC.: Institute for
Women's Policy Research. Available online at: http://www.iwpr.org/
pdf/B242.pdf.
\10\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York:
Basic Books.
\11\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York:
Basic Books.
\12\ Loda F.A., W.P Glezen, & W.A. Clyde. (1972). Respiratory disease
in group day care. Pediatrics 49:428-437.
\13\ Sullivan P., W.E. Woodward, L.K. Pickering, & H.L. Dupont. (1984).
Longitudinal study of occurrence of diarrheal disease in day care
centres. Am J Public Health 74:987.
\14\ Dahl I.L., M. Grufman, C. Hellberg, & M. Krabbe. (1991).
Absenteeism because of illness at daycare centers and in three-
family systems. Acta Paediatr Scand. 80:436.
\15\ Mottonen M. & M. Uhari. (1992). Absences for sickness among
children in day care. Acta Paediatr. 81:929.
\16\ Loda F.A., W.P Glezen, & W.A. Clyde. (1972). Respiratory disease
in group day care. Pediatrics 49:428-437.
\17\ Strangert K. (1976). Respiratory illness in preschool children
with different forms of day care. Pediatrics 57:191.
\18\ Doyle A.B. (1976). Incidence of illness in early group and family
day care. Pediatrics 58:607.
\19\ Robertson J. Young Children in Hospital. London, England:
Tavistock.
\20\ Van der Schyff G. (1979). The role of parents during their child's
hospitalization. Aust Nurs J. 8:57-61.
\21\ Mahaffy P. (1965). The effects of hospitalization on children
admitted for tonsillectomy and adenoidectomy. Nurs Res. 14:12-19.
\22\ Palmer S.J. (1993) Care of sick children by parents: A meaningful
role. J Adv Nurs. 18:185.
\23\ Taylor M. and P. O'Connor. (1989). Resident parents and shorter
hospital stay. Archives of Disease in Childhood 64(2): 274-276.
\24\ United Nations Population Division. (2004). World Population
Prospects: The 2004 Revision Highlights. New York: Department of
Economic and Social Affairs, UN. Available online at: http://
www.un.org/esa/population/publications/WPP2004/
2004Highlights_finalrevised.pdf.
\25\ Bennet S.J. (1993). Relationships among selected antecedent
variables and coping effectiveness in postmyocardial infarction
patients. Research in Nursing and Health 16:131-139.
\26\ Gorkin L., E.B. Schron, M.M. Brooks, I. Wiklund, J. Kellen, J.
Verter, J.A. Schoenberger, Y. Pawitan, M. Morris, & S. Shumaker.
(1993). Psychosocial predictors of mortality in the Cardiac
Arrhythmia Suppression Trial-1 (CAST-1). American Journal of
Cardiology 71:263-267.
\27\ Tsouna-Hadjis E., K.N. Vemmos, N. Zakopoulos, & S.
Stamatelopoulos. (2000). First-stroke recovery process: The role of
family support. Archives of Physical Medicine and Rehabilitation
81:881-887.
\28\ Seeman T.E. (2000). Health promoting effects of friends and family
on health outcomes in older adults. American Journal of Health
Promotion 14:362-370.
\29\ Berkman L.F. (1995). The role of social relations in health
promotion. Psychosomatic Medicine 57:245-254.
\30\ Gilleski D.B. (1998). A dynamic stochastic model of medical care
use and work absence. Econometrica 66:1-45.
\31\ Aronsson G., K. Gustafsson, & M. Dallner. (2000). Sick but yet at
work: An empirical study of sickness and presenteeism. Journal of
Epidemiology and Community Health 54:502-509.
\32\ Grinyer A. and V. Singleton. (2000). Sickness absence as risk-
taking behaviour: A study of organizational and cultural factors in
the public sector. Health, Risk, and Society 2:7-21.
\33\ Johannsson G. (2002). Work-life balance: The case of Sweden in the
1990s. Social Science Information 41:303-317.
\34\ Skatun J.D. (2003) Take some days off, why don't you? Endogenous
sick leave and pay. Journal of Health Economics 22(3):379-402.
\35\ Heymann S.J., S. Toomey, & F. Furstenberg. (1999). Working
parents: What factors are involved in their ability to take time
off from work when their children are sick? Archives of Pediatrics
& Adolescent Medicine 153:870-874.
\36\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York:
Basic Books.
\37\ Murphy B., H. Schofield, J. Nankervis, S. Bloch, H. Herman, & B.
Singh. (1997). Women with multiple roles: The emotional impact of
caring for ageing parts. Ageing and Society 17:277-291.
\38\ Joshi H., P. Paci, & J. Waldfogel. (1999). The wages of
motherhood: Better or worse? Cambridge Journal of Economics 23:543-
564.
\39\ National Alliance for Caregiving and American Association of
Retired People. (2004). Caregiving in the U.S. Available at http://
www.caregiving.org/data/04finalreport.pdf.
\40\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York:
Basic Books.
\41\ Earle A. & S.J. Heymann. (2002). What causes job loss among former
welfare recipients? The role of family health problems. Journal of
the American Medical Women's Association 57:5-10.
\42\ Earle A., J.Z. Ayanian, & S.J. Heymann. (2006). What predicts
women's ability to return to work after newly diagnosed coronary
heart disease: Findings on the importance of paid leave. Journal of
Women's Health 15(4): 430-441.
\43\ Lovell V. (2004) No Time to Be Sick: Why Everyone Suffers When
Workers Don't Have Paid Sick Leave. Washington, DC.: Institute for
Women's Policy Research. Available online at: http://www.iwpr.org/
pdf/B242.pdf.
\44\ Skatun J.D. (2003) Take some days off, why don't you? Endogenous
sick leave and pay. Journal of Health Economics 22(3):379-402.
\45\ Centers for Disease Control and Prevention. (2006). Key Facts
about Influenza and the Influenza Vaccine. Available online at:
http://www.cdc.gov/flu/keyfacts.htm.
\46\ Centers for Disease Control and Prevention. (2006). Good Health
Habits for Preventing the Flu. Available online at: http://
www.cdc.gov/flu/protect/habits.htm.
\47\ Li J.H., G.S. Birkhead, D.S. Strogatz, & F.B. Coles. (1996).
Impact of institution size, staffing patterns, and infection
control practices on communicable disease outbreaks in New York
State nursing homes. American Journal of Epidemiology 143(10):1042-
9.
\48\ Lovell V. (2005). Valuing Good Health: An Estimate of Costs and
Savings for the Healthy Families Act. Washington, DC.: Institute
for Women's Policy Research. Available online at: http://
www.iwpr.org/pdf/B248.pdf.
\49\ Watkins M.P. (2004). The Case for Minimum Paid Leave for American
Workers. Seattle: Economic Opportunity Institute. Available online
at: http://www.eoi
online.org/MinimumPaidLeave/Minimum%20LeaveBlueprint2004.pdf.
\50\ Casey T.F. & K. Warlin. (2001). Retention and customer
satisfaction. Compensation Benefits Review 33:27-31.
\51\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/
Montreal: Project on Global Working Families. Available online at:
http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
\52\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/
Montreal: Project on Global Working Families. Available online at:
http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
\53\ Lopez-Claros A., M.E. Porter, X. Sala-i-Martin, & K. Schwab.
(2006). The Global Competitiveness Report 2006-2007. Hampshire, UK:
Palgrave Macmillan.
\54\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/
Montreal: Project on Global Working Families. Available online at:
http://www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
\55\ Earle A. & J. Heymann. (2006). A comparative analysis of paid
leave for the health needs of workers and their families around the
world. Journal of Comparative Policy Analysis 8(3):241-257.
The Chairman. Heidi.
STATEMENT OF HEIDI HARTMANN, PH.D., PRESIDENT, INSTITUTE FOR
WOMEN'S POLICY RESEARCH, WASHINGTON, DC.
Ms. Hartmann. Good morning, Mr. Chairman.
The Chairman. Good morning.
Ms. Hartmann. Senator Enzi, Senator Isakson. Thank you very
much for the invitation to testify here this morning. I
represent the Institute for Women's Policy Research, which is a
think tank focusing on issues of importance to women. I'd like
to acknowledge the work of Dr. Vicky Lovell on our staff, who
has helped prepare the testimony today and who has conducted
the research that I will be summarizing.
And Mr. Chairman, before I begin, I'd like to thank you for
your leadership, not only on the Healthy Families Act but on so
many issues important to working women. I'd like to mention
especially let us say your encouragement to the Bureau of Labor
Statistics to reinstate the Women Workers Data series, a data
set that we used today in presenting this research. So thank
you very much.
I'd also like to acknowledge Holly Fechner's contribution
in crafting the Healthy Families Act. She took an idea, only an
idea brought to her by some researchers back in 2000 and
working with many other people along the way, including leaders
of the business community and the health profession. She has
drafted a well thought out law that we are able to hold
hearings on today.
Since the year 2000, when we first brought that idea to
your staff, IWPR has conducted research on many aspects of the
Healthy Families Act, working with other researchers, members
of Congress, State and municipal legislators and advocates
across the country.
Today I want to just briefly summarize the most important
findings and ask that the full testimony be included in the
record. Our most recent research uses the brand new
Confidential Data Set, the National Compensation Survey housed
at the Bureau of Labor Statistics, which collects data from the
nation's employers about the benefits they provide their
workers.
The first and most important point is that millions of U.S.
workers are without any paid sick days. Fifty-seven million
workers in March of 2006, the most recent survey date, lack
paid sick days. Forty-eight percent, nearly half of all private
sector workers lack paid sick days. Twenty-two million women
workers lack paid sick days.
When Mr. King will testify in a few moments that 75 percent
of employers provide some paid days off, he is correct. They
do. But that includes vacation and holidays. Having July 4th is
great but it won't help you with an illness unless you happen
to be sick on July 4th.
Actually, it's true that half of all workers have no paid
sick days. I wanted to also stress that if any employer has the
new style PTO--paid time off--the flexible leave that is
becoming more common, those employers are counted in these data
as providing paid sick days. If we can take a look for a moment
at Figure 1 (see Ms. Hartmann's prepared statement), it shows
the industries that have coverage for their workers with paid
sick days and it goes from a high of 80 percent of workers with
paid sick days and utilities and finance and insurance to a low
of only 22 percent in food service. If we look at only those in
that industry who actually handle the food, it's only 15
percent who have paid sick days and if we look further at a
smaller group, waiters and waitresses, it's only 8 percent who
have paid sick days. So 92 percent of waiters and waitresses
have no paid sick days. Childcare workers--80 percent have no
paid sick days. Retail sales clerks--57 percent have no paid
sick days.
Dr. Bhatia will testify that from a public health
standpoint, food service jobs are among the most important jobs
that should be protected with paid sick days. The very workers
we come into contact with every day--food, childcare, retail
services--they have among the worst coverage.
Besides industry and occupation, who are the workers who
most often lack paid sick days? Part-time workers, yes. Only 20
percent have paid sick days. Eighty percent don't have any. But
considering all full time workers, only 62 percent have some
paid sick days. That means that nearly half--40 percent--don't
have any.
Low pay, yes. If we take a look at Figure 2 (see Ms.
Hartmann's prepared statement), we see that only 20 percent in
the bottom quarter have some paid sick days. Eighty percent
don't have any.
The Chairman. Excuse me, do you have these charts in a
smaller form? I have difficulty seeing----
Ms. Hartmann. Yes, they should be in the testimony.
The Chairman. I have them. Thank you. One of my wonderful
staff has just placed it in front of me. Thank you.
Ms. Hartmann. Sorry. But I'd like to also call your
attention not just to the bottom quartile where we can assume
the lowest wage workers will have the least paid sick days but
look at the second quartile from the bottom, where 40 percent
don't have paid sick days and in the third quartile, 46 percent
don't have paid sick days and even if you look in the highest
paid quartile, 28 percent do not have paid sick days so that
means nearly one-third of all workers, even in the top, don't
have paid sick days. The lack of paid sick days, therefore,
goes throughout the economy in virtually every sector from the
lowest to the highest paid.
We also found in the new National Compensation Survey that
the average worker has to wait more than two and a half months
to use any sick days the employer may have on the books.
Finally, we have looked at the cost to the economy from the
turnover that exists because all of these people do not have
paid sick leave and the cost is actually $31 billion a year.
These are new 2006 estimates but we'll be--they are
provisional. We'll make new estimates when we have a new bill
and the benefits to workers would be $22 million. So the
benefit from the gain in productivity far outstrips the cost of
$22 billion, $31 billion gain, $22 billion cost. So the economy
as a whole gains.
In conclusion, I would like to say that workers need
expanded paid sick days policies. The change will be good for
our economy. It will even save employers money, $9 billion and
enacting the Healthy Families Act will therefore increase the
total output in the economy and improve the operation of the
U.S. economy. Thank you. If I or my staff can be of further
help, please do not hesitate to contact us.
[The prepared statement of Ms. Hartmann follows:]
Prepared Statement of Heidi I. Hartmann, Ph.D.
Mr. Chairman and members of the committee, I am Heidi Hartmann,
President of the Institute for Women's Policy Research, an independent,
scientific research institute focusing on women's economic issues.
Trained as a labor economist, with the Ph.D. degree from Yale
University, I have studied women's employment issues for more than 30
years. I am also a Research Professor at George Washington University.
I am pleased to have the opportunity to testify today on the impact of
the Healthy Families Act on workers, businesses, the general economy,
and public health.
research documents the need and points toward effective policies
The Institute for Women's Policy Research (IWPR) has been
conducting research on the adequacy of existing paid sick days policies
since 2000. During this period, we have analyzed confidential data
collected from employers by the U.S. Bureau of Labor Statistics to
assess coverage provided voluntarily by employers; explored workers'
use of paid time off policies with data collected by the U.S.
Department of Health and Human Services; completed scans of medical and
economics literature for data on the likely effects of expanding paid
sick days programs; and worked closely with other researchers to
develop valid approaches to measuring consequences workers experience
when they lack adequate paid sick days. IWPR has provided data and
policy analysis on this topic to Members of Congress, State
legislatures, municipal governing bodies, and stakeholder groups
working on the issue. We have completed non-partisan analysis at
critical junctures in several campaigns for expanded paid sick days
policies, including the movement in San Francisco that led to voter
endorsement of a paid sick days ballot initiative in November 2006.
current paid sick days policies leave tens of millions with no coverage
\1\
Only 58 percent of the non-agricultural wage-and-salary workforce
is covered by a formal paid sick days policy for which they are
actually eligible (Table 1). \2\ This leaves 42 percent--more than 57
million workers--without paid sick days. Nearly 23 million of these
workers are women. Workers in the public sector have much better
coverage than in the private sector. Considering the private sector
alone, fully 48 percent of employees, nearly half, lack eligibility for
any paid sick days.
Table 1.--Percent and Number of Workers With and Without Paid Sick Days, 2006
----------------------------------------------------------------------------------------------------------------
Workers with paid sick Workers without paid sick
days days Total number of
-------------------------------------------------------- workers \1\
Percent Number Percent Number
----------------------------------------------------------------------------------------------------------------
Private sector......................... 52 58,517,000 48 54,538,000 113,055,000
State and local government............. 87 16,735,000 13 2,501,000 19,235,000
Total, private and State/local \2\..... 57 75,252,000 43 57,038,000 132,290,000
Federal Government..................... 100 2,709,000 0 0 2,709,000
Total, private and public sectors...... 58 77,960,000 42 57,038,000 134,999,000
----------------------------------------------------------------------------------------------------------------
Notes: Excludes agricultural, military, private household, and self-employed workers. Rows and columns may not
sum to totals due to rounding.
\1\ Workforce numbers for 2006 use the Current Employment Statistics; IWPR's report No Time To Be Sick: Why
Everyone Suffers When Workers Don't Have Paid Sick Days (Institute for Women's Policy Research, 2004) used the
Current Population Survey, for the 2003 workforce.
\2\ These numbers and percentages are comparable to those of Table 1 in the IWPR publication No Time To Be Sick:
Why Everyone Suffers When Workers Don't Have Paid Sick Days (Institute for Women's Policy Research, 2004).
Source: Institute for Women's Policy Research analysis of the March 2006 National Compensation Survey, the
November 2005 through October 2006 Current Employment Statistics, and the November 2005 through October 2006
Job Openings and Labor Turnover Survey.
In some industries, coverage is notably worse than the overall
average (Table 1 and Figure 1). Fewer than one-quarter of workers in
the accommodation and food service industry have paid sick days (22
percent); coverage in construction is nearly as bad, at 25 percent.
Employers in administration and waste services (which includes many
clerical workers) and in arts, entertainment, and recreation extend
paid sick days to only about one-third of their workers (31 and 35
percent, respectively). Retail trade also trails the average, with 45
percent of workers covered. Many of these industries with below average
coverage are those with workers that all of us come into contact with
every day: food service workers, cashiers, sales clerks. At the other
end of the scale, roughly three-fourths of workers in wholesale trade;
health care and social assistance; information; and management have
paid sick days (71, 71, 74, and 77 percent, respectively), and more
than four of every five workers in finance and insurance and in
utilities are covered (82 and 85 percent, respectively).
Coverage is best in larger establishments: \3\ Three-fourths of
workers in the largest establishments (those with 5,000 or more
employees) have paid sick days, while only two-fifths of workers in the
smallest establishments (with one to nine workers) do (77 percent vs.
42 percent; Table 2). For all establishments covered by the FMLA, 58
percent of workers are eligible for paid sick days. For smaller
establishments, with fewer than 50 employees, 42 percent are eligible
for paid sick days.
Table 2.--Worker Eligibility For Employer-Provided Paid Sick Days
Policies in the Private Sector, By Establishment Characteristics, 2006
------------------------------------------------------------------------
Percent of
workers with
employer-
provided paid
sick days
------------------------------------------------------------------------
Industry:
Accommodation and food service....................... 22
Construction......................................... 25
Administration and waste services.................... 31
Arts, entertainment, and recreation.................. 35
Retail trade......................................... 45
Mining............................................... 49
Other services....................................... 49
Manufacturing........................................ 52
Transportation and warehousing....................... 56
Real estate and rental............................... 67
Educational services................................. 68
Professional and technical services.................. 69
Wholesale trade...................................... 71
Health care and social assistance.................... 71
Information.......................................... 74
Management........................................... 77
Finance and insurance................................ 82
Utilities............................................ 85
All.................................................. 52
Number of Employees:
1 to 9............................................... 42
10 to 24............................................. 40
25 to 49............................................. 44
50 to 99............................................. 41
100 to 499........................................... 55
500 to 4,999......................................... 71
5,000 or more........................................ 77
1 to 49 workers...................................... 42
50 or more (FMLA covered)............................ 58
All.................................................. 52
Region:
New England.......................................... 61
Mid-Atlantic......................................... 56
East North Central................................... 48
West North Central................................... 51
South Atlantic....................................... 49
East South Central................................... 48
West South Central................................... 49
Mountain............................................. 52
Pacific.............................................. 55
All.................................................. 52
------------------------------------------------------------------------
Note: Excludes agricultural, military, private household, and self-
employed workers. Rows and columns may not sum to totals due to
rounding.
Source: Institute for Women's Policy Research analysis of the March 2006
National Compensation Survey, the November 2005 through October 2006
Current Employment Statistics, and the November 2005 through October
2006 Job Openings and Labor Turnover Survey.
By region, paid sick days coverage ranges from a low of 48 percent
in the East North Central region (which includes the States of
Illinois, Indiana, Michigan, Ohio, and Wisconsin) and the East South
Central region (which includes the States of Alabama, Kentucky,
Mississippi, and Tennessee) to a high of 61 percent in New England
(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and
Vermont; Table 2).
lower-wage workers are shut out of current policies
The availability of paid sick days varies enormously along job
characteristics such as occupation, work hours, and wage level (Table
3). In general, professional and other white-collar workers have the
best paid sick days coverage, and those in lower-level service-sector
jobs are the least likely to have any paid sick days. Among
occupations, paid sick days rates are the highest for lawyers,
managers, and computer, math, architecture, and engineering
professionals, at 84 percent, 83 percent, and 81 percent, respectively.
Three of every four workers in business and financial occupations,
community and social services, and life, physical, and social sciences
also have paid sick days (78 percent, 77 percent, and 75 percent,
respectively). At the other end of the spectrum, only one in seven food
service workers has paid sick days (15 percent). Protective services
and construction workers also have very low coverage, at 22 percent and
18 percent, respectively.
Table 3.--Worker Eligibility For Employer-Provided Paid Sick Days in the
Private Sector By Job Characteristics, 2006
------------------------------------------------------------------------
Percent of
workers with
employer-
provided paid
sick days
------------------------------------------------------------------------
Occupation:
Food Preparation and Services........................ 15
Construction and Extraction.......................... 18
Protective Services.................................. 22
Personal Care and Service............................ 37
Transportation and Material Moving................... 41
Production........................................... 41
Sales................................................ 46
Building services, Grounds Cleaning, and Maintenance. 53
Installation, Maintenance, and Repair Services....... 58
Arts, Entertainment, Sports.......................... 62
Education and Training............................... 62
Healthcare Support................................... 65
Office and Administrative Support.................... 68
Healthcare Practice and Technical.................... 71
Life, Physical, and Social Sciences.................. 75
Community and Social Services........................ 77
Business and Financial............................... 78
Architecture and Engineering......................... 81
Computer and Math.................................... 81
Management........................................... 83
Legal................................................ 84
All.................................................. 52
Wage Level:
Fourth (bottom)...................................... 21
Third................................................ 54
Second............................................... 62
First (top).......................................... 72
All.................................................. 52
Work Schedule:
Full-time............................................ 62
Part-time............................................ 20
Full-year............................................ 53
Part-year............................................ 26
Full-year, full-time................................. 63
Not full-year, full-time............................. 21
All.................................................. 52
------------------------------------------------------------------------
Notes: Excludes agricultural, military, private household, and self-
employed workers. Rows and columns may not sum to totals due to
rounding. Cutoffs for wage quartiles: first (top), $21.66 or more;
second, $13.50 to $21.65; third, $9.23 to $13.49; and fourth (bottom),
less than $9.23.
Source: Institute for Women's Policy Research analysis of the March 2006
National Compensation Survey, the November 2005 through October 2006
Current Employment Statistics, and the November 2005 through October
2006 Job Openings and Labor Turnover Survey.
Full-time workers are more than three times as likely to have paid
sick days as part-time workers (62 percent vs. 20 percent). While
working a short week does provide some flexibility to respond to health
needs, many part-timers have less than full-time hours involuntarily,
and others work multiple part-time jobs in order to patch together a
full-time income. (Despite the fact that 19 percent of women and 24
percent of men would prefer to work more hours than they currently
do,\4\ some firms deliberately limit workers' hours in order to avoid
having them become eligible for benefits such as paid sick days.) Thus,
the lack of paid sick days for part-time workers is as serious an issue
as the incomplete coverage of full-time workers. Workers on part-year
schedules also have very restricted access to paid sick days, with only
one-quarter covered (26 percent).
Differences in paid sick days coverage by wage level are as extreme
as those by occupation. At the top, nearly three-fourths of workers
have access to paid sick days (72 percent; Figure 2 and Table 3).\5\
Coverage drops to three-fifths for workers in the second wage quartile
(62 percent), and then to just over half for those in the third wage
quartile (54 percent). Only about one-fifth of workers in the bottom
wage quartile have paid sick days (21 percent). (The wage threshold for
the bottom wage quartile is $9.23, approximately the same as the hourly
wage which, if worked full-time throughout the year, would provide a
poverty-line income for a family of four.)
In addition to having differential access to paid sick days,
workers at different wage levels are offered different numbers of paid
sick days (Table 4). After 1 year on the job, workers in the top wage
quartile average 10 paid sick days. Those in the second wage quartile
have nearly 8 days; in the third, 7; and in the bottom, 6.5. With 10
years of job tenure, those at the top accrue nearly an additional 3
days, for a total of 12.7, while those in the bottom wage quartile have
only one more paid sick day, giving them 7.5 days annually. The lowest-
wage workers also have to wait longer to qualify for paid sick days
than higher-wage workers: an average of 3.5 months, or nearly twice the
job tenure requirement of 1.9 months offered to workers in the top wage
quartile.
Table 4.--Number of Paid Sick Days By Years of Job Tenure, and
Eligibility Periods, By Wage Quartile
------------------------------------------------------------------------
Number of paid
sick days Number of
after: months
Wage quartile ---------------- between
10 hire and
1 year years eligibility
------------------------------------------------------------------------
Top........................................ 10.0 12.7 1.91
Second..................................... 7.8 9.1 2.33
Third...................................... 7.1 8.4 3.12
Bottom..................................... 6.5 7.5 3.48
All........................................ 8.1 9.8 2.59
------------------------------------------------------------------------
Notes: Excludes agricultural, military, private household, and self-
employed workers. Rows and columns may not sum to totals due to
rounding.
Source: Institute for Women's Policy Research analysis of the March 2006
National Compensation Survey, the November 2005 through October 2006
Current Employment Statistics, and the November 2005 through October
2006 Job Openings and Labor Turnover Survey.
workers with paid sick days take 3.9 days per year for their own
illnesses and 1.3 days to care for other family members
According to IWPR analysis of the 2004 National Health Interview
Survey, workers who are covered by paid sick days policies miss an
average of 3.9 days of work per year for their own illness and injury
(excluding maternity leave).\6\ (Workers who lack this benefit take
approximately one fewer day off for sickness per year, at an average of
3.0 days.) But, of course, individual workers vary enormously in their
need for paid sick days. Zero is the most typical number of days taken
off for illness: half (50 percent) of those with a paid sick days
policy do not miss a single day of work because of illness in an entire
year. Others--those with chronic illnesses, or medical emergencies--
need more than 1 week in at least some years.
According to the U.S. Department of Labor's 2000 Family and Medical
Leave Act Survey of Employees, workers take 0.33 days of FMLA-type
leave to care for ill children, spouses, and parents for every day of
leave taken for their own health needs. Thus, on average, we estimate
that workers need 1.3 days of paid sick time per year to care for
family members.\7\ Again, this need will vary considerably by
individual circumstances. For instance, parents of school-age children
may need to attend to their children at home for approximately 4 days
per year,\8\ and workers with responsibility for elderly parents or
disabled adult children may need more time as well.
The Healthy Families Act, as proposed in the last congressional
session, would also provide time off work with pay for workers to
obtain preventive and other care from doctors. This is likely to
involve 3.5 hours for doctor visits per year, on average, for workers'
own health needs.\9\
the healthy families act would bring benefits to workers, businesses,
and the overall economy
Workers and their families. Establishing a minimum paid sick days
standard through a bill such as the Healthy Families Act, proposed in
the last session, would bring immediate benefits to workers who
currently lack paid sick days. They would likely take an average of one
additional day off work for their own health-care needs, and thus
recuperate more completely and faster from illnesses, injuries,
surgery, and other medical treatments.\10\ Their families would not
suffer the lost income associated with staying home on unpaid leave
when working is impossible.
The preliminary 2006 estimated benefit to workers in new sick pay
under a model program proposed to the 109th Congress as the 2004
Healthy Families Act would be $19.6 billion. This is the amount of new
pay that workers who did not have sick pay before, or whose sick days
were limited, would be expected to receive each year.
Children recover their health faster with parents' involvement,\11\
and having paid time off is the primary factor in parents' decisions
about staying home when their children are sick.\12\ Thus, workers who
are granted new paid sick days will experience better health outcomes
for their children and, likely, lower health-care expenditures. Parents
who are allowed to take their children to the doctor during work hours
without missing pay may also be better able to carry out recommended
treatments and routine care, such as immunizations and well-child
check-ups. And family care will not cause workers to lose as much
income as they now do. Now, half of working mothers, and 75 percent of
low-wage working mothers, lose pay when they stay home with a sick
child.\13\ This is a costly, stressful burden to impose on families
already struggling to shoulder the responsibilities of work and family.
With better paid sick days programs, families may also be able to
avoid some short-term nursing home stays for elderly relatives. Over 21
million full-time workers are caregivers for aging family members.\14\
It is not unusual for an older patient to be dismissed from a hospital
as too healthy to need such a high level of medical care, but not being
healthy enough to be home alone. If an adult child can take a couple
days off work to provide needed care, the patient may be able to
transition directly home. With nursing homes charging an average of
$158 per day,\15\ and skilled in-home care also costly, families that
can take care of their own relatives can enjoy substantial savings.
Employers. With improved sickness absence programs, businesses will
gain in at least three ways. First, and most significant in monetary
terms: Rates of voluntary turnover will drop, as workers find their
current compensation package more attractive and are, therefore, less
inclined to search out another job. Research shows that turnover rates
will drop by between 4 and 7 percentage points, for different
demographic groups of workers.\16\ Replacing workers is very expensive:
Even in the low-wage labor market, filling a vacant position and
bringing a new worker up to full productivity can cost 43 percent of
annual pay.\17\ A more general rubric is that an employer must pay 25
percent of a worker's total yearly compensation (including the cost of
benefits) to replace a worker.\18\
This benefit alone will save employers more than the total cost of
additional wages, payroll taxes, and administrative expenses of the
Healthy Families Act.
A second major benefit for employers is that, when at work, their
workers will be healthier. That is, those who are too sick to perform
at full capacity will be at home, rather than receiving their full
compensation for being at work but not being productive. Savings
associated with better management of workers' presenteeism will help
offset new wage payments to workers who, appropriately, stay at home
when they are sick.
Finally, employers will reap benefits in lower overall sickness
rates when workers with contagious diseases remove themselves from the
workplace and avoid passing germs to their colleagues. Thirty percent
of workers report having become sick from someone in their office
during the last flu season \19\; many have experienced the phenomenon
of a cold or flu spreading through a worksite, taking out one worker
after another. This is much less likely to happen if workers can stay
home when they are in a contagious phase of a disease. Employers know
that presenteeism is not a good thing: More than half (56 percent) say
it is a problem for them.\20\
The preliminary 2006 estimate of the total benefits of a bill such
as the Healthy Families Act introduced in the last session of Congress
is $31.2 billion, which far outstrips the estimated total cost of $22.3
billion.\21\
Public health. The issue of contagion has very important
implications for public health, in addition to its impact on individual
employers. Should a serious pandemic erupt--such as might occur if the
bird flu mutated to be transmittable between humans--it will be
critical that infected workers reduce their social contacts as much as
possible while they are in a contagious phase. But even less serious
flu outbreaks can be ameliorated by good paid sick days policies that
allow workers to sensibly withdraw from worksites to avoid spreading
disease. Research has shown that the incidence of disease within
workplaces is lessened when workers have paid sick days.\22\ That also
means that fewer individuals are bringing germs home to their own
families and friends. And that is why the Centers for Disease Control
and Prevention recommend that people who have the flu stay home.\23\
The economy at large. The productivity effects of expanded paid
sick days will benefit not only individual employers--they will add to
overall economic productivity. Reducing total sickness absence by
keeping sick workers out of offices and reducing voluntary job turnover
will help to maximize workers' output. Job-protected paid sick days are
especially important to women workers. Still today women workers bear
the larger share of family care, and thus having the right to leave and
return to their jobs, and not lose pay, is of far greater benefit to
women. A bill to guarantee workers several paid sick days per year
(that can also be used for family care) will lengthen and strengthen
women's attachment to their jobs, enabling them to gain job seniority
and improve their long-term productivity. A paid sick days bill will
help women's average time on the job catch up with men's, contributing
ultimately to greater pay equity between women and men.
Holding down involuntary job loss will also contribute to economic
productivity. There is an ever-growing accumulation of anecdotal
evidence about this effect, collected by worker rights organizations
such as 9to5 \24\ as well as the Center for WorkLife Law at the
Hastings School of Law.\25\ As no government surveys measure this
phenomenon, it is difficult to estimate the dollar value of recovered
productivity that would accrue from better paid sick days policies that
keep workers from being fired for missing work when they, or members of
their families, are sick. As a rough estimate, using known data on the
share of the low-wage workforce that lacks paid sick days (79 percent),
rates of hiring in low-wage industries, and the share of low-wage new
hires that replaces workers (as opposed to filling new positions), IWPR
calculates that involuntary turnover related to the lack of paid sick
days for low-wage workers likely costs employers nearly $2 billion
annually. This cost estimate is based on using a parameter of 3.3
percent of job loss in the low-wage labor market is involuntary due to
the lack of paid sick days. The productivity impact of inadequate paid
sick days policies is certainly very substantial. Productivity losses
of this nature are a drain on the economy as a whole, in addition to
their direct impacts on workers and employers.
IWPR's research clearly shows the need for expanded access to paid
sick days and, further, that such access will bring benefits not only
to workers but also to businesses and the economy overall. In fact the
benefits substantially outweigh the costs, indicating that enactment of
such a requirement would improve the operation of the U.S. economy. Our
research also documents that workers make modest use of paid sick days
policies--the most typical number of days taken off per year is zero,
and workers who have paid sick days miss only one more day of work than
those without. I urge the Congress to develop this legislation to
address the needs of workers for paid sick days and improve overall
productivity and economic growth.
If I or my staff can be of further help to you as you continue to
deliberate on these issues, please do not hesitate to contact us. Thank
you for holding this hearing and for the opportunity to testify.
methodology
The IWPR analysis of paid sick days coverage rates begins with
analysis of the March 2006 National Compensation Survey (NCS).
Collected by the U.S. Bureau of Labor Statistics (BLS), this payroll
survey includes more than 10,000 private-sector establishments of all
sizes and 41,985 individual jobs. (Private household and military
employers and the self-employed are not included.) IWPR staff conducted
the analysis of the confidential microdata set onsite at the BLS under
contract with the BLS. Weighting variables calculated by the BLS allow
generalization of findings to the entire U.S. private-sector workforce.
The March 2006 NCS did not survey local and State governments, so
participation rates for workers in those sectors are from IWPR's
previous analysis of the 1996-1998 Employee Benefits Survey, the
precursor to the NCS.
The NCS queries employers on numerous benefits provided to workers
for which the employer incurred a cost. Regarding paid sick days
benefits, it specifically collects data on whether jobs are covered by
a policy allowing workers to stay home, with pay, when they are sick.
(Thus, general paid-time-off policies that do allow this use are coded
as being paid sick days programs.) Individual incumbents in those jobs
may not yet have met employer-imposed eligibility thresholds related to
job tenure. That is, the NCS provides data on ``access'' to paid sick
days, but not on ``participation.'' To adjust for eligibility, data on
the percent of workers who are new hires, taken from the BLS' Job
Openings and Labor Turnover Survey, by industry, were combined with
data from the NCS on the average number of days between date of hire
and eligibility for paid sick days policies (78 days). In the analysis
presented here, ``participation'' refers to the share of the workforce
that has ``access'' to paid sick days, according to the NCS, and has
also met the average eligibility threshold.
Workforce size estimates use the Current Employment Statistics
payroll survey.
In estimating the 2006 benefits of the Healthy Families Act, the
2003 estimates presented in Valuing Good Health: An Estimate of Cost
and Savings for the Healthy Families Act (Washington, DC.: Institute
for Women's Policy Research, 2005) were used, with final dollar values
for wages and other factors inflated to 2006 dollars using the CPI.
To estimate the costs of involuntary job loss by low-wage workers,
the most likely to lack paid sick days, IWPR combined information from
several sources. The size of the low-wage workforce was estimated as
the lowest paid quartile, using the sources described above; 79 percent
of these lack paid sick days according to IWPR analysis of the 2006
National Compensation Survey. Monthly new hires from the Job Openings
and Labor Turnover Survey for Accommodation and Food Service were used
to proxy new hires for the low-wage labor force as a whole. IWPR then
adjusted these numbers downward to obtain an estimate of the amount of
job replacement, as opposed to job growth, based on data from the BLS
for those with a high school degree or less.\26\ We estimate that 3.3
percent of all turnover in the low-wage labor market is involuntary job
loss due to the lack of paid sick days. Finally, we estimate the annual
compensation cost of the low-wage worker from Valuing Good Health
(inflated to 2006 dollars) and, following that report, assume that
turnover costs equal 25 percent of total annual compensation.
Endnotes
\1\ Data presented here are from Institute for Women's Policy
Research analysis of the March 2006 National Compensation Survey, which
collected information on employment benefits from over 10,000 non-
agricultural private-sector establishments. (Private households were
not surveyed.) The survey's data on workers' ``access'' to paid sick
days was adjusted to reflect actual participation in these programs
using data on new hires from the Job Openings and Labor Turnover
Survey, to account for workers who have not yet met job tenure
eligibility criteria for participation in offered paid sick days
programs.
\2\ Refers to the workforce excluding Federal, military, and
private household employees and the self-employed.
\3\ These data are for establishments--individual physical business
locations; the National Compensation Survey does not collect data at
the level of firms. (A firm may comprise a number of individual
establishments.)
\4\ Jeremy Reynolds, ``When Too Much Is Not Enough: Actual and
Preferred Work Hours in the United States and Abroad,'' Sociological
Forum 19, 1 (2004): 89-120.
\5\ The top wage quartile includes workers making $21.66 or more
per hour; second, $13.50 to $21.65; third, $9.23 to $13.49; and fourth
(bottom), less than $9.23.
\6\ Vicky Lovell, Valuing Good Health in San Francisco: The Costs
and Benefits of a Proposed Paid Sick Days Policy (Washington, DC.:
Institute for Women's Policy Research, 2006).
\7\ Rutgers University Center for Women and Work analysis of data
from U.S. Department of Labor, Family and Medical Leave Surveys, 2000
Update, April 12, 2005.
\8\ Vicky Lovell, No Time to be Sick: Why Everyone Suffers When
Workers Don't Have Paid Sick Leave (Washington, DC.: Institute for
Women's Policy Research, 2004).
\9\ Lovell 2006.
\10\ Anne Grinyer and Vicky Singleton, ``Sickness Absence as Risk-
Taking Behavior: A Study of Organizational and Cultural Factors in the
Public Sector,'' Health, Risk and Society 2 (March 2000): 7-21.
\11\ Sarah J. Palmer, ``Care of Sick Children by Parents: A
Meaningful Role,'' Journal of Advanced Nursing 18 (February 1993): 185-
191.
\12\ Jody S. Heymann, Alison Earle, and Brian Egleston, ``Parental
Availability for the Care of Sick Children,'' Pediatrics 98 (August
1996): 226-230.
\13\ Roberta Wyn, Victoria Ojeda, Usha Ranji, and Alina
Salganicoff, Women, Work, and Family Health: A Balancing Act
(Washington, DC.: Henry J. Kaiser Family Foundation, 2003).
\14\ National Alliance for Caregiving and AARP, Caregiving in the
U.S. (Bethesda, MD: National Alliance for Caregiving, 2004).
\15\ MetLife, The MetLife Market Survey of Nursing Home & Home Care
Costs (Westport, CT: MetLife Mature Market Institute, 2004).
\16\ Philip F. Cooper and Alan C. Monheit, ``Does Employment-
Related Health Insurance Inhibit Job Mobility?'' Inquiry 30 (Winter
1993): 400-416.
\17\ Walter E. Johnson and Dan M. Tratensek, ``Employee Turnover,''
Do-It-Yourself Retailing 180 (June 2001).
\18\ Employment Policy Foundation, ``Employee Turnover--A Critical
Human Resource Benchmark,'' HR Benchmarks (December 3, 2002): 1-5
(January 3, 2005).
\19\ National Foundation for Infectious Diseases, New National
Survey Shows Employees Feel Pressured to Go to Work, Despite Being Sick
with Flu
(February 8, 2007).
\20\ CCH Incorporated, ``Findings from the 2006 Unscheduled Absence
Survey'' (January 24, 2007).
\21\ Institute for Women's Policy Research analysis updating the
findings presented in Vicky Lovell, Valuing Good Health: An Estimate of
Cost and Savings for the Healthy Families Act (Washington, DC.:
Institute for Women's Policy Research, 2005) to account for inflation.
\22\ Jiehui Li, Guthrie S. Birkhead, David S. Strogatz, and F.
Bruce Coles, ``Impact of Institution Size, Staffing Patterns, and
Infection Control Practices on Communicable Disease Outbreaks in New
York State Nursing Homes,'' American Journal of Epidemiology 143 (May
1996): 1042-1049.
\23\ U.S. Department of Health and Human Services, Influenza
Symptoms, Protection, and What to Do If You Get Sick (February 8, 2007).
\24\ 9 to 5: National Association of Working Women, 10 Things that
Could Happen to You if You Didn't Have Paid Sick Days (February 9, 2007).
\25\ Joan C. Williams, One Sick Child Away From Being Fired: When
``Opting Out'' is Not an Option (San Francisco: UC Hastings College of
Law, WorkLife Law, 2006).
\26\ Daniel E. Hecker, ``Occupational Employment Projections to
2014,'' Monthly Labor Review (November 2005): 70-101.
The Chairman. Thank you very much.
Rajiv.
STATEMENT OF RAJIV BHATIA, M.D., MPH, DIRECTOR OF OCCUPATIONAL
AND ENVIRONMENTAL HEALTH FOR THE SAN FRANCISCO DEPARTMENT OF
PUBLIC HEALTH AND ASSISTANT CLINICAL PROFESSOR OF MEDICINE AT
UNIVERSITY OF CALIFORNIA AT SAN FRANCISCO
Dr. Bhatia. Good morning, Mr. Chairman, Senator Isakson,
Senator Enzi. My name is Rajiv Bhatia. I served as the Director
of Occupational and Environmental Health for the City and
County of San Francisco since 1998. I also teach at the
University of California. My research focus is on methods to
study the health impacts of social, economic and environmental
policies. It has always been important to me that health is
valued with economic concerns equally. In fact, health is the
reason that we promote economic concerns in the first place.
In November 2006, San Francisco became the first place in
the United States to require employers to provide sick days.
Sixty-one percent of the voters approved this ballot
initiative, in part because of the impacts on public health. In
my testimony, I want to focus on three important issues that
have already been, in part, mentioned by the other witnesses
here today.
First, I want to talk about the trade-offs that workers
without paid sick days have to face. Second, the risk of
infectious disease in the workplace and third, the economic and
social costs of avoidable hospitalization.
For the tens of millions of workers that don't have paid
sick days, you're asking them to make a choice between two
pretty unacceptable adverse health impacts--not taking care of
themselves or their children or risking eviction or hunger or
potentially a loss of future economic employment. About 14.1
million households pay 50 percent of their income or more in
rent. They are severely rent burdened. They have a few hundred
dollars extra a month.
Twelve percent of U.S. households are food insecure and 4
percent are hungry. When a worker without paid sick days has to
make a choice, they are making a choice between two pretty
unacceptable health consequences.
The health impacts of these choices don't stop just with
the individuals who don't have the sick days; they affect all
of us. We've heard about the spread of infectious disease.
Three of the most important infectious diseases that are really
easily spread from person to person are influenza, stomach flu
and meningitis. These diseases are spread just by touching or
shaking hands or contact with the surface or sneezing--things
that happen easily at workplaces or schools.
Up to 20 percent of the population gets the flu. Thirty-six
thousand people die from it. These viral gastroenteritis and
viral meningitis affect tens of thousands of children a year.
The Center for Disease Control recommends when you have
influenza, stay home from work when you're sick. Paid sick days
lets Americans make a responsible choice.
The third and I think very important reason for us to
provide paid sick days has to do with food service workers. We
go to restaurants every day. We go to catered parties and food
service workers are working here without paid sick days. They
know--we know food service workers are not supposed to go to
work sick but food service workers may not recognize the
symptoms of a food borne illness. They may defer it to earn
some extra money and they are putting--in that short period of
time, they can be spreading the disease, not only just to a few
people through a restaurant but thousands of people if they are
working in a food processing plant.
As we know, only 15 percent of workers in the food service
industry have paid sick days and this is among the lowest rate
of occupations.
Finally, I want to talk about hospitalizations. There are
few hospitalizations for chronic diseases that are entirely
preventable with appropriate and timely care. There are 14.7
million diabetics in this country. There are 600,000
hospitalizations for diabetes. There are 30 million asthmatics
with 500,000 hospitalizations every year. Early treatment can
prevent these hospitalizations and save, for example, up to
$13,000 for the hospitalization costs of asthma.
In order to get this timely caring, you not only need
health insurance but you need time off. You need
transportation. Sick day benefits, in my experience, have been
one that helps patients get to their doctor appointments and
prevents these hospitalizations. This can have tremendous
social costs. It can particularly prevent and help our public
safety hospitals who are caring for the majority of low
income--a lot of low-income workers without paid sick days.
I want to conclude by just highlighting the significance of
employment and social policies in general, on public health.
The United States spends the most of the developed world on
health: $6,000 per year--15 percent of our GDP. This is over
twice the spending of every other western democratic market
economy in the world and our health performance is the poorest.
Canada and England--we live a full year less than people in
Canada and England--3 years less than Spain, Sweden and
Switzerland. The fact that our health performance is poor
underscores what public health professionals know--that we
don't provide the social and economic and environmental
conditions for good health for all Americans and that is why
these other countries are outperforming us in health. I am very
encouraged that you're considering the public health
consequences of this law. I sincerely hope that we can have
paid sick days for all Americans, not only because it's humane,
because it's in the interest of public health. Thank you.
[The prepared statement of Dr. Bhatia follows:]
Prepared Statement of Rajiv Bhatia, M.D., MPH
My name is Rajiv Bhatia. I have a Medical Doctorate from Stanford
University and a Masters in Public Health from the University of
California at Berkeley. I have practiced medicine since 1989 and
environmental public health for the past 11 years. Since 1998, I have
served as the Director of Occupational and Environmental Health for the
city and county of San Francisco's Department of Public Health. I also
hold the position of Assistant Clinical Professor of Medicine at the
University of California at San Francisco.
I want to thank the committee for recognizing that having paid sick
days can have important public health consequences. In November 2006,
San Francisco became the first place in the United States to require
employers to provide paid sick days. Sixty-one percent of the voters
approved this ballot initiative and the law took effect February 5,
2007.
In part, San Franciscans passed this law understanding its
importance to health. I believe that there are a number of important
public health reasons to provide paid sick days. These include:
1. Enabling workers to take the time off needed to manage and/or
recover from an illness and care for ill family members.
2. Protecting co-workers and the public from infectious disease.
3. Reducing the social and economic costs of avoidable
hospitalizations.
When most people are ill, they need and want to take the time off
to access health care or simply to recuperate. Sick children need to
stay home from school and need their parents or caregivers to take care
of them. While not all people who are sick would choose to stay away
from work or school, paid sick days allow workers to make this
important choice without sacrificing other equally important needs.
For the 66 million workers without paid sick days benefits, an
illness in the family means having to make an extremely difficult
choice. Should they take unpaid time off from work to care for
themselves or their children; or, should they go to work sick or send
their children to school sick? For low-income workers, not going to
work for even a few days may mean not having enough money to pay the
rent or buy food. Some workers may also be insecure in their jobs, not
knowing whether an absence from work may translate into the loss of a
job. These workers must consider unemployment, hunger, and eviction
when making a choice about staying home to take care of themselves or a
family member. Such competing pressures mean that workers without paid
sick days are more likely to go to work sick or let their children go
to school sick. In fact, research tells us that parents who had paid
sick days were 5.2 times as likely to care for their children when they
were sick.\1\
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\1\ Heymann SJ, Toomey S, Furstenberg F. Working parents: what
factors are involved in their ability to take time off from work when
their children are sick? Arch Pediatr Adolesc Med. 1999;153(8):870-4.
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The health impacts of these difficult choices are not limited to
workers and their families. Going to work or school with an infectious
disease can mean transmitting it to others. Several common infectious
diseases are transmitted in workplaces, schools, and other public
institutions through casual contact. For example, influenza virus is
spread mainly from person to person through coughing or sneezing. Or
people may become infected by touching something with flu viruses on it
and then touching their mouth or nose. Every year in the United States,
5 percent to 20 percent of the population gets the flu; more than
200,000 people are hospitalized from flu complications; and, about
36,000 people die from flu.
Viral gastroenteritis, often called the ``stomach flu,'' is
contagious and spread through close contact with infected persons.\2\
Rotovirus, the most common cause of severe diarrhea among children,
results in the hospitalization of approximately 55,000 U.S. children
each year.\3\
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\2\ Viral gastroenteritis is caused by a variety of viruses
including rotaviruses, noroviruses, adenoviruses, sapoviruses, and
astroviruses.
\3\ Centers for Disease Control 2006.
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About 90 percent of cases of viral (``aseptic'') meningitis, which
causes inflammation of the tissues that cover the brain and spinal
cord, are caused by viruses known as enteroviruses which are also
spread through casual contact. In the United States, there are between
25,000 and 50,000 hospitalizations due to viral meningitis each year.
For all these common diseases--influenza, stomach flu, viral
meningitis--infection can be prevented by allowing a sick worker to
stay away from their workplace and by keeping sick children home from
school. In fact, the U.S. Centers for Disease Control Web site provides
the very common sense recommendation to people with influenza: ``stay
home from work and school when you are sick.'' All things being equal,
having paid sick days enables all Americans to follow our Federal
public health recommendations.
The public health importance of keeping sick employees out of the
workplace is far more significant for some occupations. For occupations
such as health care workers, child care providers, and people who
handle food, there is the potential for a sick worker to transmit an
infectious disease to many, many people. In the case of food handlers
or food service workers, there is the potential for transmission to
hundreds or thousands of others. The spread of foodborne illness by an
infected worker can happen at a catered party or at a neighborhood
restaurant, but it can also happen in food processing plants and result
in outbreaks of illness nationally. Overall, foodborne diseases cause
approximately 76,000,000 illnesses, 325,000 hospitalizations, and 5,000
deaths in the United States each year.\4\
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\4\ Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C,
Griffin PM, Tauxe RV. Food-Related Illness and Death in the United
States. Emerging Infectious Diseases. Centers for Disease Control and
Prevention, Atlanta, Georgia, USA Pathogens responsible for foodborne
illnesses include the Norwalk viruses, the Hepatitis A virus,
Salmonella typhi, Shigella species, Staphylococcus aureus, and
Streptococcus pyogenes.
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Of course, people with foodborne illnesses who work in the food
industry should not be going to work. In reality, we rely on workers to
recognize the illness and their employers to self-enforce requirements
that protect the public. A worker may recognize a symptom but may not
associate it with a foodborne illness.\5\ It takes time and often a
visit to the doctor to find out that you have a foodborne illness. A
food worker may not want to take unpaid time to obtain a diagnosis or
may defer care until the symptom worsens, in the meantime, potentially
infecting co-workers and patrons. A recent published review of
foodborne Hepatitis A outbreaks in the United States demonstrated that
in many cases the infected food handler either did not seek medical
care or delayed getting medical care.\6\ Unfortunately, only 15 percent
of workers in the food service industry have paid sick days--the lowest
rate among major groups of industries.\7\ Paid sick days would help a
food service worker get a timely diagnosis and help them stay away from
work until they recover.
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\5\ Signs or symptoms in persons who handle food may include
diarrhea, vomiting, open skin sores, boils, fever, dark urine, or
jaundice.
\6\ Fiore A. Hepatitis A transmitted by Food. Clinical Infectious
Diseases 2004;38:705-15.
\7\ Based on analysis of 2006 data by Vickie Lovell. Institute for
Women's Policy Research. Washington, DC.
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Providing paid sick days is also a strategy that can be employed to
reduce the burden of chronic diseases, which are responsible for a
growing share of national health care costs. Many of the admissions to
our hospitals for chronic diseases such as asthma, hypertension, and
diabetes are entirely preventable with timely and effective outpatient
and primary care.\8\ Many of these hospitalizations occur in working
age adults and among children. In 2004, there were almost 200,000
hospitalizations for childhood asthma alone.\9\ Early treatment of a
flare-up of asthma in a doctor's office or clinic can prevent
deterioration to the point where hospital care is required. In
California, a single hospitalization for asthma costs over $13,000.\10\
Getting timely primary care requires not only access to services and a
way of paying for services, but also transportation, time, and the
ability to leave work. A paid sick day benefit removes one of key
barriers that people face in utilizing timely primary care.
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\8\ Billings J, Anderson GM, Newman LS. Recent findings on
preventable hospitalizations. Health Affairs 1996 Fall;15(3):239-49.
\9\ Akinbami LJ. The State of Childhood Asthma, United States,
1980-2005. Advance Data Number 381 December 12, 2006.
\10\ California Office of Statewide Health Planning and Development
2006. Available at: http://www.oshpd.cahwnet.gov/oshpdKEY/
hospitalcharges.htm.
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If we look at the patterns of hospitalizations in States and cities
across the United States, we see that such preventable hospitalizations
are more common in areas with a high proportion of low-income
households. Lower-income workers are also the least likely to have paid
sick days benefits. Providing paid sick days for all workers is a
common-sense solution that addresses health disparities and reduces the
strain on public hospitals that provide our safety net of services to
low-income individuals.
I would like to conclude my testimony by highlighting the
significance of employment policies such as paid sick days for the
health of all Americans. According to the Organization for Economic
Cooperation and Development, the United States spends more on health
care services than any other country in the world. We spend $6,102 per
person, amounting to 15 percent of our GDP.\11\ Despite spending double
that of countries we consider peers, life expectancy in the United
States is a full year less than in Canada and England and 3 years less
than Spain, Sweden, and Switzerland. These startling facts on our
performance in health underscore what public health professionals are
acknowledging more and more. Health is largely a function of our day-
to-day living and working conditions. One of the most important roles
our government can play is to help ensure that day-to-day living and
working conditions support health. One reason these other countries may
be outperforming with respect to health is that they have paid
attention to ensuring a minimum set of healthy working conditions.
---------------------------------------------------------------------------
\11\ Organization for Economic Cooperation and Development Health
Data 2006. Available at: http://www.oecd.org/document/16/
0,2340,en_2825_495642_2085200_1_1_1_1,00.html.
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I am proud that San Francisco has led the Nation in providing paid
sick leave to workers. Paid sick leave is a humane policy; and it is
also a practical and cost-effective public health policy to reduce
disease transmission, avoid unnecessary hospitalization, and help bring
health care costs down. For these many reasons, I hope that you will
consider providing a minimum number of paid sick days to workers
throughout the country.
The Chairman. Thank you.
Mr. King.
STATEMENT OF G. ROGER KING, PARTNER, JONES DAY, COLUMBUS, OH
Mr. King. Thank you, Mr. Chairman, Senator Enzi, Senator
Isakson. I do want to note on a personal basis, it's very, very
heartfelt that I'm back here with this committee. I had an
opportunity to work with Senator Kennedy and his staff in the
1970s, as he noted, with Senator Javits and Senator Taft and it
was a great experience. Senator, thank you for your warm
welcome.
The Chairman. Thank you very much.
Mr. King. There can be no question that paid leave is
important. My practice, over 30 years, has been working with
employers from all different phases of industry throughout this
country. I don't know of one employer that would come here
today and argue many of the points that have been made except
perhaps the economics.
The employer community in this country is committed to paid
leave. Seventy-five percent, as noted, of the employers in this
country provide one form or another of paid leave and they do
so on a voluntary basis. That's something we should not lose
sight of. There is a commitment and there will continue to be a
commitment. It makes good business sense to recruit workers,
retain workers, reduce turnover, to increase productivity, to
prevent the spread of illness in the workplace--those are all
very legitimate and I commend the panel here this morning for
their intellectual and emotional commitment to this concept.
It's one we all can agree on. There is no question about
that. But as those of us that worked in the legislative arena
know, it doesn't stop there. It's not that easy and I'd like to
go through some concerns from the employer perspective, a very
legitimate stakeholder in this discussion.
We've heard from the worker perspective and that's quite
important, no question. But this is what I hear as I travel the
country and talk to employers. First, we would respectfully
submit on behalf of many in the business community that the
legislative branch and executive branch need to fix FMLA and
they need to do it now. You'll get a much more receptive
audience among employers in this country if you address that
question. FMLA is a great statute. As Chairman Kennedy
mentioned, many years were devoted to hearings and study on
that particular legislation. Bipartisan support for it. Well
accepted by the employer community, well accepted in this
country but it needs attention now. It needs to be looked at.
We have rules and regulations that are conflicting and many of
those rules and regulations don't work. In the intermittent
leave area particularly, we have tremendous problems. So those
need to be addressed.
Again, I would submit, if we can get over that hurtle,
we'll have a much more receptive business audience or employer
audience, if you will, for additional mandated leave.
The second point I would note is on the metrics or the cost
of this legislation. I note the testimony from the George
Washington Institute of $22.3 billion. I would submit to this
committee that's a serious underestimate of the cost of this
proposed legislation. If you do some sample or quick math, the
statement has been made here this morning that there are 57
million workers in this country that do not have one form or
another of paid leave. I question that because as noted,
vacation leave is folded into PTO. It is available for people
who do have illness. But put that aside for a moment. If you
take the metric of 57 million workers times 56 hours in a given
year times approximately $25 an hour and that's what it costs
when you're fully loaded with all benefits and with all
compliance costs, you're talking somewhere in terms of $79.8
billion--or more. That's a substantial cost. And the arguments
that are being made here is that smaller employers don't offer
this. Well, that varies. But let's assume that premise is
correct. You're putting a tremendous financial burden on the
employers in this country that have the least ability to pay
for it. That's something we need to talk about. The cost of
this legislation is and would be considerable.
The third point I would carry back to this committee from
various employers of various sizes is that employers are
overwhelmed with the cost of compliance with various Federal,
State and local laws. Many of these laws are conflicting. Many
of them overlap. They are hard to follow and the stealth cost,
if you will, simply engaging in appropriate compliance, is
very, very difficult. As I've noted in my prepared remarks and
I would like those included in the record, if I might, we have
situations under the present FMLA situation where we have FMLA,
the Americans with Disabilities Act and State Workers
Compensation statutes forming what I would deem and many of my
colleagues have deemed the Bermuda Triangle of Compliance. It's
very difficult. If we were to have the HFA, the Healthy
Families Act, the Fair Labor Standards Act and the FMLA Act,
State Workers Compensation statutes and many now local and
State regulations on top of that in the leave area, we're in
another Bermuda Triangle of Compliance. It's exceedingly
difficult. That's something that needs to be thought about in
some great detail.
With respect to the legislation itself and having been a
member of the staff of this committee and having drafted
legislation, I understand how difficult it is draft legislation
in this area or any other area--exceedingly difficult. But I
must tell you that in reviewing the proposal, Mr. Chairman,
that was put in the last Congress, there are many, many
difficulties from just a sheer mechanics perspective, let alone
a policy perspective.
Let me share just a few of those. First, there is no
minimum requirement for nexus with the workplace. As I read
this statute, you could start on Monday and be entitled to paid
leave on Tuesday. Under FMLA, you have to have at least a year
of employment and 1,250 hours. Senator Enzi mentioned the basic
qualification situation. Under FMLA, we have at least 50
employees before coverage begins. Here, it's 15. Further, this
statute would permit, in theory, an employee to work for
various employers throughout the year and qualify for paid
leave for each of those employment situations. Further, paid
time off as mentioned, a well now accepted concept in our
Nation's benefit structure but paid sick leave has really
folded into that particular paid time off approach. You have
traditional vacation, you have paid sick leave, you have
personal leave, you have any number of different types of
leave. Our employers that have paid time off like that in
compliance with the equivalency requirements of the statute--I
think it's debatable. Further, many of those particular paid
leave off time scenarios don't pay the person that does not
show up for work add-ons, like shift pay, differential pay,
night shift pay. Are those to be added on? I don't know. That
would be in addition to the figure I shared with this
committee.
The definition of family. I agree in part, it's quite broad
but it goes way beyond that. It talks about someone that has an
infinity with others living in a particular work and family
environment. I don't know what that means. Does it mean if
people go to college that are friends and live in the same
apartment or same dorm room, that they're covered? I would hope
not. I think that goes well beyond what we're talking about
here.
Further, we have questions about part-time and full-time.
One of the problems with the basic figures that we're talking
about here are many part-time workers do not have this type of
coverage. I would concede that. But those are entry-level
positions. Often people working while they're going to college,
often working while they are in an educational environment and
by definition, a part-time employee has time off during the
week to address many of the needs that you've heard here today.
I could go on but I've listed in great detail concerns
about this legislation in my prepared testimony. Finally, I
want to close with--one of my biggest frustrations when I
worked on the Hill and also as a member of the business
community and I do consider myself in that broad definition.
Witnesses come here and just testify against things. That
doesn't really help. I think there are some definite areas here
that we could reach an agreement on or at least ought to have
that kind of dialogue.
One, we ought to look at the Fair Labor Standards Act and
again examine comp time. If we had some flexibility for
workers, mothers and others, to have some time off on work week
one and make it up in work week two, that would be of
tremendous help. So far, we've not been able to have that
dialogue on the Fair Labor Standards Act reform. We should.
Second, tax credits for employers, particularly small
employers that perhaps do not have the financial resources to
address paid leave. We ought to look at that.
Third, public health. I agree. Public health is exceedingly
important. Perhaps we ought to look at additional funding for
public health clinics, particularly that offer after hours or
evening hours access. I have found in my experience working
with employers that workers that can get to a public health
clinic after they have left work can have tremendous treatment
and health in preventive disease areas.
Further, we should have more money, I would submit, in the
elderly daycare and child daycare programs, tremendously
important for employers in this country.
Further, one concept I'd share with this committee that is
catching on, relatively new, is the old office health nurse is
back. This nurse or other health practitioner comes into the
workplace, works with employees, works with workers to address
their health needs. Tremendous cost benefit analysis.
But in the end game, if you will, what we're really talking
about here is health insurance reform, health care reform in
this country. The employer community cannot bear all of that
cost. This committee is well aware of that. But that's the
dialogue we really need to have.
Thank you very much.
[The prepared statement of Mr. King follows:]
Prepared Statement of G. Roger King *
Good morning Chairman Kennedy, Senator Enzi, and members of the
Senate Health, Education, Labor, and Pensions Committee. My name is G.
Roger King, and I am a partner in the Jones Day law firm. Jones Day is
an international law firm with 2,200 lawyers practicing in 30 offices
located both in the United States and throughout the world. We are
fortunate to count more than 250 of the Fortune 500 employers among our
clients. I have been practicing labor and employment law for over 30
years and I work with employer clients located in various parts of the
country with varying workforce numbers. I have been a member of various
committees of The Society for Human Resource Management (SHRM) and The
American Society of Healthcare Human Resources Association (ASHHRA) and
I also participate in the work of other trade and professional
associations that are active in labor and employment matters. My
testimony today is based on my personal and professional experience.
---------------------------------------------------------------------------
* Mr. King wishes to acknowledge the assistance of his associate
Rebekah Bennett, a member of the Jones Day Labor & Employment Group in
preparing this testimony.
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In the previous Congress, Chairman Kennedy with the co-sponsorship
of other Members of this Body introduced two virtually identical bills
the provisions of which I understand are the subject matter of today's
hearing--S. 932 and S. 1085. Both of these bills have been captioned
the ``Healthy Families Act'' (``HFA'') and have as their fundamental
objective the requirement that any private or public sector employer in
the country with 15 or more employees provide at least 7 paid days (or
56 hours) of sick leave annually to their employees. It is my further
understanding that the committee's objective today is to discuss the
potential effects of the requirements of the HFA on workers, employers,
the economy in general and on public health.
Initially, I believe six fundamental policy and structure
observations are appropriate to review regarding the HFA:
First, based on well-established data, employers in this
country are not opposed to the concept of paid leave for their workers
and have an excellent record in providing such leave on a voluntary
basis. Indeed, numerous studies and analyses have conclusively
established that 75 percent of the country's employers provide, in one
form or another, paid leave including paid sick leave. (U.S. Department
of Labor, Bureau of Labor Statistics, the 2006 Employee Benefits
Survey). This system of voluntary compliance, which includes
collectively bargained policies and procedures, has worked
exceptionally well and should not be disturbed. To the extent that
positions or employers do not provide paid sick leave, such positions
often are entry level in nature or constitute initial or part-time
employment. Frequently, human capital market forces quickly respond to
such situations with workers leaving or progressing out of such entry
level positions to higher paid positions and jobs that do offer paid
leave.
Second, given the above-noted employer commitment to the
paid leave concept, and a high percentage of employers providing such
leave--including paid leave for sick time--a fundamental question that
should be asked by this committee is whether the HFA or a similar
legislation is needed. I would submit the answer to such a question is
in the negative. Employers in this country are already burdened by
numerous Federal, State and local regulations which result in millions
of dollars in compliance costs. These mandated, and largely unfunded,
``cost of doing business'' requirements in certain instances not only
hinder and impede the creation of new jobs, but also inhibit our
Nation's employers from competing globally. Simply stated, a compelling
case needs to be established before any additional regulations and
statutes are imposed upon our Nation's employers in this area.
Third, enactment of the HFA would create a second
``Bermuda benefits triangle'' for employers with FMLA, HFA and
corresponding and often conflicting State laws forming such a triangle.
Employers already face the difficult Bermuda compliance triangle
composed of the American With Disabilities Act (ADA), FMLA and various
State workers compensation statutes.\1\ The potential overlap of all of
the above statutes will pose considerable practical/operational and
legal burdens on the employment community in this country. Such
additional administrative burdens, and the cost of same, including loss
of productivity and ability to compete with offshore employers, must be
addressed before the Congress proceeds with consideration of the HFA.
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\1\ See, e.g., Chapman, Russell D., Garay, Joyce-Marie, Avoiding
the ``Bermuda Triangle": Navigating the ADA, FMLA and Workers' Comp
Void, Compensation & Benefits Review, Vol. 34,
No. 3, 58-67 (2002); Bell, Christopher G., The ADA, FMLA, and Workers'
Compensation: The Bermuda Triangle of Employment Law, SHRM Legal Report
(1997).
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Fourth, the fundamental mechanics and metrics included in
the HFA regarding ``equivalency'' and the requirement that employers
provide annually 7 paid days of sick leave, would appear to be
fundamentally flawed and raise serious policy, practical and expense
concerns. To begin with, the term or phrase ``sick leave'' is a term or
concept that is no longer used by a substantial number of employers in
this country. Paid sick leave has been replaced or folded into
comprehensive leave programs such as paid time off (``PTO'') and other
similar leave policies and procedures. This approach combines
traditional paid sick leave days, vacation days and other paid leave
time (e.g., personal days, attendance incentive pay, etc.) into a
consolidated or comprehensive paid leave program. Under this approach,
a worker is given the option of when to take such paid leave time and
may choose to do so within general constraints for any reason for which
he or she chooses, including taking leave for personal or family
illness situations. The ``equivalency'' provision of the HFA raises
serious questions as to how such PTO and analogous programs would deem
to be ``equivalent'' to the
7-day paid sick leave requirement of the HFA. Indeed, the cost of
regulatory staff and time associated with such ``equivalency'' reviews
no doubt would be considerable as would be the cost of the inevitable
litigation that will arise from such determinations. Consider the
following hypotheticals:
An employer has a paid time-off program that provides
employees with 20 paid days off which an employee may use as he
or she wishes (encompassing paid vacation leave, sick leave and
personal days). The program has no separate ``category'' for
sick leave. Does this program meet the ``equivalency'' test?
An employer has a paid time-off program that provides
full-time employees (those who work 40 or more hours per week)
with 20 paid days off, but does not provide a similar benefit
for part-time employees (defined as those employees who work
less than 40 hours per week). How will this program have to be
adjusted to meet the ``equivalency'' test?
An employer has a paid time-off program that includes
20 paid days off, which includes vacation days, personal days,
and attendance incentive days which can be used by an employee
for illness situations. The employer also provides employees
with 5 paid sick days per year. Does this employer have to add
2 paid sick days annually to meet the ``equivalency'' test?
An employer provides employees with 5 paid sick days
per year along with other paid leave time and permits exempt
employees to accrue compensation time for hours worked over 40
in a given work week. Does this employer have to add 2 paid
sick days annually to meet the ``equivalency'' test?
An employer provides, at no cost to employees, a
short term and/or a long term disability plan that provides
paid sick leave time to employees. Is the employer in
compliance with the HFA's ``equivalency'' requirement?
Fifth, while employers in this country have embraced the
spirit and the concept of the Family Medical Leave Act (FMLA) and are
committed to its continuation, this statute and its implementing
regulations need to be fixed before any other federally mandated leave
requirements are enacted. Notwithstanding FMLA's laudable policy
objectives and the high degree of acceptance that it has achieved with
employers it simply does not work well in a number of areas. Further,
certain of the regulations implementing FMLA are in particular need of
renewed scrutiny and redrafting. It has been well-documented in
proceedings both in this committee and in committees of the Other Body
that FMLA in its current regulatory enforcement state is confusing,
subject to abuse and a source of considerable litigation. As this
committee is well aware, The U.S. Department of Labor (DOL) has
presently pending a request for information (RFI) regarding a number of
issues with respect to the regulations that implement FMLA. I submit
that this committee may be well informed by many of the comments that
the DOL will receive in response to its RFI. Specifically, I would urge
this committee to review the following issues that have arisen with
respect to FMLA compliance:
(1) Definition of what constitutes a ``serious health condition'';
(2) The use (and abuse) of intermittent leave;
(3) The inadequacy of notice and certification before a leave
period begins;
(4) The time period to measure eligibility for FMLA leave;
(5) The time in which a worker is eligible to commence FMLA leave;
(6) Employer communication with health care providers and
verification of ``serious health condition'' claims; and
(7) Impact on attendance incentive programs.
Intermittent leave is one area that particularly deserves this
committee's attention. Two different regulations, the regulation
permitting intermittent leaves when there is no planned and scheduled
medical treatment on the day of the absence and the regulation
embracing chronic conditions as covered ``serious health conditions,''
intersect to create one of the biggest problems for employers in terms
of day-to-day operations. Together, these regulations allow an employee
to have unscheduled absences of up to 60 single work days per year or
approximately 25 percent of all workdays for conditions that may not be
a serious health condition. This means that an employee could be absent
for 1.2 days every single week in a calendar year or a consecutive 12-
month period. Additionally, intermittent leave could be taken in as
little as 10- or 15-minute increments with the potential, therefore,
for an employee to take off a portion of his or her workday everyday in
the calendar year or in a consecutive 12-month period. Further, if the
employee manages to work 1250 hours in the previous 12 months, the
employee will be eligible to continue this cycle.
Problems arising from other FMLA compliance issues as noted above
have also resulted in considerable litigation. One example of such
litigation is the recent case Rucker v. Lee Holding Co., d/b/a Lee's
Auto Mall, 471 F.3d 6 (1st Cir. 2006). In this case, the Court of
Appeals for the First Judicial Circuit ruled that an employee could
meet the 12-month FMLA eligibility requirement by combining separate
periods of employment, including the employee's current employment
period together with a prior period of employment with such employer
that was separated by a period of 5 years. The underlying regulation
that is applicable to such issues--29 C.F.R. 825.110--lacks clarity and
has provided the result noted above which from any perspective is
neither practical nor workable.
Sixth, to the extent that the HFA is premised on the
concept of ``presenteeism'' [a relatively new term used to describe
workers who remain on the job, or come to work, but who are not as
productive as usual due to stress, depression, injury, or illness], I
would submit that additional analysis and research needs to be
undertaken regarding this workplace issue. For example, the most
frequently cited illnesses on which the presenteeism studies' cost
estimates are based are depression (approximately $36 billion), and
other chronic conditions such as back problems, arthritis, headaches,
and stress (approximately $47 billion). An employee's inability to work
productively because of depression or arthritis is unlikely to be
resolved by 7 days of paid sick leave. Further, the Journal of
Occupational and Environmental Medicine reports that family health-
related work absence accounted for only 6 percent of all health-related
productivity loss.\2\ The same article also states that because costs
vary significantly by worker characteristics, intervention needs vary
by specific subgroups. Additionally, if lost productivity is a true
cost of presenteeism, employers will no doubt conduct their own cost-
benefit analysis and will, if appropriate, adjust their leave policies
to correct for lost productivity. This will ensure that employers
receive the full benefit of enacting such a program (without offsetting
such a benefit with compliance and recordkeeping costs associated with
the HFA). Finally, to the extent presenteeism is a problem in the work
place there are other solutions. For example, many employers already
provide employees with alternatives to working 5-day weeks and 9-to-5
schedules. Specifically, many employers permit employees to
telecommute, provide flexible work arrangements, and compensation time.
These alternatives are more likely to effectively address the chronic
conditions (headaches, arthritis, etc.) that impact presenteeism
issues.
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\2\ Stewart, Walter F., Ricci, Judith A., Chee, Elsbeth,
Morganstein, David, Lost Productive Work Time Costs from Health
Conditions in the United States: Results from the American Productivity
Audit, J. Occup. Environ. Med., vol. 45, no. 12, pp. 1234-1246 (2003).
In addition to the above outlined concerns and issues, HFA as
drafted in the last Congress presents numerous ambiguities and
questionable policy and legal conclusions. Certain of these policy and
legislative drafting issues include the following:
section 2: findings
Discrimination
Subsections 13 through 15 discuss the gender stereotypes
associated with family caretaking responsibilities. It is debatable
that the HFA would assist in any meaningful manner the present
regulatory scheme and related statutes that prohibit gender
stereotyping. For example, employers are already subject to civil
rights laws, such as Title VII of the Civil Rights Act of 1964, that
effectively address these issues. For example, an employer that
penalizes men who take leave for caretaking purposes, or denies men
such leave while granting women a similar accommodation are in
violation of Title VII, which specifically prohibits evaluating
employees by assuming or insisting that they match a certain gender
stereotype.\3\
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\3\ See Price Waterhouse v. Hopkins, 490 U.S. 228, 251 (1989) (``As
for the legal relevance of sex stereotyping, we are beyond the day when
an employer could evaluate employees by assuming or insisting that they
matched the stereotype associated with their group, for `[i]n
forbidding employers to discriminate against individuals because of
their sex, Congress intended to strike at the entire spectrum of
disparate treatment of men and women resulting from sex stereotypes.'')
(internal citations omitted).
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section 4: definitions
``Applicant''
Why is an applicant contained in the definition of
``employee'' in section 4? Are applicants for employment to be covered
by this legislation? If so, on what basis? How would an applicant for
employment qualify for HFA leave and how much paid leave time would an
applicant be entitled to receive?
``Covered Employee''
How long does an employee have to be employed to be
covered by this legislation? If applicants are covered, presumably
there is no minimal employment period. Seemingly, an employee or
applicant could start work on Monday and be eligible for some number of
paid leave days on Tuesday.\4\ In contrast, under FMLA an employee is
required to be employed by an employer for 12 months and have at least
1,250 hours of service with such employer before the employee is
eligible for the act's benefits and coverage. 29 U.S.C.
Sec. 2611(2)(A). The FMLA approach would appear to be a more
appropriate eligibility requirement.
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\4\ It is not clear under section 5(b)(1) how much ``accrual'' an
employee is required to receive in a given calendar quarter.
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``Employer''
The definition of ``employer'' under the HFA includes
entities that employ 15 or more employees for each working day during
each of 20 or more calendar work weeks in the preceding calendar year.
By contrast, before FMLA is applicable, an employer must employ at
least 50 employees within 75 miles of a worksite. 29 U.S.C.
Sec. 2611(2)(B)(ii). Why should the HFA be applicable to business
entities that are quite small and may have difficulty in being
compliant? The FMLA definition of ``employer'' would appear to be more
appropriate.
section 5: provision of paid sick leave
This section mandates that 7 days of sick leave with pay
shall be annually provided for employees working 30 or more hours per
week and that a pro rata number of days of paid sick leave be available
with pay on an annual basis for employees working less than 30 hours
per week or 1,500 hours throughout the year involved. The financial
impact of such an unfunded mandate on employers should be carefully and
thoroughly researched. Although, as noted above, many employers in this
country provide paid leave in excess of such 7-day requirement,
employers with workforces in the 15-50 category may experience
financial difficulty in complying with such requirement. Further, even
those employers that have the resources to be compliant may experience
considerable additional costs of compliance if the HFA is enacted,
especially depending on how the HFA ``equivalency'' test is applied.
Full-Time Employee Definition
Why is the definition of full-time employees under the HFA
at 30 hours per week when the traditional work week in this country is
40 hours? Indeed, this is the definition generally utilized under the
Fair Labor Standards Act. Further, the HFA's requirement of providing
paid sick leave for employees working less than 30 hours per week, even
on a pro rata basis, is inconsistent with many employer leave plans and
would appear to be unreasonable in many employment settings. For
example, is there a minimum number of hours that an employee must work
to qualify for HFA coverage? Presumably, an employee could work only 1
hour a week and still qualify for fractional paid leave benefit. Would
an employee working for multiple employers be entitled to more than 7
paid sick leave days annually? How would employees working multiple
part-time jobs be treated under the HFA?
Definition of Pay
The HFA does not define the word ``pay'' in either section
4 or section 5. Does this term include all types of compensation
associated with a given work day even though the employee would not be
present and working? For example, would it include such compensation as
incentive pay, differential pay, specialty pay, weekend bonus pay,
night shift differential, bonus pay, and other similar compensation
arrangements that generally only result in an employee receiving such
additional compensation if and when such a employee appears for and
completes a work day? Does the term ``pay'' include all benefits that
would otherwise be applicable from working such day? For example, would
the employee receive accrual credit for pension and other like benefits
when a mandated paid sick leave day situation arises and the employee
does not work on such day? Stated alternatively, many employer paid
sick leave and PTO plans only pay an employee on leave their straight
time hourly rate without payment of differentials or other compensation
tied directly to the employee working his or her shift. Arguably, under
the HFA this approach may not meet the equivalency requirement and such
employers, therefore, would be required to increase the amount of
compensation an employee would receive while on paid sick leave. There
is obviously considerable ambiguity in this area and there is mandated
in this section of HFA alone the potential to place millions of dollars
of additional paid leave expenses on our Nation's employers.
Intermittent Use
The calculation of how the paid sick leave system would
work is particularly troubling. Section 5(c), the calculation section,
would permit paid leave to be on an hourly basis or in the smallest
``increment that the employer's payroll system uses to account for
absences or use of leave.'' This literally could be in minute
increments as many employers track absences in such minute incremental
amounts. Indeed, as discussed above, this concept is already a
tremendous problem area under FMLA.
Use Standards
Section 5(d) is extremely broad in defining when a worker
could qualify for sick leave and would no doubt result in considerable
disagreement and potential litigation. For example, an absence
resulting from obtaining medical diagnoses or care, or preventive
medical care is very broad and is in need of considerable additional
specificity. Again, this is a problem area under FMLA which has an
analogous open-ended definition of ``serious health condition.'' 29 CFR
Sec. 825.114.
Definition of Family
Equally troubling under section 5(d) is the potential for
use of the mandated paid sick leave for an individual that has an
``affinity whose close association with the employee is the equivalent
of a family relationship.'' What does this mean? This phrase is
obviously susceptible to a very broad inclusion of a variety of
individuals. Does it include frequent visitors to a household? Does it
include domestic partners? Does it include ``friends'' living together,
for example, while away at college?
Scheduling
Section 5(e) would only require an employee to make a
``reasonable effort to schedule leave.'' This open-ended and minimal
requirement of notice to an employer for unscheduled leave will pose
significant practical and operational problems.
Foreseeability
Section 5(f) regarding notification procedures is
similarly deficient as it only requires oral and written notice 7 days
in advance of any leave that is foreseeable. This period is too short
and will pose considerable problems for many employers. By contrast,
FMLA requires in most instances 30 days advance notice for qualified
foreseeable leave. 29 U.S.C. Sec. 2612(e)(1).
No Dispute Resolution Mechanism
The HFA contains no mechanism for an employer to question
or challenge a certification that an employee may receive to qualify
for the required paid leave. By contrast, under FMLA, employers may
require the employee to obtain a second medical certification from a
health care provider selected by the employer. 29 U.S.C. Sec. 2613.
Certification
Section 5(f) requires certification only if the employee
takes leave for more than 3 consecutive work days. This very ``loose''
standard will no doubt impede the employer's ability to curb abuse.
Further, under section 5(f)(2) an employee is given up to 30 days
before a certification would need to be provided to an employer. This
period is too long. Finally, section 5(f)(2)(B)(ii) states that:
``A health care provider shall make reasonable efforts to
limit the medical facts described in clause (i)(III) that are
disclosed in the certification to the minimum necessary to
establish a need for the employee to utilize paid sick leave.''
What does this mean? It would appear to severely limit an
employer's ability to use the certification requirements (such as they
are) to prevent abuses of paid sick leave.
Equivalency
The section 5(g) ``equivalency requirement'' in addition
to the problems noted above, also contains a mandate that ``an employer
may not eliminate or reduce leave in existence on the date of
enactment'' of the HFA. This edict would appear to contradict other
sections of the HFA that will require employers to substantially modify
their leave policies to become compliant with the HFA.
Further, section 5(g)(2) is troubling as it states:
``An employer may not eliminate or reduce leave in existence
on the date of enactment of this Act, regardless of the type of
such leave, in order to comply with the provisions of this
Act.''
As noted above, does this subsection prohibit even minor
adjustments to an employer's current leave programs? For example, would
an employer that has a paid time-off program that does not specifically
identify sick leave be prevented from changing in any manner how this
paid time-off system works, including the eligibility and accrual
levels associated with such plan?
Enforcement Authority
Section 8 of the HFA provides the Department of Labor with
broad investigative and enforcement authority. What will be the cost of
such enforcement and oversight? Does the Department have the resources
to carry out these new obligations?
This section also provides for private lawsuits for lost
wages and benefits, re-
instatement and other equitable relief, and attorney fees for a
prevailing employee. Given the numerous ambiguities in the HFA, this
section would appear to be an open invitation for considerable
litigation, including class action lawsuits that already are causing
our Nation's employers to pay millions of dollars in unnecessary legal
fees and costs.
Effect on Other Laws (No Preemption)
Section 10 of the HFA is an ``anti-preemption'' provision
and would permit State and local laws to co-exist with, or supersede,
the provisions of the HFA. If the Congress does proceed to enact
further mandated leave legislation, either paid or unpaid, considerable
attention must be directed to the question of whether there should be
uniform national standards. The varying and often conflicting State
statutes and regulations regarding leave pose significant
administrative costs for employers and can result in confusion and
potential error. Neither employers nor workers are well-served with
such a difficult regulatory scheme. The approach taken with respect to
ERISA preemption should be given serious consideration.
Effect on Existing Employment Benefits
Section 11(a) of HFA states that its provisions shall not
be read to diminish the ``obligation of an employer to comply with any
contract, collective bargaining agreement, or any employment benefit
program or plan that provides greater paid sick leave rights to
employees in the rights established under this right.'' Subsection B
states ``the rights established for employees under this Act shall not
be diminished by any contract, collective bargaining agreement or any
employment benefit program or plan.'' The above subsections read
together with section 5(g)(2)--the Equivalency Section--would appear to
unduly ``lock in'' current employer leave program provisions and make
any change of same unlawful, including in collective bargaining
settings. This approach is too rigid and will restrict both employers
and unions in collective bargaining from having any flexibility in
making even minor adjustments in benefit plan provisions.
Encouraging More Generous Leave Policies
Section 12 of the HFA makes the following interesting
policy statement:
Nothing in this Act shall be construed to discourage
employers from adopting or retaining leave policies more
generous than policies that comply with the requirements of
this Act.
Unfortunately, if the HFA is enacted based on the
experience of many employers under FMLA, and the problems outlined
above that can be anticipated with the enactment of the HFA, employers
of all sizes may be discouraged from implementing any additional
improvements in their paid leave programs--assuming after paying for
their additional paid leave costs, administrative expenses, and
litigation costs associated with the HFA that they would even have any
resources left to make such improvements. Indeed, in many instances it
may be that the added administrative and litigation costs and other
compliance expenses associated with the HFA will drain any resources
that otherwise would have been available for paid leave benefit
improvements.\5\
---------------------------------------------------------------------------
\5\ Ironically, the testimony in a number of congressional hearings
has documented how, as a result of the FMLA, some employers are moving
toward eliminating their more generous pre-FMLA programs and other
companies are being urged by consultants not to adopt programs more
generous than the FMLA. See Senate Testimony of Deanna R. Gelak, SPHR
on behalf of the FMLA Technical Corrections Coalition and the Society
for Human Resource Management, July 14, 1999, p. 22. For example,
Thomas E. Burns, corporate director of compensation and benefits, NYNEX
Corporation, New York, N.Y., testified before the U.S. House
Subcommittee on Oversight and Investigations, at the June 10, 1997
hearing, (page 14) that ``NYNEX Corporation's sickness disability
benefit plan provides up to 52 weeks of paid salary continuation for
each illness. Since the FMLA was enacted, NYNEX has experienced a 42
percent increase in the percentage of incidental absences from 1992 to
1995, despite a reduction in the workforce of 7,000 employees.
Incidental absences are those of 7 days or less for an employee's own
illness.''
Mr. Chairman, Senator Enzi, and other members of the committee,
thank you for permitting me to share my views with you this morning. I
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would be happy to answer any questions that you might have.
The Chairman. Very good. Thank you for your suggestions and
ideas. I'm always--this is always a subject matter that I find
enormously compelling because I--shortly after I entered the
Senate, I found out that my son had osteosarcoma in this leg
and he had to have it amputated and he had to get a treatment
up in Boston and he had to go two and a half days every 3 weeks
for 2 years. I never showed up for work here in the United
States Senate. Never showed up. Talked to Mike Mansfield and
said, I'm outta here on these Fridays. You have an important
vote and need my vote, this is it but I'm gone.
I think if I hadn't gone, the people of Massachusetts would
generally have thrown me out and they probably should have. But
I never had to worry about missing a paycheck all during that
time. And yet, I always remember these parents being in those
rooms where other children who were getting treatment and what
they were facing every time, every few weeks, they were going
to miss a day or two being with their children.
We ought to be able to work this out. I mean, this is
about--I don't buy into this. Maybe there are abuses in certain
areas--abuses in a lot of areas around here about the
exploitation on this. It's difficult for me to buy those
arguments easily.
I'm interested in these health--we're doing a good deal of
talk on our committee about how we're going to try and save
resources and how we're going to find common ground and the
preventative aspect stands out as one of the ones that everyone
sort of agrees on and you talk about a preventive aspect of
this kind of thing. We can all get into all of our various
parts of things which we think can be done in terms of
preventive care, boy, this is certainly one of them, if you're
talking about education. You're talking about schools, you
talked about teachers and what's happening in schools all over
this country, particularly my part of the country and colder
areas. New England, what happens to a number of children that
are missing each day from these kinds of health challenges that
Dr. Bhatia has mentioned.
Let me just--I'd like to ask, on the public health, the
Center for Disease Control. I'd like to try and keep it this on
what they say, what the real type public health, what the
Center for Disease Control say about children. I mean, we know
that children recover a lot faster. I remember 40 percent, I
don't what it is but it's a lot faster when they are with a
parent. We all know that. We know there are going to be a
certain number of children that are going to get sick over the
course of this year. We know that--pretty predictable in terms
of the flu and the rest of these. What is the Center for
Disease Control and our State agencies say about the public
health implications of this, Doctor? I'll ask Dr. Bhatia first.
Dr. Bhatia. The public health implications----
The Chairman. Well, take first of all, the CDC. You quoted
some studies in the CDC and then if you can, tell us about the
various public health. Another area I'm very interested in is
the pediatricians' talk about this. Jody, you might talk about
that a little afterwards about what the doctors--so we try and
keep this, to the extent that we can--on what those that are
the trained medical professionals feel about this issue as a
public health issue, as a preventative issue. What's in the
best interests of children? They have a pretty good--we've got
to worry about our employers certainly but we also have
children and family members that are important to give
consideration to as well.
Dr. Bhatia. So I don't think it's just the CDC. I think
there is a pretty wide consensus that when there is a
contagious disease, you try to avoid contact. In an adult
situation, perhaps you can say, okay, adults shouldn't be
shaking hands--but with kids, you can't control that situation.
So it's not--the CDC is pretty clear with certain infectious
diseases, don't go to school. Don't go to work. That is their
official recommendation. It's on their Web site, it's on their
fact sheets. These recommendations are also made by physicians.
They are so commonly made--I don't think that they are
published anywhere as recommendations. They are codified in our
school districts. Our school districts tell parents, if you
have a child with a fever, don't bring that child to school.
Stay home 24 hours after the last time the child has fever and
I think that most parents would like to follow these
recommendations but as I was saying, I think that there is a
number of competing pressures--work pressures, economic
pressures that are also health issues that are making many
people have to make tradeoffs between one adverse public health
consequence, not following those public health--their doctor's
recommendations and risking hunger or risking eviction. These
are diseases that affect tens of millions of people every year,
several times a year and these are fairly clear
recommendations.
I want to mention one other thing about the tradeoffs. The
tradeoffs cause stress and I think research has shown
increasingly that stress is, in itself, is a factor that
operates biochemically to affect diseases, ranging from obesity
to infectious disease. So not only are these kids not getting--
having the time to get better from their infectious diseases,
not only are they spreading them, they are being put--their
families and them are being put at greater risk of infectious
diseases and other illnesses because of the stress that is
ensuing.
The Chairman. And finally, if Jody could talk about the
pediatricians, not only on the stress but it's the stress on
the employer, too. They are worried about their child at home
that's sick, in terms of productivity and where they're going.
Dr. Heymann. Thank you, Mr. Chairman. Let me give a series
of numbers here, both about adults and children. I think one
very striking one about adults is influenza. So these are
Center for Disease Control numbers. Influenza leads to 200,000
hospitalizations a year, over 36,000 deaths in an average year
and we know very clearly what the recommendations are. You get
sick, you should stay home.
We also know that it's infectious after people have
symptoms, that they are coughing and sneezing on people,
they're spreading it at the workplace and what happens
commonly, if people don't have paid sick days, is they go to
work sick. This is an enormous dollar cost, by the way. They
spread it to others at work. Those folks are home some of the
time. When they're not home, they're at work. Presentism--not
at full capacity but the health costs are enormous.
When it comes to children, there are several things we
should be aware of. When children are sent to childcare sick,
which they are and they are so commonly that if you ask daycare
teachers, they'll tell you about the Tylenol sign. That's when
the children have a little pink collar because the parents have
given the child Tylenol to mask the fever before sending them
to the childcare center and the little child dribbles out the
pink Tylenol onto their shirt but then they go there and what
happens is, at noon, the fever goes up. The Tylenol has worn
off. The child has diarrhea, vomiting, spreads it to the other
kids and we know this leads to three and four times the rate of
infections among children in these centers.
When parents are present, in contrast, even in serious
illnesses like hospitalizations, the hospital stays are
decreased by 31 percent. That's an enormous amount of cost
savings.
I guess the last thing I want to mention on these health
numbers, which is included in my prepared remarks and I hope
that will also be included in the written testimony, is
thinking about these other countries that are doing it. Why?
Because I think it does go to this core issue of can we afford
to do it? For sure, if 19 out of 20, all but us in the most
competitive economies are providing paid sick days. Our
companies are as good. We can make this work, too. It is
noteworthy that those top economies are also higher ranked in
terms of their health outcomes.
Thank you.
The Chairman. Debra, I'll come back. My time is 2 minutes
over here. I'll come to you in just a minute. Don't forget what
you were going to say.
Senator Enzi.
Senator Enzi. Thank you. You know, we talk about the stress
of the employee who has these problems. I don't want you to
think that the employer isn't under any stress. Everything that
we've talked about here are things that most of the businessmen
that I know would love to be able to give to their employees.
They think it is essential. They just haven't figured out how
to pay for it. The hearing is extremely helpful. There will be
some people out there that will be introduced to this concept
that haven't been before and they'll make some adjustments. And
it will make a difference.
Now as far as the legislation itself, there are a lot of
unintended consequences that I think would happen if we were to
go ahead and pass this because I don't think we have any
concept of what those businessmen, the ones between 50 and 500
employees are going through with their decisions and this
affects all of them but a lot of them above that, 75 percent of
them above that provide this benefit already. I was kind of
surprised that 25 percent of big businesses don't. But I'm more
worried about the small businesses and how they get along and I
know that some people in small business, to try and figure out
the dilemma of how to handle this, have said, I'm going to go
ahead and pay my people sick leave and I'm going to pay it on
every paycheck. I'm going to show it on that paycheck as paid
sick leave. They don't have to have any excuses for taking sick
leave off. Hopefully they take that money, they save it for
when they do have something but it's a way that they can have
the money for it but it's also a way that when they think maybe
they're sick--they know they got paid for it so maybe they'll
determine whether they really need to come to work or not.
Now, of course, we all hope that nobody comes to work
really sick but I can tell you that the employers do because
they don't have anybody to fill in for them.
I'm an accountant and I had a little trouble with some of
the numbers in this bill. We usually talk about 40 hours but
this drops down to 30 hours for qualification and then 20 hours
for pro-ration and I was trying to figure out--20 hours is two-
thirds of 30 hours but when you multiply that by 7 days the
employer has to come up with some minutes that he has to work
out there, I also noticed that you could take this in 1-hour
increments or smaller increments if people keep track of their
time on that basis and I think a lot of people keep track of it
in 6-minute increments. So I guess we're giving people
permission to have 6 minutes worth of being sick. That's the
way it will work out and somebody will have to do all the
record keeping on it.
Mr. King, you mentioned some of the lack of clarity in the
bill's equivalency provisions coupled with the requirement that
existing leave policies be frozen. Do you have any opinion as
to what employers would be advised to do with their existing
leave problems and entitlements were this bill likely to be
enacted?
Mr. King. Senator Enzi, I can refer the committee to the
experience in employer area after FMLA was enacted. Many
employers, including very large Fortune 500 employers, said the
cost of compliance is such that we will not increase or add on
to our current benefit package. And that has been the
experience with many. The costs on the margin here to comply
can be considerable so I think that what you will see if
legislation such as this were enacted, would be less resources
(a) available for paid leave and (b) a great reluctance on many
employers' part to put more money in this area, which is
counterproductive.
I might note in reference to the public health discussion
also, certainly employers agree with virtually everything that
has been said here regarding the CDC. We don't want sick
workers coming to our place of business. That's not good for
productivity. It's not good for clients or customers. Many
employers have flex time situations where they permit a
different hour for the person to come in or a different day.
Many of our employers in this e-age we live in, this electronic
age we live in, permit employees, workers to work from their
home. They telecommute. There are many things that can and
should be done in this area.
This legislation, Senator, has a lot of areas that just
from a pure mechanical legislative drafting perspective, as I
mentioned, needs attention.
Senator Enzi. Thank you. Actually I think you were very
kind on that. I think there are a lot of attorneys across this
country that would say to the small businessmen, cancel your
paid time off. You're going to have to make it up for sick
leave and we don't know where the sick leave is going to go
after this. Those who are providing more than 7 days sick leave
will be encouraged to cut back to 7 days of sick leave and the
advice they will be given is, blame Congress. They said that
was adequate sick leave, so cut it back.
Mr. King. Senator, if I may, I hear that all the time and
what you also may see is vacation banks or other paid leave
time being decreased to meet the mandate of the statute. So I
think you are correct in your analysis.
Senator Enzi. I think maybe some attorneys would worry
about their liability if they didn't give some advice like that
but I guess they don't worry about liability or they'd be
doctors.
I have questions for all of you and most of them have some
more levels of detail in them that I'd like to have so I'll
provide those in writing because I am interested in whether it
is your intention that we cover cosmetic things, like Botox and
teeth whitening and there were some comments about nursing home
costs in there and I'm wondering if you think we ought to shift
the cost of nursing homes over to employers, also the cost of
friends? I don't know why we picked 7 days. It could be 14
days. In the presentism study that was cited, flex time among
Federal workers increases morale. On the presentism study--I've
got a lot of questions on how those numbers were derived. I've
got some questions on these other countries that have the lower
rates, what their employee compensation is to begin with and
what their rate of unemployment is. I've got some questions
about flex time, of course, because we allow Federal employees
to do that because it increases morale and we know that it does
but we deny private employers from doing that same thing. I
have whole lists of questions here that I'd like to have
answered and so I hope that you'll respond in writing to these
as you get them. Thank you.
The Chairman. Senator Sanders.
Senator Sanders. Thank you very much, Mr. Chairman and
thank you for holding this important hearing. My apologies for
not being here earlier. I was over at a Veterans Committee
meeting and what was interesting and one of the aspects of the
discussion at the Veterans Committee meeting was the pride that
everybody, including the Bush Administration, took in the
quality of care that our veterans are receiving at the VA and I
found it rather amusing, Mr. Chairman, after all the attacks on
big government, how government can't do anything, we have
everybody saying that the Veterans Administration is providing
cost effective, high quality care to our veterans. Maybe that's
a lesson that we might want to think about when we keep
attacking the government and how it can't do anything. The
importance of this hearing, I think, and I'm going to ask Dr.
Heymann a question in a moment and I think we have to do this a
lot, Mr. Chairman.
You know, I hear people saying, America, we're No. 1. We're
No. 1. Well, if you look around the world in terms of how we
treat our children and how we treat our working families, we're
not No. 1. We're way, way, way on the bottom and I think we
need more discussion to ask why countries in Scandinavia, in
Europe can virtually eliminate childhood poverty while we have
the highest rate of children poverty in the world.
I think, Mr. Chairman, we should be asking why, in this
country, millions of workers go to work today and you know
what? They have zero--zero vacation time or 1-week vacation
time when all over the world, people are guaranteed 3, 4, 5
weeks of paid vacation. So when people talk about us being No.
1, yeah, we have the most unfair distribution of wealth and
income of any major country on earth. We're No. 1 there.
[Applause.]
Senator Sanders. We have the highest rate of childhood
poverty of any country on earth, we're No. 1 there. But maybe--
maybe the Chairman is going to quiet you down, so let's--I'll
save him the----
The Chairman. Gently, gently.
[Laughter.]
Senator Sanders. But the real issue is how we can be No. 1
in protecting the needs of working families and our kids and I
would hope--I would hope that that is where we strive to be No.
1.
Senator Enzi has very appropriately pointed out the
problems facing small businesses. He's absolutely right,
certainly in the case of the State of Vermont. We know that.
But we also know that in the tax bill that the President has
just presented to the Congress, guess what? The Walton family
that owns Wal-Mart is going to get $32 billion in tax relief.
While we have the highest rate of childhood poverty in the
industrialized world. Maybe we should start changing those
priorities.
What I wanted to ask Dr. Heymann is--and I think you've
already gone over this--is the United States No. 1 in paid sick
leave?
Dr. Heymann. Unfortunately, the United States is very far
down the list on paid sick leave and you mentioned other family
priorities. In fact, it's very far down the list overall. We've
heard a lot about the FMLA today but it's unpaid leave. I'll
mention that that leaves us near the bottom. We have data on
173 countries--168 of these provide for paid leave for women at
childbirth. Who doesn't? The Sudu, Liberia, Swaziland, Papa New
Guinea and the United States of America. That's it.
Now when it comes to the paid sick days, 145 provide paid
sick days and as I mentioned, 100 of these--it's from day one,
for over 100 of these, it's at least a month. Seven days is
quite few by those measures.
In terms of Senator Enzi's question about unemployment,
which is an important one, the answer is that many of these
countries have lower rates of unemployment and when you look at
the relationship between the duration of their paid sick days
and unemployment, which we have, for all countries, there is
absolutely no relationship there. The only relationship is the
competitiveness. When we do this against the Competitive Index
from the World Economic Forum, the top quarter of competitive
countries offer the most paid sick days. The bottom quarter
offers the least paid sick days. We don't think that's a
coincidence. It's because having a healthier workforce is a
competitive advantage, as is having better educated children.
Thank you.
Senator Sanders. You raised the Family and Medical Leave
Act and I remember how hard we had to struggle to pass that and
yet, if you don't have money, it doesn't do you any good
because you've got to go work to pay the bills. How many
countries in the world--well, you just told us. In that regard
and I would hope that everybody recognizes that when your child
becomes ill, your parents become ill, you want to be able to
spend time with them. That's kind of pretty basic. And yet, we
provide zero guarantee, zero pay for low-income workers, many
of whom can't even take advantage of that Leave Act, is that
correct?
Where do we rank internationally in terms of providing
health care to all of our people?
Dr. Heymann.
Dr. Heymann. Why, I think we know unfortunately again,
compared to most industrialized countries, we're very far down
that list.
Senator Sanders. What about maternity leave?
Dr. Heymann. Maternity leave, we're basically at the
bottom.
Senator Sanders. What about vacation time for American
workers?
Dr. Heymann. Vacation time--137 countries around the world
guarantee paid annual leave. We don't guarantee any.
Senator Sanders. Mr. Chairman, we've got a lot of work to
do. The United States should not be at the bottom of the
international community in terms of benefiting its workers.
[Applause.]
The Chairman. [Pounding gavel to restore order.] Thank you,
thank you. Please.
Senator Isakson.
Senator Isakson. Thank you, Mr. Chairman. Dr. Heymann, I
want to make sure I heard what you said a minute ago. You said
the--you talked about the top quarter of the most competitive
and the bottom quarter and the correlation was, the bottom
quarter didn't have paid sick leave and the top quarter did. Is
that correct?
Dr. Heymann. So what I said is, we looked at duration of
sick leave and quality of sick days and the most competitive
countries are the ones providing it and you can look at it both
across the countries. The other way we looked at it, is we took
this World Economic Forum list--the list put together by top
business leaders and we said, what about the top 20 countries?
And I'll just give you some of the top 10: Switzerland,
Finland, Sweden, Denmark, Singapore, United States, Japan,
Germany, Netherlands, UK. That's the top 10 in rank order.
Everybody but the United States guarantees paid sick days in
that list and the United States is falling in competitiveness.
We're now ranked No. 6. We used to be ranked No. 1 and I think
that's about a chronic under investment.
Senator Isakson. Doctor, thank you. The reason, before I
lose my train of thought here.
Dr. Heymann. I'm sorry.
Senator Isakson. The reason I asked that question is--and
you sort of noted it at the end of your answer. The people that
are at the bottom don't have required annual sick leave,
except, in the top 10 is the United States that doesn't have
any required sick leave, which is the point I want to get to,
is something that Mr. King alluded to. While the United States
does not have mandatory, minimum number of paid sick leave
days, it is true that a significant portion of the United
States of America's employers voluntarily have benefit programs
for sick leave for their employees, I think. I know Ms. Ness
said that 57 percent had paid sick leave and 43 percent don't
or something like that and then Mr. King said 75 percent had
it. I think the difference is formal policy versus informal
policy, is that not correct?
Dr. Heymann. That's--if I could answer--is it okay if I
answer that?
Senator Sanders. Sure.
Dr. Heymann. Senator, I think it is important and valid
question and in fact, again, of those top ten, just to take as
an example, they all, except for the United States, have higher
rates of paid sick days, even when you include informal policy
as well as formal policy. While there is informal policy in the
United States, it covers half of the private sector and
importantly, I've heard from many employers that among those
employers who do provide it, they're having a hard time because
they are competing against other companies down the street that
aren't. Among those who would like to provide it, many of them
feel that putting it in the law would give them a level playing
field.
But in direct answer to your question about those other top
competitive economies, they all have higher percentages of
employees receiving paid sick days than we do.
Senator Isakson. My point is that I respect all the things
that Senator Sanders said but this is a great country and
America does a lot of things voluntarily that it doesn't get a
lot of credit for and so does American business and the point
of my whole statement is, Mr. King makes a very valid point.
And that is, we need to look at--no one is opposed to what is
being talked about today. That's the first thing but it's how
you--the devil is in the details and every time you deal with
these issues and isolated mandates based on circumstance, they
accumulate. And to some pretty unbelievable mandates on
business and the question about re-looking at the Family
Medical Leave Act as you address this area of sick leave is
tremendously important. Second, the reason--in a positive
sense, not a negative sense and I think Mr. Sanders'
recognition of the importance of small business is critical--I
ran a small business for 22 years before I came here and many
times, Federal mandates for minimums become maximums and
ceilings because you don't have the flexibility as an employer
to do what's right for the employee.
And as bad as many employers are categorized and castigated
by statements that really are taken out of context and
inappropriate. The fact of the matter is that any good business
person that runs a business and owns it is very compassionate
about their employees because they have no business without
their employees. And I'm making a speech here rather than a
statement but--I want everybody to understand--it really
bothers me a lot when we take out after this country as being
so bad about everything when we're so great about everything,
much of it voluntarily and on our volition and not because some
government mandated that it happens so as we--and I appreciate
all your testimony. I think this is a great thing for us to
look at and improve because I care about the plight of every
worker but let's look at it in the context and the perspective
of all the--and this is not a question for you, necessarily,
Doctor. It's a speech I'm making right now and I apologize for
that but we need to look at these things in the context of all
of them and not let them stack and accumulate.
Last point----
Dr. Heymann. Would it be all right to mention one thing
from a small business perspective in response to this?
Senator Isakson. As long as you don't take all the rest of
my time.
Dr. Heymann. Okay, I'll be very brief. Senator Kennedy
mentioned Dancing Deer. They are a small business. We did a
case study of them because they treat their employees well.
They right now don't have paid sick days. They'd like to have
them very much because this kind of law will mean that they can
compete with other bakeries while offering it. So I think there
really is an important perspective. In no way does the fact
that some companies don't offer it now means they are not good
companies. It means that the public policy can help them as
well, as we've heard.
Senator Isakson. Well, Chairman Kennedy, if you would or
have your staff, I want to ask you a point of information later
on, on the accumulation provision in the bill. It appears to
me--it says it allows accrual of sick leave days but no more
than 7, which leads me to believe that you can accumulate 7 in
1 year and roll those forward and add them to the 7 in the next
year, so it could go as high as 14, the way it's worded. And I
think we need to take a look at that because that would have an
unintended consequence that I don't think the Senator intends
to do.
The Chairman. That's right. Thank you.
Senator Brown.
Senator Brown. Thank you very much, Mr. Chairman. Last
month, Senator Kennedy led the fight here in this Senate for a
higher minimum wage. Opponents to the minimize wage said that
it will make business--it will put some people out of work, it
might even put some businesses out of business. It will put
minimum wage workers, low-income workers out of work, that it
will overall hurt the economy all over the country.
Our answer to that and Senator Kennedy's answer and the
answer of many of us was that to look at those States which had
higher minimum wages, state-imposed minimum wages and found
that in fact, those States, by and large, are more prosperous
States than those without higher minimum wages. We're hearing
the same kind of argument and opposition to this proposal--that
this will make America less competitive as a nation. Both Ms.
Hartmann and Dr. Heymann, if you would, answer to that with a
little more specificity. Ms. Hartmann mentioned in her
testimony and I apologize for being late and having to leave. I
have other hearings I have to do today but replacing workers is
very expensive. Even in the low-wage labor market, filling a
vacant position and bringing a new worker up to full
productivity can cause 43 percent of annual pay. I would like
Ms. Hartmann to expand on that a bit and Dr. Heymann, if you
would expand on the competitiveness, why, in fact, the United
States--you've made clear we stand out as a country that
doesn't do this while others do--but why, in fact, this would
make us, if you would, delineate in this global economy, why
this will make us more productive, faster growing and a better,
stronger economy and Ms. Hartmann, if you start.
Ms. Hartmann. Thank you very much for the question.
Basically, what we found in doing this research is that
turnover rates differ between companies where workers do have
paid leave and where they don't and that differential and
turnover means that when a company puts in paid leave, they can
expect their turnover to fall. We value that turnover with a
number that comes from the Employment Policies Foundation,
which is a business think tank. So we used their number of 25
percent rather than the 45 percent that we mentioned in the
testimony. So we low-balled, if anything, the estimates, which
are savings from reducing turnover and what we found was that
the savings from reducing turnover outweigh what you would
actually pay the workers for leave. The reason my numbers
differ from Mr. King's is that we look at the amount of leave
that people would actually use so in the economy as a whole,
again, if you have paid sick leave now, you use only one more
day of sick leave per year than if you have unpaid leave. So
the amount of increase that you would get is small and we
measured that increase as a cost and the cost of providing that
money to workers is substantial--it's $20 billion but the cost
of the reduced turnover and adding to it, the reduced spread of
flu in the workplace, we get a savings of $32 billion. So on
that, there is about a $9 billion difference. So anything that
economists can say, where the gainers can pay the losers and
then have a surplus--that's considered Fredo optimal. It's
considered that you are increasing total output in the economy
so it's basically a net gain for the society because we can
actually gain more than we lose. So all the points that Mr.
Enzi and others have made are very valid but you also have to
look at it from the point of view of society as a whole and if
you can do any change, which saves the economy more money than
it would spend, then all economists would say, do it.
[Applause.]
Senator Brown. Dr. Heymann, if you would address the issue
of making us more competitive.
Dr. Heymann. Sure. On a national level, there are really
three things that make an enormous difference in making us--any
country competitive, including us. One, is the education of the
population. Second, is the health of the population and the
third is the training and skills that are specific to the job.
And in that last one, I want to mention, we've done a study of
very successful companies across the country and around the
world from Alabama to Connecticut, from China to Ireland to
Norway to South Africa. Our competitors, as well as our local
companies, including manufacturers of clothing to bricks to
call centers and all of the CEOs, human resource people at
every level talk about the same thing. If you can keep your
employees on the job, active, there a long time, there is so
much job specific knowledge that the productivity goes up
markedly. So this gets back to what I think Heidi was saying in
terms of turnover rates and what we know from our own work,
paid sick days reduce turnover dramatically among those who
have been sick. So that kind of training retention--big impact
on a company by company basis and long-term impact for the
country. The other areas--health--the population health numbers
are just striking. What makes the biggest difference in health
long term are the prevention measures. We know this from really
countless studies and the countries that have this kind of
policy in place have much better health outcomes.
Finally, development of children. Paid sick days makes
parents five times as likely to care for their kid's health.
When their kids are healthy, their development is better, their
education is better. That really is a tremendous long-term
investment and we know the statistics bear this out on the
countries. Thank you.
Senator Brown. Thank you. Thank you, Mr. Chairman.
The Chairman. Senator Allard.
Senator Allard. Thank you, Mr. Chairman. I guess--from my
own background, I come from a small business person's attitude
but in addition to that, many of us represent small businesses
that are in rural areas. One of the problems that you have, as
a small businessman, is you have an employee who is trained to
do one specific function for that business. If they don't show
up for work, the business can't take care of its clients or its
customers or whoever is utilizing that and it creates a
hardship for the business owner, who by the way, is a
hardworking American. Many times, small business people put in
more hours than anybody on the payroll because they know that
when they're not there, the business doesn't function.
So I have a concern about those particular types of
businesses and I guess I look at it from a total compensation
package. I think the comment that says that well, if you're
looking at the total compensation, some types of employees
prefer different types of benefits from the business than other
types of employees. It depends on where they are in their work
cycle. It depends on what type of community they are in and
those types of things and it seems to me that when we have
mandates, we take away that flexibility.
I have a question for Mr. King. Has any effort been made to
analyze on a local basis, how this may impact small
communities, for example. If you have a business that provides
one particular type of service to a small community, I guess if
the person who wants the service has to drive 60 miles, that's
not anything that's going to help that local community. So has
any study been done on that?
Mr. King. Senator, not to my knowledge and that's a real
problem. This legislation, as introduced in the last Congress,
covers small businesses with 15 employees, which is a dramatic
difference from FMLA that goes to 50. So that's a very real
concern and one other point I would just make in the attack on
the business community to a certain extent here. We don't
disagree with turnover data. We don't disagree with all of the
things that have been said. Paid leave is very desirable. The
flexibility question is a very real one. This country, by the
way, Senator Sanders, and the business community has billions
of dollars of benefits--billions of dollars. If someone did an
economic analysis, a true economic analysis, the amount of
money that the business community in this country voluntarily
provides--I'd like to see where we rank. I would say we're
probably No. 1 by far in pure dollars. But Senator, you're
absolutely right. The practical impact on the small business
person is very real and to my knowledge, it's not been thought
out.
Senator Allard. Doctor--how do you pronounce your----
Dr. Bhatia. Dr. Bhatia.
Senator Allard. Bhatia.
Dr. Bhatia. If I may and I know that San Francisco is just
one place but we've passed a number of mandates in the past few
years. They include a living wage, a minimum wage and now sick
days and soon to be universal health care requirement. One of
my responsibilities is ensuring food safety for the 6,000
restaurants and we track the openings and closings of the
restaurants, their size, their employees and we've been asked
by the local business association, restaurant association, what
effect is this having on openings and closings and over the
past 8 years that I've been doing this and in the course of
these mandates, there has been no change in the openings and
closings of these restaurants. These restaurants--6,000 small
business--mostly small businesses appear to be running about
the same that they always have. So that's just one anecdotal
experience from one place.
Senator Allard. I wonder if that explains why more
California businesses are moving to Colorado.
[Laughter.]
Dr. Bhatia. Well, I don't think our 6,000 restaurants, the
small businesses of San Francisco, the small markets, are
moving to Colorado.
Senator Allard. That's right. Thank you, Mr. Chairman.
The Chairman. Just thank you all very much. We'll have
other questions. Debra--and I wanted to just finally and I just
have a question of you on the implementation of this
legislation and your reaction to your own kind of studies about
having supported other kinds of protections for workers,
whether you feel that this a zero sum game, that if they
advance this, they're going to get cut back on some of the
other benefits. What's your own kind of experience? But on the
implementation, how complex do you think this would be?
Ms. Ness. Well, I don't think there is any evidence that
this is a zero sum game or that providing paid sick days, a
minimum number of paid sick days, has proven to be economically
challenging to countries that do it or businesses in this
country that do it. There are many who do and do it because it
makes a lot of sense and they have managed to do it without a
great deal of administrative difficulty.
I hate for us to think about the ability to take time when
you're sick or to get preventive health care as a privilege or
a benefit. It seems to me that we should be thinking of this as
a minimum labor standard.
Earlier on we were talking about the public health benefits
and we focused primarily on children. I would say we also urge
adults to get preventive health care all the time. We tell them
to get mammograms. We tell them to get colonoscopies. But yet
if they don't have the days off to do that, I don't know any
place you can do that on weekends or evening hours. We know
that there are people in this country now that have not just
one but two and increasingly three chronic conditions and
that's going to get worse and the costs of that are huge to our
healthcare system. Five percent of the population is
responsible for 50 percent of our health care costs yet we know
people being able to take a little bit of time out to get the
preventive care they need can keep them from reaching the point
where they need extensive hospitalizations or more expensive
healthcare down the road and from a personal point of view,
people who don't get that care--they spiral downward very fast.
It's not just they miss a day or two of work. They get sicker.
They potentially lose their job. They potentially lose their
health insurance if they were lucky enough to have it. And for
those people, the costs are enormous. We now know that about 50
percent of all bankruptcies are probably a result of medical
bills triggered by illness. So I hope we can get a place where
we think of this as a minimum labor standard. Thank you.
The Chairman. Thank you.
[Applause.]
Ms. Hartmann. Senator Enzi, I'd like to congratulate you
for your leadership with the Work for Us Investment Act and one
of the things you did in that act was highlight the importance
of pay and equity between women and men and one of the things
that paid sick leave would do, would actually improve pay
equity between women and men because it would reduce turnover
on the job and women still bear the brunt of leaving work
because of illness. When you look at the unemployed, something
like 40 percent of women say that they left their last job and
now can't find work for family reasons. So if you have a paid
sick day or two to tide you over so you don't have to lose your
job, you will be able to increase your seniority on the job.
You'll increase your productivity on the job and that will
raise your wage. So I think that this minimum labor standard
should really be seen as something that will help redress the
imbalance between men and women in the labor market and really
raise women's pay and I'd just like you to be aware of that
because I know this is a very important issue for you.
[Applause.]
Senator Enzi. If we really want to increase or decrease
that gap, we're going to have get more women to do non-
traditional jobs and we're going to have to get more people to
move out to Wyoming, where we have a lot of those jobs that are
very good jobs that they could do and they'd get paid $60,000
to $80,000 a year for them and get paid medical leave and get--
I'm told, vacation.
The Chairman. Where is this magnificent place?
[Laughter.]
Senator Enzi. This is in Gillette, Wyoming and every time I
make this kind of announcement, we get one or two more people
that come out there and take advantage of it. But most people
don't want to leave whatever kind of a job with whatever kind
of a benefit because they are afraid of change. I'm a little
disappointed that today we haven't talked about the pressing
issue of getting health insurance for more employees. Of
course, when we do the paid medical leave, that will drive up
some of the business costs and every time the costs go up by 1
percent, 100,000 people get dropped out of the insurance market
because small business can't afford it. And that's from some
very good studies. So I don't know whether they would consider
this part of the cost, if they'd say, okay, you can get off to
go take care of it but we're not going to pay for it anymore.
That would be a huge disadvantage. So somehow, we've got to
figure out how to solve all of these problems and I don't think
we're going to be able to do it with a big government one-size-
fits-all mandate when we're talking about such a diverse
economy. I do know that when we were talking about the economy
that we talk about how it goes up when the minimum wage goes up
and it will go up when this happens and I don't necessarily
doubt those statistics. But it doesn't go up in every business
and when a business goes out of business, the people that own
the business and the people that work for that business really
feel like the economy has gone to hell. That's the economy that
they're interested in, where they work, the job that they have,
the job they understand, the job that they like going to every
day. When that disappears, the economy is bad. So I hope we'll
do some more discussion on small business and health insurance
and of course, I have the small business health plan proposal
that would have allowed businessmen to group together to get
some lower prices, largely reducing administrative costs.
Hopefully some of those ideas will move along yet and solve
some problems for small business and their employees.
The Chairman. You can see we have a full agenda here and
not uniformity of agreement on most of these issues. If there
is any further, we'll leave this open. You've been very, very
helpful. We'll leave the record open for additional questions.
We're very thankful to our witnesses. It's been very
informative and valuable and we're grateful to you.
The committee stands in recess.
[Additional material follows.]
ADDITIONAL MATERIAL
Prepared Statement of Senator Harkin
For the past few decades, people have been throwing around
the term ``family values'' here in Washington. But the policies
that have been passed in that name often reflect anything but
valuing families. I am proud to cosponsor this bill because it
represents two of my highest priorities: respect for workers
and their families, and workplace wellness.
First, I think it is time for us to take a whole new view
of labor policy. For the last several years, we have been
moving in the direction of concession. We have been told that
in the name of profit, in the name of competitiveness, that we
have to force workers to give up the rights that past
generations have fought and died for. We've seen overtime
rights eroding. We have seen pensions evaporating out from
under workers--while the executives keep their deferred
compensation. We're rewarding record workplace productivity
with more mandatory overtime and lower wages. Yet, CEOs are
getting paid a record 400 times the wages of the average
worker. We keep moving in the wrong direction.
This bill is a step in the right direction. This bill says
parents should have the right to take their sick child to the
doctor. Workers should have the right to take care of their own
health and well-being without worrying about losing pay or
losing their job. I hope that we can begin to think again about
the working men and women of this country as human beings with
basic needs and basic rights, like the right to take a day off
when they are sick.
Unfortunately, a whopping 50 percent of private sector
workers, and 76 percent of low-income workers don't have paid
sick leave. These are people who have to work long hours,
increasingly during nights and weekends, just to survive.
As witness Jody Heymann has found, the United States is
behind the curve in providing sick leave. She found that 139
countries provide paid leave for short- or long-term illness--
with 117 of those providing a week or more annually.
I know some of the witnesses have talked about this, but I
really want to underscore the cruel irony that low-wage
workers, who are least likely to have paid sick leave--and
their kids are sick more often. It isn't surprising that kids
health outcomes are better when a parent can spend time helping
them to get better. If we value families, we shouldn't force
parents to choose between job responsibilities and taking care
of their sick children.
As I said earlier, this is also a public health issue. I
find it amazing that companies don't see their own interest in
encouraging sick employees to stay home, and avoid infecting
coworkers or customers. But amazingly, 78 percent of food
service workers do not have paid sick days. In one hotel in
Nevada, a worker who didn't have paid sick time went to work
with a stomach virus and infected 600 customers and 300
employees.
As you know, wellness and illness prevention have been a
top priority for me for many years. Americans spend an
unbelievable $1 trillion every year on health care. Three
quarters of that cost is accounted for by chronic diseases like
heart disease, cancer, and diabetes that, in many cases, are
preventable. We can save hundreds of billions of dollars on
unnecessary hospitalization, treatment, and disability, but
only if we make the up-front investment in prevention and allow
our workers to take time off to get essential preventative
screenings and assessments. We also know that one of the best,
most common sense measures to preventing illness is keeping
people with communicable illness at home until they are well
again.
Mr. Chairman, families are feeling more pressure every day
to try to make ends meet with more responsibilities heaped on
them. Rosa Pederson, from Fort Dodge, Iowa is working and
raising a toddler. She writes, ``We're all supposed to be
supermen. We're supposed to price compare health services and
know which practices are proven most effective. We're supposed
to actively manage our funds in a way that consistently beats
the market. We're supposed to work our way through school and
get through in 4 years. We're supposed to . . . save more and
spend more while making less.'' Add to that having to show up
to work even when you're sick, or to find a way to manage your
child's sickness while still working full-time or more--or
worse--you or your child is sick because someone else at work
couldn't take a sick day. It is easy to see how families
suffer.
Prepared Statement of Senator Clinton
I would like to thank Chairman Kennedy and Ranking Member
Enzi for holding this important hearing on the Healthy Families
Act. I am a proud cosponsor of this legislation that would
provide workers with 7 paid days of sick-leave, giving parents
time off from work to go to the doctors' office with their
child, aging relative, or to address their own health needs.
Throughout my career as a lawyer, mother, First Lady and
Senator, I have sought solutions to the difficult challenges
that working parents face.
That is why I am looking forward to re-introducing my
``Choices in Child Care Act of 2007'' to meet the child care
needs of working families. My bill provides a modest and
important option for families who have none; it gives them the
chance to stay at home with their infants when there is no
childcare available to them. This is the critical next step to
ensure low-income families welcoming children in their lives
are afforded more economic security than they would have
otherwise.
I am also looking forward to re-introducing my ``Paycheck
Fairness Act'' in March. This bill would prevent, regulate, and
reduce pay discrimination for women across the country by
taking critical steps to empower women to negotiate for equal
pay, to create strong incentives for employers to obey the laws
that are in place, and to strengthen Federal outreach and
enforcement efforts.
With this month marking the 14th anniversary of the Family
and Medical Leave Act, we can celebrate how far we have come in
terms of providing benefits for the hardest working families in
this country. But we must also recognize the challenges
Americans face in balancing work and family life today. The
time has come, with the new 110th Congress, to give parents
additional resources and options in helping them address these
challenges.
Thank you.
Prepared Statement of Senator Brown
We are here today to discuss a very simple piece of
legislation. The Healthy Families Act will guarantee millions
of Americans the basic right to care for a family member or
recuperate from an illness without worrying if they will be
able to pay the rent that month. In my State of Ohio, 42
percent of workers--2,232,125 workers in total--have no paid
sick days. These people are forced to choose every day between
their jobs and the health of themselves or a family member.
This is a decision no American should have to make. A single
parent should not have to worry about losing their job simply
because they need to take their ailing child to the doctor.
Paid sick leave improves overall health, lowers healthcare
costs and makes good business sense. Experts agree that the
ability to take time off and go to the doctor lowers the
likelihood of chronic illness and ultimately the cost of
healthcare. This benefits productivity and prevents ill workers
from spreading their sickness to coworkers. The ability to stay
home when you are sick is critical.
This legislation would provide paid sick days for an
employee's medical condition, doctor's appointment or other
preventative treatment. It would also provide prorated leave
for part-time employees and require employers to post notice of
the availability of sick leave. This is crucial to thousands of
Ohioans and middle class Americans who are just trying to work
hard and take care of their families. I thank the Chairman for
holding this hearing and drawing attention to the plight of so
many Americans. I fully support this bill and encourage my
colleagues to do the same. The time for mandatory paid sick
leave is long overdue and millions of working Americans deserve
better.
Statement of Dancing Deer Baking Co.
Employers, families and our economy depend on the existence of a
healthy workforce. I commend Senator Kennedy for his leadership in
seeking paid sick days for employees around the Nation.
At Dancing Deer Baking Company we have always sought to ensure that
our employees can have the time to address their own and their
families' health needs. We also provide all employees with short- and
long-term disability insurance as a secondary safety net. Full time
non-exempt employees at our company receive a minimum of 15 days per
year in their first year of employment as paid time off (which can be
used for any reason, including not coming to work because of the flu)
which they start accruing immediately upon employment with us. It makes
good business sense and good people sense to put structures in place to
help people live more balanced, healthier lives.
A national paid sick days law that sets a minimum standard is
important because it means that employees do not have to choose between
coming to work sick or staying home and losing a day's wages--or a job.
National data indicates about half of private sector employees do not
have paid sick days. That's an incomprehensible statistic, until you
break it down and look at the granular, person-by-person implications.
What you find is that health issues and family care issues are often
the final straw that throws families into crisis. We see this in our
work in the community targeted at ending family homelessness; Our
``Sweet Home Project'' provides funds that help homeless families (the
majority of whom are the working poor) move to healthy, economically
stable lives.
A national paid sick days law creates a level playing field for all
businesses. Personally, I believe that we have a competitive advantage
from our benefits policies, but many small businesses struggle with
this issue. I believe that creating a level playing field with respect
to incentives and requirements for ``doing the right thing'' is a good
idea for all.
It is encouraging that the committee is holding hearings on paid
sick days. We hope that a bill will move through both Chambers and be
on the President's desk. Paid sick days should be a non-partisan issue.
A healthy nation is a productive nation.
Founded in 1994 as a local bakery, Dancing Deer has advanced to the
national stage through creativity, hard work and a maniacal attention
to quality, detail and customer satisfaction. As we learned what and
who did and didn't work organizationally, we developed a philosophy for
the business. If people are happy, it shows in the food. Dancing Deer
currently has approximately 70 full-time employees; The Company's
policies are tailored to the inner city employee base. Dancing Deer has
a low hourly requirement for full-time benefits (just 24 hours per
week) and a flexible PTO (paid time off) policy, which allows single
parents access to health care, and other benefits while managing family
commitments.
For more information contact: Ursula Liff ; (617) 442-7300 ext. 210;
Ursula.liff
@Dancingdeer.com; 77 Shirley Street, Boston, MA 02119.
______
The Medical Legal Partnership for Children,
Boston, MA 02118,
February 12, 2007.
Hon. Edward Kennedy,
317 Russell Senate Building,
Washington, DC. 20510.
Dear Senator Kennedy: We are a group of pediatricians who work
among the most underserved populations in Boston, Massachusetts.
Collectively we work at Boston Medical Center and the South End
Community Health Center. We strongly support the Healthy Families Act
because we believe the Healthy Families Act could be one of the most
powerful treatments we have for children.
As pediatricians, we support the well-being of the children and
families with whom we work. Within the fabric of the family and the
larger community, we seek to keep kids healthy. When there is a
medicine, therapy, or treatment that will shorten the course of an
illness or improve the health outcomes for children, we advocate for
its use and make these recommendations to our patients and families. As
physicians, we see what the research literature tells us: that children
stay sick longer when their parents cannot be home to care for them.\1\
This is where we see the tremendous potential of the proposed
legislation. As pediatricians seeking the best treatment and outcomes
for our patients, we need to ensure that paid sick-time is available
and accessible for all children and families, especially those without
other resources. On a daily basis in the course of our practice, we are
confronted with the many reasons that a parent would need the benefits
of the Healthy Families Act.
---------------------------------------------------------------------------
\1\ Jody Heymann, The Widening Gap: Why America's Working Families
Are In Jeopardy & What Can Be Done About It, Perseus Book Groups, p.
115 fig. 61. New York, NY. 2000.
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Children aged 5 to 17 year's old miss an average of more than 3
days of school per year for health reasons.\2\ Younger children have
higher rates of illness than those who are school age.\3\ The American
Academy of Pediatrics recommends preventative medical care for children
to stay healthy. It is of utmost importance that parents be present at
these visits to give critical information to pediatricians about their
children. The following examples clearly illustrates the importance and
impact that the Healthy Families Act could have on children.
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\2\ Vicky Lovell, No Time to be Sick: Why Everyone Suffers When
Workers Don't Have Paid Sick Leave, Institute for Women's Public Policy
Research, May 2004, p. 3.
\3\ Virginia Fried, Diane Makuc, and Ronica Rooks, Ambulatory
Health Visits by Children: Principal Diagnosis and Place of Visit, U.S.
Department of Public Health and Human Services, DHHS Pub. No. 98-1798,
Hyattsville, MD, 1998.
---------------------------------------------------------------------------
``L'' is a school-aged child of a single working mother. His
performance in school was fine until the third grade when his
schoolwork started to deteriorate. He was starting to show signs of
learning disabilities and Attention Deficit Hyperactivity Disorder
(ADHD). L came with his grandmother to his yearly physical exam and a
number of behavior-related visits, L's mother was unable to come to
these appointments because of her fear of losing her job if she missed
work, and without his mother's direct input, we had great difficulty
understanding the scope and extent of the problem. It took many follow-
up calls to schedule a time where his mother could bring him in for an
appointment and subsequently make a treatment plan which has
dramatically helped L's school performance. This was not because L's
mother did not want to help her son--it was because she was forced to
make the unthinkable choice of keeping her job or bringing her child to
important doctor appointments.
Another story we would like to share with you is about ``B.'' B is
a school-aged child with asthma. Because of the nature of her illness,
she is admitted to the hospital a few times a year. Staying in the
hospital is a scary situation for most people, especially children.
Parents are allowed to stay with their children while hospitalized,
however, this is not possible if the parent needs to be at work every
day. That was the case with B. Her mother could not take time off of
work to stay with B, and could only visit before and after work.
Children like B who are alone in the hospital often tell us that they
are afraid to sleep at night so they try to stay awake as long as
possible. This stress prolonged B's recovery and impacted her hospital
stays. We believe such occasions--which are all too frequent--might be
avoided if parents could be with their children throughout their
hospitalization, without fear of economic consequences. Paid sick time
would allow more parents to be at their child's side during both
illness and recovery--promoting recuperation, reducing stress on the
family, and saving money for the health care system. We know that
hospital stays are reduced by 31 percent if a parent is present in the
children's care.\4\ By supporting the Healthy Families Act, you support
minimizing expensive hospital stays for children, and getting parents
back to work more quickly.
---------------------------------------------------------------------------
\4\ See, Jody Heymann.
---------------------------------------------------------------------------
These brief vignettes reflect the unthinkable choices our families
are forced to make--go to work, or tend to my child's medical needs?
Studies show that sick children have shorter recovery periods, better
vital signs, and fewer symptoms when their parents participate in their
care.\5\ Regardless of socioeconomic status, parents who received paid
leave are five times more likely to be able to care for their sick
children.\6\ And, this comes back to our essential point: The Healthy
Families Act helps children get better quicker and families get back to
work.
---------------------------------------------------------------------------
\5\ See, Jody Heymann.
\6\ See, Jody Heymann.
---------------------------------------------------------------------------
For these reasons we offer our strongest support for the funding
and passage of The Healthy Families Act.\7\
---------------------------------------------------------------------------
\7\ Boston Medical Center & South End Community Health Center; 617-
414-7430; [email protected], [email protected],
[email protected], Megan.Sandel
@bmc.org.
---------------------------------------------------------------------------
Robyn Riseberg, MD,
Jack Maypole, MD,
Lauren Smith, MD, MPH,
Megan Sandel, MD, MPH.
The authors are all affiliated with the Medical-Legal Partnership for
Children at Boston Medical Center.
______
Children's Hospital Boston,
Boston, MA 02115,
February 13, 2007.
Hon. Edward M. Kennedy,
Chairman,
Committee on Health, Education, Labor, and Pensions,
U.S. Senate,
Washington, DC 20510.
Dear Senator Kennedy: On behalf of Children's Hospital Boston and
the children and families we care for, I want to thank you for
introducing the Healthy Families Act.
As the Medical Director of the Cerebral Palsy Program at Children's
Hospital Boston, I work with families all the time who are trying to
balance work responsibilities with caring for their child with complex
health care needs. Arranging the time off for medical appointments is a
major source of stress. It is important for employers to give families
flexibility to meet the health care needs of their child in a timely
manner. Children need to have their parents present for emergencies as
well as for management of their chronic health concerns. Affording
families paid sick days also can reduce the spread of disease in child
care settings, schools and at work.
This legislation eases some of the tough choices that families have
to make to meet the competing demands of their family and professional
lives. I appreciate your work on this important issue.
Sincerely,
Laurie Glader, M.D.
______
Statement of Jeff Levi, Ph.D., Executive Director, Trust for America's
Health (TFAH)
tfah supports the healthy families act; sick and family leave measures
in bill would be critical for containing a possible pandemic flu
outbreak
``People shouldn't have to choose between protecting the health of
their families and a paycheck during a crisis. The sick and family
leave measures proposed in the Healthy Families Act, as introduced by
Senator Edward Kennedy (D-MA), are important for ensuring that all
Americans, regardless of their economic status, could take time off
when they are sick or to care for family members. But the proposed sick
and family leave policies are also essential for containing the spread
of infectious disease and limiting the risk of illness during public
health emergencies.
Currently, 59 million workers in the United States do not have paid
sick leave. Eighty-six million workers do not have paid sick leave that
they can use to care for immediate family members. Three out of four
`low-wage' workers have no sick leave at all.
One of the biggest current threats to our Nation's health is a
possible pandemic flu outbreak. The Centers for Disease Control and
Prevention (CDC) is proposing that individuals who might become ill
during a pandemic should stay home from work until they are fully
recovered (an estimated 10 days), and that household members of those
who are sick should also stay home while the individual is sick until
it is clear that the household member has not become ill, which is
known as voluntary home quarantine. The CDC has also suggested that
schools could potentially close for 12 weeks during a pandemic, leading
parents and guardians to struggle with managing child care issues
during that time frame.
Compliance with public health recommendations will be critical
during the first wave of a pandemic, when vaccines would not yet be
widely available. The minimum 7 days of paid sick leave a year that
employees could use to meet their own medical needs or care for sick
family members would allow people to meet most of the minimum
requirement for recuperation and family care during a pandemic. TFAH
also encourages employers to plan for a possible pandemic, and create
tiered sick leave plans to allow for more time off during a public
health crisis, when designated by the U.S. Secretary of Health and
Human Services.''
Trust for America's Health is a non-profit, non-partisan organization
dedicated to saving lives by protecting the health of every community
and working to make
disease prevention a national priority.
Media Contacts: Laura Segal (202) 223-9870 x 27 or [email protected]
or Nicole Speulda (202) 223-9870 x29 or
[email protected] .
Response to Questions of Senators Kennedy and Enzi by Debra Ness
questions of senator kennedy
Question 1. Would you please comment on why you think the provision
of paid sick days is needed, and why reliance solely on voluntary
benefits is insufficient?
Answer 1. Currently, no Federal law guarantees paid sick days, and
working families must rely on voluntary workplace policies.
Consequently, nearly half (48 percent) of private-sector workers--and
nearly four in five low-wage workers (79 percent)--lack even a single
paid sick day.\1\ Two in five low-income working parents (41 percent),
with household incomes below twice the poverty level, do not have any
paid time off at all: no paid sick time, no paid vacation and no paid
personal days.\2\ As a result, working people are forced to choose
between taking care of their own health or a sick child or family
member, and losing their pay--or even losing their job. An ordinary
illness like the flu, can have devastating economic consequences for a
struggling family. Clearly, reliance on voluntary benefits is not
enough.
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\1\ Institute for Women's Policy Research, analysis of March 2006
National Compensation Survey.
\2\ Katherin Ross Phillips, Getting Time Off: Access to Leave among
Working Parents (Policy Brief B-57), Urban Institute.
---------------------------------------------------------------------------
Our existing labor laws are outdated and don't take into account
the increasing numbers of working mothers and dual-earning families.
The Healthy Families Act would establish a basic labor standard for
paid sick days, much like the minimum wage does. From a business
perspective, a basic labor standard levels the playing field for all
businesses. While some may argue that businesses that provide paid sick
days voluntarily are at a competitive disadvantage, a minimum standard
would eliminate the perception of disadvantage.
Question 2. The Healthy Families Act covers only businesses with 15
or more employees, which is also the threshold set in the ADA and Title
VII. Would you please comment on why you think 15 employees is an
appropriate threshold, and why you think that businesses of that size
are likely to be able to readily provide paid sick leave?
Answer 2. I believe the 15-worker threshold is appropriate as it
tries to cover as many workers as possible, while mitigating the burden
of compliance for businesses.
As the smallest of businesses grow and reach the 15-worker
threshold, they begin to seek assistance from human resource managers
or employment lawyers. At this size, businesses must understand and
comply with the requirements of the ADA and Title VII. They are also
required to display State and Federal posters that inform workers about
workplace discrimination. By adopting this 15-worker threshold, the
Healthy Families Act ensures that its compliance standards for small
businesses are simplified.
Question 3. Could you please comment on whether or not the Healthy
Families Act's notice and medical certification provisions are
reasonable and workable?
Answer 3. The Healthy Families Act requires employers to post a
notice describing leave available to workers under the act as well as
pertinent information regarding the leave in conspicuous places or in
employee handbooks. This is a reasonable and workable provision for
employers. Most employers subject to the provisions of the Healthy
Families Act already must comply with other posting requirements
including minimum wage, FMLA, ADA, discrimination and safety and health
standards. Therefore, they have the management and human resources
capacities in place to accommodate the Healthy Families Act's minimal
posting requirements. Furthermore, the posting requirements under the
act are intentionally minimal so not to place an undue burden on
businesses, even if it may impose a challenge to workers seeking
additional information.
The Healthy Families Act requires that workers provide their
employer with medical certification for leave longer than three
consecutive work days. This provision is reasonable for employers
because it balances the need for certification, which would alleviate
employer concerns of abuse, against the desire to not overburden human
resources professionals with unnecessary paperwork or accounting tasks,
which may occur with a more-frequent certification provision.
The medical certification provision is reasonable for workers as it
requires certification only for leave longer than three consecutive
work days. For low-wage workers, a more-frequent certification
requirement would create a barrier likely preventing them from taking a
paid sick day. Two in five low-wage working people (41 percent), with
incomes between $20,000 and $40,000 a year, were uninsured for at least
part of 2005, the year the study was conducted.\3\ For low-wage workers
without health insurance, the cost of a simple doctor's visit to obtain
certification would present a financial hardship.
---------------------------------------------------------------------------
\3\ Sara R. Collins, Gaps in Health Insurance: An All-American
Problem, Commonwealth Fund, 2006.
Question 4. The Healthy Families Act sets 7 paid sick days as a
minimum required national standard. Why do you think this is an
appropriate minimum? How does it compare with the standards set by
other countries?
Answer 4. The 7 paid sick days labor standard established by the
Healthy Families Act is really a minimum number of days. Among the 52
percent of private-sector workers who currently have access to paid
sick days, the leave available to them varies from 8 to 11 days in
smaller firms, and 11 to 21 days in larger firms.\4\ The Federal
Government guarantees their workers 13 paid sick days a year.\5\ By
comparison, the Healthy Families Act establishes a standard of 7 days--
significantly lower than what is currently offered to half the
workforce in the private sector and Federal Government workforce--to
set a minimum standard for paid sick days. Much like the minimum wage,
the Healthy Families Act is intended to set a floor for the number of
paid sick days.
---------------------------------------------------------------------------
\4\ Bureau of Labor Statistics, 1996-1997 data (most recent
available).
\5\ United States Federal Government, USA Jobs: the Official Job
Site for the United States Federal Government Web site, http://
www.usajobs.gov/ei61.asp.
---------------------------------------------------------------------------
The United States lags behind other countries in paid sick day
standards. Globally, 145 countries provide paid time off for short- or
long-term illnesses, with 127 providing a week or more annually. More
than 79 countries provide sickness benefits for at least 26 weeks or
until recovery. Additionally, 37 nations provide some type of paid time
for working parents when a child is ill.\6\
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\6\ Jody Heymann, et al., The Work, Family, and Equity Index, How
Does the United States Measure Up?, 2007.
Question 5. The Healthy Families Act provides that paid sick leave
can be used to care for ``a child, a parent, a spouse, or any other
individual related by blood or affinity whose close association with
the employee is the equivalent of a family relationship.'' Could you
please comment on why it is important to provide this scope of
coverage? How is the act's definition of family member similar to other
laws and how other countries are defining family for purposes of short-
term leave?
Answer 5. The scope of coverage ensures the needs of all families,
including blended, joint and non-traditional families, are adequately
addressed. Twenty-nine percent of children are being raised outside the
traditional two-parent family.\7\ In addition, as Baby Boomers retire,
more working families are caring for elderly parents and relatives. An
estimated 34 million people provide care for older family members.\8\
As the definition of ``family'' continues to evolve, it's clear that
our workplace policies too must change to fit the needs and realities
of our families. Today's families deserve the same peace of mind and
opportunities to care for the members of their families as traditional
families of past generations.
---------------------------------------------------------------------------
\7\ U.S. Census Bureau, Living Arrangements of Children: 2001, July
2005.
\8\ National Alliance for Caregiving/AARP, Caregiving in the U.S.,
NAC/AARP, 2004.
---------------------------------------------------------------------------
Unlike the proposed Healthy Families Act, many older Federal
workplace laws, such as FMLA, are not as inclusive in their scope.
Leave under the FMLA allows workers to care for spouses, children (step
and biological) and parents, but does not permit the care of same-sex
partners or grandchildren.
San Francisco's paid sick day legislation, which passed in 2006,
provides for a broader scope of coverage. Workers may provide care to
``other persons'' including a child, parent, legal guardian or ward,
sibling, grandparent, grandchild, spouse, registered domestic partner
under any State or local law, coworker or ``designated person'' of
their choosing.
Other countries have broader definitions of family member to
accommodate the needs of today's families or family-like relationships.
For example, in the United Kingdom, all ``employees'' have the right to
``reasonable'' time off work to help family members or friends who
depend on them for assistance in an emergency, including a parent,
wife, husband or child, or someone who lives with the employee as part
of their family. A dependent can also be someone who ``reasonably''
relies on the employee for help if they are ill, or has an accident or
when their normal care arrangements have broken down, such as a
neighbor or friend with a disability.\9\
---------------------------------------------------------------------------
\9\ Trades Union Congress, Time off for Families, http://
www.tuc.org.uk/tuc/families.pdf.
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In Canada, workers can take ``compassionate care'' leave to care
for a child; spouse or common-law partner; parent or their spouse;
grandchild or their spouses; sibling; son/daughter-in-law, father/
mother-in-law; uncle/aunt or their spouse/partner; niece/nephew or
their spouse/partner; former foster parent; or current/former foster
child. Workers can also take ``compassionate care'' leave to care for a
gravely ill person who considers you like a family member, such as a
close friend or neighbor.\10\ In Australia, paid ``carer's leave''
allows workers time off to provide care to a member of the worker's
immediate family or household.\11\
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\10\ Government of Canada, Service Canada Web site, http://
www1.servicecanada.gc.ca/en/ei/types/compassionate--care.shtml#family.
\11\ Australian Government, Employment & Workplace Relations
Services Web site, http://www.workplace.gov.au/workplace/Programmes/
WorkFamily/Carersleave.htm.
Question 6. A statement was made at the hearing that some employees
do not need paid sick days because they could use flextime when they
become ill or need medical care. Would you please comment on whether
flextime is a workable substitute for paid sick days?
Answer 6. Flex-time is not a suitable substitute for paid sick
days. Some suggest that flex-time policies would allow workers to
switch the time of their work when they are sick or when their child is
sick. However, in most cases, flex-time does not give workers the
option to choose their work hours. For these workers, their hours of
work are at the discretion of their employers, and they don't have the
guarantee that they will have time off when they need it most, when
they are sick or when they must care for an ill family member.
The majority of private-sector workers who would benefit most from
paid sick days legislation are in the food service, hotel and retail
industries. Additionally, majorities of child care and nursing home
workers also would benefit from the Healthy Families Act. These
occupations are customer-service oriented and are among the least
flexible since they have specific hours of operation and structured
worksites. Even with flex-time provisions in place, these workers would
have little or any control over when they choose to work.
Question 7. Mr. King claimed that employers will have difficulties
complying with the Healthy Families Act because of existing compliance
requirements under the FMLA and workers' compensation laws. Do you
agree, why or why not?
Answer 7. Mr. King's argument that adding the Healthy Families Act
to existing compliance requirements will increase employers'
``practical/operational and legal burdens'' is exaggerated. First, the
Healthy Families Act applies to businesses with 15 or more workers. As
businesses reach the 15-worker threshold, they seek out human resource
managers or employment lawyers to help them with compliance. Therefore,
by adopting this threshold, the added burden on compliance is minimal.
Second, the notification requirements for this and other compliance
requirements are intentionally minimal, so not to burden employers. The
Healthy Families Act's requirement to post a notice in a conspicuous
place and in employee handbooks is a very minor charge. Mr. King also
asserts that Healthy Families Act compliance would create additional
administrative burdens, comparing it to the FMLA. However, the greatest
potential administrative load created by the Healthy Families Act would
arise only after a worker has taken leave for more than 3 consecutive
days. At that point, the employer may require a certification issued by
a health care professional. Requesting and reviewing certification
would take little time and money. In fact, a survey of similar FMLA
medical certification requirements found that it took 39 percent of
surveyed employers less than 10 minutes per case to request and review
certification, and an additional 21 percent less than 30 minutes.\12\
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\12\ WorldatWork, FMLA Perspectives and Practices survey, April
2005, http://www.worldatwork.org/pub/E157963FML05.pdf.
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Finally, Mr. King's assertion that the Healthy Families Act and its
administrative requirements would hamper employers' ability to compete
with offshore businesses is unsubstantiated. The businesses that are
the least likely to provide paid sick days, such as in the food
service, hotel, retail, child care and nursing home industries, are the
least likely to have offshore competition. Businesses in these
industries provide direct services to customers in structured,
established worksites, which cannot be outsourced.
Question 8. King argued that compliance with the Healthy Families
Act will be administratively burdensome on employers. Given that so
many employers in the United States and around the world already
provide paid sick days, do you see compliance with these additional
requirements as a problem for employers? Why or why not? What, if any,
administrative procedures would the act add to typical payroll
procedures?
Answer 8. The vast majority of employers in the United States
guarantee paid time off to their workers,\13\ as do employers around
the globe. These workplaces have administrative practices in place to
track time off. The Healthy Families Act targets the employers that
don't offer the most basic workplace standard to their workforce: paid
sick days. For these employers, the Healthy Families Act ensures that
they are minimally burdened.
---------------------------------------------------------------------------
\13\ Society for Human Research Management, 2006 Benefits, Survey
Report, 2006, Table G-1.
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The administrative recording requirements of the Healthy Families
Act are in accordance with the Fair Labor Standards Act. To minimize
any potential undue burden on employers, the Healthy Families Act
states that paid sick time provided may be accrued as determined by the
employer as long as it is less than a quarterly basis. The act also
allows for leave to be counted on an hourly basis--or in the smallest
increment that the employer's payroll system uses to account for
absences. Both of these provisions of the act would place a minimal
administrative or procedural load on the business.
Question 9. King asserted that employers will likely reduce
benefits in response to the act's paid sick days requirement. Would you
please comment on why that may or may not be the case?
Answer 9. The argument that establishing a basic labor standard of
paid sick days would result in an offsetting reduction of fringe
benefits, including the receipt of health insurance, a partially-paid
insurance premium, pension coverage or access to job training, is not
new. It has been used most commonly against increases in the minimum
wage, another basic labor standard. However, research has found no
strong evidence that an increase in the minimum wage causes a reduction
of fringe benefits or decline in working conditions.\14\
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\14\ Kosali Ilayperuma Simon and Robert Kaestner, ``Do Minimum
Wages Affect Non-Wage Job Attributes? Evidence on Fringe Benefits,''
Industrial & Labor Relations Review 58, (Issue 1 2004), Article 3.
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The Healthy Families Act is a basic labor standard that would
guarantee to more working people paid time off and job protection when
they are sick or need to care for an ill family member. For the
businesses that already provide paid sick days for their workers, a
basic labor standard such as this would level the competitive playing
field by requiring all businesses to guarantee paid sick days. When
workers are guaranteed a minimum number of paid sick days, employers
benefit as healthier workers are more productive and the spread of
illness in the workplace is reduced.
Without paid sick days, ill workers have no alternative but to go
to work sick and risk spreading illness to coworkers and customers,
lowering the overall productivity of the workplace. More than half (56
percent) of human resources executives report that ``presenteeism''--
the practice of coming to work even when sick--is a problem in their
companies. Studies have shown that ``presenteeism'' costs our national
economy $180 billion, or an average of $255 per worker per year, in
lost productivity annually. This productivity loss exceeds the cost of
absenteeism and medical and disability benefits.\15\
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\15\ Ron Goetzal, et al., ``Health Absence, Disability, and
Presenteeism Cost Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers,'' Journal of Occupational and
Environmental Medicine (April 2004).
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Businesses that don't offer their workers paid sick days may also
be making themselves more vulnerable to illness-related costs, bad
publicity and lawsuits. The recent surge in ``stomach-flu'' food-borne
outbreaks in restaurants and on cruise ships is alarming the restaurant
industry in particular. According to Restaurant News, the industry's
own publication, the frequent outbreaks are a ``near-indictment of
prevailing sick-leave practices.'' \16\ Nearly half of ``stomach flu''-
related outbreaks (largely caused by the norovirus) are linked to ill
food-service workers,\17\ who are the least likely to have paid sick
days.
---------------------------------------------------------------------------
\16\ Peter Romeo, ``NRA Virus Confab Frames Contagious Workers as
Leading Food Safety Threat,'' Restaurant News (7/27/07).
\17\ Centers for Disease Control and Prevention, Norovirus Outbreak
Associated with Ill Food-Service Workers, 1/2006.
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A single food-borne outbreak could cost a restaurant up to $75,000
in direct costs, including clean up, re-staffing, restocking,
settlements and regulatory sanctions. For a chain restaurant with
several locations within a metropolitan area, the negative publicity
resulting from a single food-borne outbreak can be devastating to the
entire chain. The indirect loss of business resulting from a single
food-borne outbreak at one establishment can total up to $7 million for
all the restaurants in the chain within the metropolitan area.\18\
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\18\ Norman G. Marriott, Principles of Food Sanitation (An Aspen
Publication: 1999).
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questions of senator enzi
Question 1. In your written testimony, you state that paid sick
leave will reduce ``presenteeism'' and therefore be good for
businesses. The study you cited found that the most productivity-
reducing conditions were depression and other mental illnesses,
hypertension, heart disease, and arthritis. Considering that the
mandate will reduce employer income margins by about $1,000 per
employee, I think anyone can see that employers will have to look for a
way to pay for this, and that way may be reducing healthcare benefits.
For example, one could increase co-pays, reduce or eliminate
prescription drug coverage, or worse. Can you see that employees with a
mental illness, hypertension, heart disease, or arthritis--all of which
are often treated with prescription drugs and none of which typically
require time off--could be negatively impacted by this mandate?
Answer 1. Studies have shown that both employers and workers would
benefit significantly from the savings associated with the Healthy
Families Act.
I am not aware of the origin of the estimated $1,000 cost per
employee cited in the above question. According to a cost-benefit
analysis of the Healthy Families Act, costs associated with the bill
were much less, at just $3.04 per worker per week, calculated for all
wage and salary workers. The low cost of the Healthy Families Act is
far outweighed by the benefits associated with the bill. The total
savings associated with the bill, calculated for all wage and salary
workers, is $4.26 per week--clearly higher than its cost. The costs and
benefits are higher if calculated for only workers covered by the HFA:
the per-worker per week cost of $5.98 is significantly less than the
savings of $8.38 per worker per week.
In addition, providing paid sick days to workers could result in
health care cost savings for employers. Health care costs will decline
because workers will be able to use the paid sick days to take care of
their own health and the health of family members without being
penalized by a cut in pay or disciplined. Workers would be more likely
to access preventative care for themselves and family members,
including regular physicals, vaccinations and screenings for diseases
such as cancer, diabetes and heart disease. This could lead to reduced
health care costs in the long run, and even a reduction in employer-
paid insurance premiums.
Question 2. What was the methodology used in the ``presenteeism''
study? Who conducted it? Has the study, its methodology or its findings
been subjected to any kind of academic peer review or professional
validation? If so, who has conducted this review or validation and
where are the findings reported? How was the $180 billion savings
estimate calculated?
Answer 2. The study, ``Health, Absence, Disability, and
Presenteeism: Cost Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers,'' was conducted by a group of
researchers affiliated with the Cornell University Institute for Health
and Productivity Studies, led by researcher Ron Goetzel, Ph.D. It was
published in the Journal of the American College of Occupational and
Environmental Medicine in April of 2004, a highly-regarded scientific
publication that contains clinically-oriented research articles to
guide physicians, nurses, and researchers. The journal maintains a
rigorous peer review procedure. Each article is reviewed, using a
double-blind procedure, by a group of academics in the field.
Goetzel et al. calculated the direct and indirect costs of
productivity loss associated with 10 common health conditions, using
administrative data sources (insurance claims regarding medical care,
employee absenteeism, and short-term disability payments) as well as
employee self-reported data on presenteeism. Researchers found that
presenteeism losses accounted for 61 percent of the total cost of the
10 selected health conditions--higher than medical costs in most cases.
The American Productivity Audit (APA) calculated that presenteeism
costs $180 billion in lost productivity each year. The APA is a survey
of nearly 30,000 workers that aims to put a numeric value on the
effects of health conditions on work. The survey measures lost
productive time, in both hours of work and dollars, related to health.
Question 3. What is the direct labor cost to the private sector of
the paid leave mandate contained in the Healthy Families Act? How was
that cost calculated? What individual(s) or organization(s) calculated
these direct private sector costs, what was the methodology utilized,
and has the study, calculation and/or estimate been fully peer-
reviewed?
Answer 3. Dr. Vicky Lovell of the Institute for Women's Policy
Research \1\ estimated the total costs and benefits of taking leave
under the Healthy Families Act using several data sources and
analytical methods. Lovell estimated that the HFA's annual cost would
be $20,235,900 for wages paid to workers taking HFA-provided paid sick
days, payroll taxes, and administrative expenses. This number breaks
down to $5.98 per HFA-covered worker per week. These costs, however,
are far outweighed by the benefits of implementing the Healthy Families
Act. According to Lovell's analysis, the total savings associated with
the HFA would be $8.38 per HFA-covered worker per week. The sources of
the costs and savings identified by Lovell's analysis are outlined
below.
---------------------------------------------------------------------------
\1\ Dr. Lovell and the Institute for Women's Policy Research are
both well-respected for their quantitative techniques and original
research, as well as their efforts towards research dissemination and
citizen education.
Costs of the Healthy Families Act
Lovell's analysis measured the costs associated with the HFA.
Lovell calculated how many workers would be affected were the HFA to be
enacted. Lovell used the numbers of workers who meet the HFA
eligibility criteria, the number of workers who currently have no paid
sick days or are not allowed to use their leave for ill children or to
attend doctor visits, and the number of workers who currently have
fewer paid sick days than provided by the HFA and would have access to
additional paid sick days under the HFA.
Lovell used data from a variety of sources, including the National
Health Interview Survey, to calculate how many paid sick days workers
would take if the law were enacted, for their own medical needs, for
family care, for doctor visits, and for maternity leave and
corresponding time for new mothers' partners.
Next, Lovell utilized data on how much workers earn, the cost of
legally mandated payroll taxes, the cost of administrative expenses,
and the cost of replacing workers on HFA leave, should employers elect
to hire a temporary worker during the leave. Again, the cost of the
HFA, paid by employers, is estimated at $5.98 per HFA-covered worker
per week.
Savings from the Healthy Families Act
The savings associated with allowing workers to take paid sick days
to care for their own illness or family members' illness are difficult
to quantify. For the purposes of the analysis, Lovell estimated only
the quantifiable aspects of the bill, including its health-related
benefits, and then suggested other benefits that should be included in
the analysis when the necessary data becomes available. Therefore, the
analysis did not include all the possible benefits that may be
associated with the bill.
Savings from Reduced Presenteeism
The first cost savings Lovell identified was the savings associated
with wages that businesses currently pay to sick workers on the job but
with diminished productivity (``presenteeism'' costs). Lovell
calculated the number of HFA-eligible workers who do not have paid sick
days, as well as the cost of wages to sick workers with low
productivity, the costs of the hourly wages of these workers, and the
associated payroll taxes. Lovell found that the HFA would save
$41,571,500 annually in wages that would have been paid to sick workers
on the job who are less productive due to illness.
Savings from Reduced Turnover
Second, Lovell calculated the cost savings associated with reduced
turnover. Lovell cited research that concluded having paid sick days
reduced workers' voluntary turnover by 5.58 percentage points for
married men, by 3.61 percentage points for married women, 5.75
percentage points for single women, and 6.43 percentage points for
single men. If all employers offered paid sick days, voluntary turnover
would reduce as workers considering a job change would have the same
option of paid sick days at their current job as at a potential job--
with the exception of firms with fewer than 15 workers.
Access to paid sick days also affects involuntary turnover by
decreasing job termination related to unauthorized absences from work
by sick workers or workers caring for sick family members. There are no
data for estimating the savings associated with involuntary turnover,
however, and Lovell's estimates did not include these savings.
Turnover-related costs, which include expenses such as the cost of
recruiting a new worker, low productivity of new workers, training, and
human resources processing time for exit and entry, can be expensive
for businesses, up to 25 percent of a worker's total compensation.
Lovell's formula for calculating the costs associated with the HFA
included the number of HFA-eligible workers who currently do not have
paid sick days, the reduction in turnover associated with providing
paid sick days, the cost of turnover, workers' hourly wages, and wages
as a percent of total compensation (necessary for calculating the cost
of turnover). Using this formula, Lovell estimated that the savings
associated with reductions in turnover total $25,840,000 annually.
Savings from Reduced Spread of Flu
Third, Lovell calculated the cost savings associated with the
reduced spread of the flu within workplaces, due to reductions in
absences and lowered productivity. Lovell used flu-related data to
calculate savings, because the flu is highly contagious and accounts
for a large proportion of illness-related worker absences. Lovell's
analysis, which included both employers' wage costs and workers'
medical costs, found that the savings due to reductions in the spread
of the flu in workplaces would total $738.5 million annually if the HFA
were enacted.
Savings from Reduced Short-Term Nursing Home Stays
Fourth, Lovell added the cost savings associated with reduced
short-term nursing home stays if workers were given the flexibility
under the HFA to provide informal care for disabled, elderly, and
medically-fragile relatives. Lovell found that the savings from
reductions in short-term nursing home stays would total $225 million
annually.
Conclusion: The HFA Yields Savings for Stakeholders,
Particularly Employers
Lovell outlined the distributed costs and savings to stakeholders
under the Healthy Families Act. While the costs of the bill would be
paid for by employers, employers reap the large majority of the
estimated net savings, $2.40 per HFA-covered worker per week, which
accrues to employers, workers, families, and taxpayers.
Question 4. What is the indirect cost to the private sector of the
paid leave mandate contained in the Healthy Families Act? How was that
cost calculated? What individual(s) or organization(s) calculated these
indirect private sector costs, what was the methodology utilized, and
has the study, calculation and/or estimate been fully peer-reviewed?
Answer 4. See answer for Question 3 for a complete answer to this
query.
Question 5. Do you believe that the bill's 15 employee coverage
threshold is appropriate? Why shouldn't the threshold be 50 employees?
Why shouldn't the threshold be 2 employees?
Answer 5. We believe the 15-worker threshold is appropriate as it
tries to cover as many workers as possible, while mitigating the burden
of compliance for businesses.
As the smallest of businesses grow and reach the 15-worker
threshold, they begin to seek assistance from human resource managers
or employment lawyers. At this size, businesses must understand and
comply with the requirements of the ADA and Title VII. They are also
required to display State and Federal posters that inform workers about
workplace discrimination. By adopting this 15-worker threshold as well,
the Healthy Families Act ensures that its compliance standards for
small businesses are simplified.
Question 6. Do you believe that the bill's entitlement of 7 paid
sick days is appropriate? Why shouldn't the entitlement be 3 paid sick
days? Why shouldn't the entitlement be 14 paid sick days?
Answer 6. We believe a guarantee of 7 days per year is a reasonable
minimum number of paid sick days employers should provide to workers.
The intent of the Healthy Families Act is to establish a basic labor
standard, much like the minimum wage. From this point, employers can
offer additional days as appropriate for their workforce.
Among the 52 percent of private-sector workers who currently have
access to paid sick days, the time available to them varies from 8 to
11 days in smaller firms, and 11 to 21 days in larger firms.\2\ The
Federal Government guarantees their workers 13 paid sick days a
year.\3\ By comparison to a large portion of the private sector and our
government, the Healthy Families Act's minimum standard of 7 days is
significantly lower.
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\2\ Bureau of Labor Statistics, 1996-1997 data (most recent
available).
\3\ United States Federal Government, USA Jobs: the Official Job
Site for the United States Federal Government Web site, http://
www.usajobs.gov/ei61.asp.
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On average, workers currently miss about four and a half days of
work per year to recover from illness or address health needs.\4\ With
all adults working in 70 percent of today's families,\5\ and a stay-at-
home parent no longer the norm, working people need additional days to
care for ill family members. The 7-day standard accommodates the very
basic health needs of working people and their families. School-age
children miss at least 3 school days per year due to health reasons.\6\
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\4\ Vicky Lovell, Valuing Good Health: An Estimate of Costs and
Savings for the Healthy Families Act, 2005, www.iwpr.org/pdf/B248.pdf.
\5\ Williams, Joan. One Sick Child Away from Being Fired.
University of California, Hastings College of Law. Undated. Boushey,
2008. Analysis of U.S. Census Bureau, Current Population Survey, Annual
Social and Economic Supplements, Tables F14, F13, F10, and FINC03.
\6\ Vicky Lovell, No Time to be Sick, Institute for Women's Policy
Research, May 2004.
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While the 7-day standard is intended to set a minimum standard for
paid sick time, the reality is that the overwhelming majority of
workers will not take the maximum number of the days they are
guaranteed. An analysis of the 2003 National Health Interview Survey
(NHIS) showed that when constrained to 7 days of work loss, workers
offered paid sick days miss only 1.8 days annually on average due to
illness and injury, excluding maternity leave. Workers who are not
provided with paid sick days miss an average of 1.3 days annually, and
the average for all workers is 1.6 days.\7\
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\7\ Lovell, 2005, ``Valuing Good Health.''
Question 7. As I am sure you are aware, under the Fair Labor
Standards Act, Federal workers can enter into voluntary arrangements
with their employers to establish flex-time schedules, i.e. 80 hour bi-
weekly schedules, as a means to better balance work, personal and
family life. Would you be in favor of extending this to workers in the
private sector? What is [are] the reason[s] for your view?
Answer 7. Flex-time is not a suitable substitute for paid sick
days. Some suggest that flex-time policies would allow workers to
switch the time of their work when they are sick or when their child is
sick. However, in most cases, flex-time does not give workers the
option to choose their work hours. For these workers, their hours of
work are at the discretion of their employers, and they don't have the
guarantee that they will have time off when they need it most, when
they are sick or when they must care for an ill family member.
The majority of private-sector workers who would benefit most from
paid sick days legislation are in the food service, hotel and retail
industries. Additionally, majorities of child care and nursing home
workers also would benefit from the Healthy Families Act. These
occupations are customer-service oriented and are among the least
flexible since they have specific hours of operation and structured
worksites. Even with flex-time provisions in place, these workers would
have little or any control over when they choose to work.
Flex-time schedules that establish an 80-hour 2-week work period
would hurt millions of working families by giving them less control
over their daily schedules and serve as a pay cut. The Fair Labor
Standards Act established a 40-hour work week to enable working people
to spend more time away from work and with their families, and
discourage employers from requiring excessive overtime by making
overtime more expensive. Undermining the 40-hour work week would result
in employers requiring more people to work more overtime. For example,
under an 80-hour 2-week work period, workers who work 50 hours in 1
week would not receive any overtime pay. Workers who rely on time-and-
a-half overtime pay under a 40-hour work week may need to get a second
job to make ends meet, which would put additional stress on working
families that are already stretched thin. For employers, maintaining a
40-hour work week that provides for overtime pay beyond 40 hours
ensures that they recruit and retain talented, dedicated workers.
Question 8. Please provide the committee with a copy of the study
which you cite in footnote 23 of your testimony.
Answer 8. Please see attached for the full text of the report.
[Editor's Note: Due to the high cost of printing, previously
published materials will not be reprinted. The above report can be
found in committee files or by contacting the American College of
Occupational and Environmental Medicine.]
Response to Questions of Senators Kennedy, Enzi, and Coburn
by Jody Heymann, M.D., Ph.D.
questions of senator kennedy
Question 1. Would you please comment on why you think the provision
of paid sick days is needed, and why reliance solely on voluntary
benefits is insufficient?
Answer 1. The Healthy Families Act is crucial because of the
transformation that has occurred in the workplace and in American
families. Today, the clear majority of working Americans are caring for
children, or disabled or elderly family members. According to the
Bureau of Labor Statistics, 70 percent of mothers with children under
18 are in the workforce. At the same time, between 25 percent and 35
percent of working Americans are currently providing care for someone
over 65. According to the Census Bureau, 2 in every 7 families report
having at least one member with disabilities. The ability of Americans
to provide essential health care for their families while working
depends enormously on the availability of paid sick days.
Yet, in the absence of a Federal mandate on paid sick days, the
private sector has not filled the gap. Nearly half of private sector
workers have no paid sick days at all. An even larger percentage lack
the ability to take days off to care for sick family members. While
many families cannot reliably count on paid sick days, working poor
families are at the highest risk. As The Widening Gap, a book reporting
a series of national studies on American working families, notes, 76
percent of low-income working parents do not consistently have paid
sick days. Moreover, despite greater caregiving demands, working women
are less likely than men to have paid sick days.\1\ While voluntary
adoption of paid sick day policies has covered some Americans, the only
way to address these gaps for all Americans is through Federal
legislation.
Question 2. Is additional research needed to determine who lacks
paid sick days in America, whether paid sick days would make a
difference, and whether the United States can remain competitive while
requiring paid sick days? Do you think there has been adequate research
to demonstrate the need for paid sick days?
Answer 2. The research evidence on sick days is by now thoroughly
comprehensive. The benefits of paid sick days for individual and family
health are clear. From as far back as 1965, studies of hospitalized
children have shown that sick children have shorter recovery periods,
better vital signs, and fewer symptoms when their parents are available
to provide care.\2\ \3\ \4\ Numerous studies from 1972 onward have
indicated that sending children to day care sick with contagious
diseases increases the rate of observed infections in day care
centers,\5\ \6\ \7\ \8\ including respiratory and gastrointestinal
infections.\9\ \10\ \11\ Research on both families and child care
providers makes clear that when parents lack paid sick days they are
far more likely to send sick children to both child care and
school.\12\ \13\ I led the research team that carried out the first
primary data collection to look at the impact of paid sick days on the
ability of parents to care for children when they are sick. This peer-
reviewed research by Heymann, Toomey and Furstenberg found that parents
with paid sick days are five times as likely to be able to care for
sick children at home and are also more likely to provide preventive
health care.\14\
Since 1993, a wealth of research has also shown that when sick
adults receive support from family members, they have substantially
better health outcomes from conditions such as heart attacks \15\ \16\
and strokes.\17\ In addition, elderly individuals live longer when they
have higher levels of social support from friends and family
members.\18\ \19\ Studies have also demonstrated that taking time off
from work to rest and recuperate when sick encourages a faster recovery
\20\ and may prevent minor health conditions from progressing into more
serious illnesses that require longer absences from work and more
costly medical treatment.\21\ \22\ \23\
In 1996, a Pediatrics article by Heymann, Earle, and Egleston
detailed the first study to examine how many paid sick days families
might need, using the National Medical Expenditure Survey to look at
illness in a national sample and the NLSY to make estimates of paid
sick leave availability across America.\24\ The study found that one in
more than a third of families, family members were sick enough to stay
home from school or work for 2 weeks or more each year. However, the
study also found that millions of Americans lacked paid sick days. The
wide gaps between what Americans need in sick days and what employers
provide have thus been clear for over a decade. The impact of meeting
sick needs on success at work is also clear. Other researchers have
found that without paid sick days, working families who take time off
to provide care for family members are prone to both wage and job
loss.\25\ \26\ \27\ In 2000, results from the first nationally
representative daily diaries survey to gauge how often working
Americans disrupt work for family members, published in The Widening
Gap, revealed that the leading reason for disruptions is health.\28\ A
peer-reviewed study by Earle and Heymann, published in 2002, used over
a decade of longitudinal data to look at job loss and found that, after
controlling for a wide range of human capital factors and social
conditions, ill health and the poor health of children are leading
determinants of job loss.\29\ Moreover, an article by Earle, Ayanian,
and Heymann, published in the Journal of Women's Health in 2006,
demonstrated the importance of paid sick days in improving the return
to work among adults with major health problems, finding that nurses
are more than twice as likely to return to work after a heart attack or
angina if they have paid days.\30\
Policy options have also thoroughly been explored. Since 2004,
Institute for Women's Policy Research (IWPR) has been publishing pieces
on the availability of paid sick days in the United States and the
affordability of remedying the gap. Their studies in Massachusetts and
California have likewise shown the importance of paid sick days and
their ready feasibility. Since 2004, the National Partnership for Women
and Families has documented state by state the general shortage of
provisions available for private sector employees to take paid time off
from work in order to care for their own health, as well as for the
health of their families. In 2004, The Project on Global Working
Families conducted the first studies to look at the global availability
of paid sick days and leave \31\ and, in 2006, how provision of paid
sick days is related to the ability of countries to compete
economically.\32\ This second study published in the Journal of
Comparative Policy Analysis found that the more economically
competitive countries are more likely to provide paid sick days and
leave.
This is only a fraction of the research that has been conducted on
sick days. As a researcher, it would be easy to call for more research,
but the reality is we know enough for Congress to act.
Question 3. The Healthy Families Act covers only businesses with 15
or more employees, which is also the threshold set in the ADA and Title
VII. Would you please comment on why you think 15 employees is an
appropriate threshold, and why you think that businesses of that size
are likely to be able to readily provide paid sick leave?
Answer 3. Providing sick days to employees is feasible for
businesses of all sizes. While absences due to illnesses can be
challenging, businesses already deal with these absences. In companies
that provide paid sick days, employees are not even absent a day more a
year on average than in companies which do not provide sick days.\33\
The real difference is that it's paid and your job is protected.
Moreover, we know from practical experience that the smallest companies
in the United States are able to provide paid sick days and remain
economically competitive. In businesses with only one to nine
employees, 42 percent of employees are currently eligible for paid sick
days. Lastly, countries around the world have ensured paid sick days
for firms of all sizes. Thus, limiting this benefit to businesses with
more than 15 employees is a conservative approach.
Question 4. Could you please comment on whether or not the Healthy
Families Act's notice and medical certification provisions are
reasonable and workable?
Answer 4. Clearly, there are some health care needs that working
Americans have flexibility in scheduling. Examples of these include
routine checkups and annual preventive medical tests. While employees
will face some constraints due to the health care system in scheduling
these, it makes sense that they should make a reasonable effort to
schedule these at a time that is not unduly disruptive to work. Other
health care needs, such as caring for a sick child, addressing one's
own serious acute illness, or caring for a dying parent, clearly cannot
be scheduled. The Healthy Families Act has been drafted to require
employees to make the important effort to meet schedulable health care
needs while trying to minimize any unnecessary impact on work.
Question 5. The Healthy Families Act sets 7 paid sick days as a
minimum required national standard. Why do you think this is an
appropriate minimum? How does it compare with the standards set by
other countries?
Answer 5. A national standard of 7 guaranteed paid sick days is a
minimum compared to international norms. At least 136 countries provide
a week or more of paid sick days annually.\34\ All of the most
economically competitive countries, with the exception of the United
States, guarantee paid sick days, and 18 of the top 20 provide 31 or
more sick days with pay.
Question 6. The Healthy Families Act provides that paid sick leave
can be used to care for ``a child, a parent, a spouse, or any other
individual related by blood or affinity whose close association with
the employee is the equivalent of a family relationship.'' Could you
please comment on why it is important to provide this scope of
coverage? How is the act's definition of family member similar to other
laws and how other countries are defining family for purposes of short-
term leave?
Answer 6. The definition of family used in the Healthy Families Act
comes from the regulations covering Federal employees issued after
passage of the Federal Employees Family Friendly Leave Act of 1997.
(See 5 CFR 630.201.) Just like Federal employees, Americans have a
wide range of close family relationships, and it is crucial for
legislation to honor American families in all the ways they care for
each other.
The Widening Gap reports evidence from a study that asked working
Americans in every State across the country when they had to disrupt
work to care for a family member. While care for children accounted for
42 percent of work disruptions that were related to family, 15 percent
were to care for parents, 12 percent to care for spouses or partners, 7
percent for grandchildren, and 24 percent for other family members.
This should not come as a surprise to us. When a grandparent is caring
for a grandchild whose parents are serving in the military, they need
to be able to take time from work to care for that grandchild. When an
American is caring for an aging aunt who has no children and becomes
gravely ill, the niece or nephew may be the only person available to
provide care. These are only two of a number of crucial circumstances
that need to be covered. It will be important to have specific
guidelines on the interpretation of this clause, but this is best done
in regulation, not in law, to ensure that it covers American families
well as their circumstances change.
Recognition of the breadth of family commitments is shared by many
other countries. Just to cite a few examples of countries that ensure
leave to care for sick family members: Austria's coverage includes all
persons in need of care living in the same household; New Zealand
similarly includes people who depend on the employee for care. Nor is a
full understanding of family limited to high-income countries. El
Salvador, for example, covers spouses, ascendants, descendants, and
others who depend economically on the worker.
Question 7. A statement was made at the hearing that some employees
do not need paid sick days because they could use flextime when they
become ill or need medical care. Would you please comment on whether
flextime is a workable substitute for paid sick days?
Answer 7. Flextime is not a workable substitute for paid sick days.
Currently, most flextime programs require substantial advance
notification which makes it unworkable for covering unexpected
illnesses. Even when flextime is available with little notice--a far
less common circumstance--it is not an adequate substitute for paid
sick days. For example, employees who have been sick for a week cannot
readily make up 40 hours of work at a different time while
simultaneously caring for their health and their family.
Question 8. Mr. G. Roger King, who testified at the hearing,
claimed that employers will have difficulties complying with the
Healthy Families Act because of existing compliance requirements under
the FMLA and workers' compensation laws. Do you agree, why or why not?
Answer 8. Employers should not have difficulty complying with the
Healthy Families Act while complying with the FMLA and the workers'
compensation laws. In fact, half of the private sector already provides
paid sick days, as noted above. These companies are successfully
ensuring their employees can care for their health, and are able to do
this without conflict with the FMLA or workers' compensation laws. Paid
sick days may be used to cover both common health problems--these are
not covered by the FMLA, and so there is no overlap at all--and serious
illness. In the case of serious illness, nothing in the FMLA prohibits
paying employees, so ensuring they are paid under the Healthy Families
Act for 7 days will not create any compliance difficulties.
Question 9. Mr. King argued that compliance with the Healthy
Families Act will be administratively burdensome on employers. Given
that so many employers in the United States and around the world
already provide paid sick days, do you see compliance with these
additional requirements as a problem for employers? Why or why not?
What, if any, administrative procedures would the act add to typical
payroll procedures?
Answer 9. An employer that does not currently provide sick days
will need to develop a system for granting requests for sick days and
keeping track of the number of sick days taken and remaining for the
year. Those procedures, however, can easily be integrated into existing
payroll procedures, as has already been done by employers for half of
all private sector employees.
Question 10. Mr. King asserted that employers will likely reduce
benefits in response to the act's paid sick days requirement. Would you
please comment on why that may or may not be the case?
Answer 10. As currently written, the act clearly prohibits
employers from reducing benefits in response to the act's passage. Any
employers that reduce benefits in response to the act if it passes
would violate the law.
endnotes
\1\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York: Basic
Books.
\2\ Van der Schyff G. (1979). The role of parents during their
child's hospitalization. Aust Nurs J. 8:57-61.
\3\ Mahaffy P. (1965). The effects of hospitalization on children
admitted for tonsillectomy and adenoidectomy. Nurs Res. 14:12-19.
\4\ Palmer S.J. (1993) Care of sick children by parents: A
meaningful role. J Adv Nurs. 18:185.
\5\ Loda F.A., W.P. Glezen, & W.A. Clyde. (1972). Respiratory
disease in group day care. Pediatrics 49:428-0437.
\6\ Sullivan P., W.E. Woodward, L.K. Pickering, & H.L. Dupont.
(1984). Longitudinal study of occurrence of diarrheal disease in day
care centres. Am J Public Health 74:987.
\7\ Dahl I.L, M. Grufman, C. Hellberg, & M. Krabbe. (1991).
Absenteeism because of illness at daycare centers and in three-family
systems. Acta Paediatr Scand. 80:436.
\8\ Mottonen M. & M. Uhari. (1992). Absences for sickness among
children in day care. Acta Paediatr. 81:929.
\9\ Loda F.A., W.P. Glezen, & W.A. Clyde. (1972). Respiratory
disease in group day care. Pediatrics 49:428-437.
\10\Strangert K. (1976). Respiratory illness in preschool children
with different forms of day care. Pediatrics 57:191.
\11\ Doyle A.B. (1976). Incidence of illness in early group and
family day care. Pediatrics 58:607.
\12\ Heymann S.J. (2000) The Widening Gap: Why American Families
are in Jeopardy and What Can Be Done About It. Basic Books: New York.
\13\ Heymann S.J., Vo PH, and Bergstrom CA. (2002). Child care
providers' experiences caring for sick children: Implications for
public policy. Early Child Development and Care 172(1): 1-8.
\14\ Heymann S.J., S. Toomey, & F. Furstenberg. (1999). Working
parents: What factors are involved in their ability to take time off
from work when their children are sick? Archives of Pediatrics &
Adolescent Medicine 153:870-874.
\15\ Bennet S.J. (1993). Relationships among selected antecedent
variables and coping effectiveness in postmyocardial infarction
patients. Research in Nursing and Health 16:131-139.
\16\ Gorkin L. E.B. Schron, M.M. Brooks, I. Wiklund, J. Kellen, J.
Verter, J.A. Schoenberger, Y. Pawitan, M. Morris, & S. Shumaker.
(1993). Psychosocial predictors of mortality in the Cardiac Arrhythmia
Suppression Trial-1 (CAST-1). American Journal of Cardiology 71:263-
267.
\17\ Tsouna-Hadjis E., K.N. Vemmos, N. Zakopoulos, & S.
Stamatelopoulos. (2000). First-stroke recovery process: The role of
family support. Archives of Physical Medicine and Rehabilitation
81:881-887.
\18\ Seeman T.E. (2000). Health promoting effects of friends and
family on health outcomes in older adults. American Journal of Health
Promotion 14:362-370.
\19\ Berkman L.F. (1995). The role of social relations in health
promotion. Psychosomatic Medicine 57:245-254.
\20\ Gilleski D.B. (1998). A dynamic stochastic model of medical
care use and work absence. Econometrica 66:1-45.
\21\ Aronsson G., K. Gustafsson, & M. Dallner. (2000). Sick but yet
at work: An empirical study of sickness and presenteeism. Journal of
Epidemiology and Community Health 54:502-509.
\22\ Grinyer A. and V. Singleton. (2000). Sickness absence as risk-
taking behaviour: A study of organizational and cultural factors in the
public sector. Health, Risk, and Society 2:7-21.
\23\ Johannsson G. (2002). Work-life balance: The case of Sweden in
the 1990s. Social Science Information 41:303-317.
\24\ Heymann S.J., Earle A., and Egleston B. (1996). Parental
availability for the care of sick children. Pediatrics 98(2 part
1):226-230.
\25\ Murphy B., H. Schofield, J. Nankervis, S. Bloch, H. Herman, &
B. Singh. (1997). Women with multiple roles: The emotional impact of
caring for ageing parts. Ageing and Society 17:277-291.
\26\ Joshi H., P. Paci, & J. Waldfogel. (1999). The wages of
motherhood: Better or worse? Cambridge Journal of Economics 23:543-564.
\27\ National Alliance for Caregiving and American Association of
Retired People. (2004). Caregiving in the U.S. Available at http://
www.caregiving.org/data/04finalreport.pd.
\28\ Heymann J. (2000). The Widening Gap: Why America's Working
Families are in Jeopardy and What Can Be Done about It. New York: Basic
Books.
\29\ Earle A. & S.J. Heymann. (2002). What causes job loss among
former welfare recipients? The role of family health problems. Journal
of the American Medical Women's Association 57:5-10.
\30\ Earle A., J.Z. Ayanian, & S.J. Heymann. (2006). What predicts
women's ability to return to work after newly diagnosed coronary heart
disease: Findings on the importance of paid leave. Journal of Women's
Health 15(4): 430-441.
\31\ Heymann, S.J., Earle A., Simmons S., Breslow S.M., and
Kuehnhoff A. (2004). Work, Family, and Equity Index: Where Does the
United States Stand Globally? Boston: Project on Global Working
Families.
\32\ Earle A. & J. Heymann. (2006). A comparative analysis of paid
leave for the health needs of workers and their families around the
world. Journal of Comparative Policy Analysis 8(3):241-257.
\33\ Lovell V. (2005). Valuing Good Health: An Estimate of Costs
and Savings for the Healthy Families Act. Washington, D.C. : Institute
for Women's Policy Research. Available online at: http://www.iwpr.org/
pdf/B248.pdf.
\34\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/Montreal:
Project on Global Working Families. Available online at: http://
www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
questions of senator enzi
Question 1. In your written testimony you said that the Healthy
Families Act is ``superbly constructed.'' By that, do you mean that it
is the bill supporters' intention to cover cosmetic procedures such as
botox injections or teeth whitening?
Answer 1. Currently, American mothers who stay home to care for an
infant with a 104 degree fever are being fired. Sons who seek to
address the health needs of elderly parents are having to choose
between neglecting their own mothers and fathers and losing jobs. To
avoid losing pay, millions of Americans are going to work every month
sick and spreading infections to their coworkers and those they come
into contact with at work. Restaurant workers need paid sick days so
they don't spread disease to all those they serve, and health care
workers need paid sick days so they don't spread illness to their
vulnerable patients. The Healthy Families Act is indeed well
constructed to begin to meet these crucial needs and to have a
substantial positive impact on public health at an affordable cost.
Question 2. Vacation time has demonstrable effects on employee
morale, and productivity. Would you favor mandating paid vacation time
for all private sector employees?
Answer 2. As you correctly note, vacation time has important
benefits for both employees and employers. Moreover, it is readily
affordable. One hundred thirty-seven countries guarantee paid annual
leave.\1\ The majority of the most competitive countries globally
guarantee paid annual leave. That having been said, the bill under
consideration addresses a far more urgent need--paid sick days. Whether
or not we have consensus on other legislation, paid sick days are
crucial to public health, the health of employees and their families,
to the long-term economic productivity of the country, and to the
welfare of all Americans.
---------------------------------------------------------------------------
\1\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/Montreal:
Project on Global Working Families. Available online at: http://
www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
Question 3. What is the direct labor cost to the private sector of
the paid leave mandate contained in the Healthy Families Act? How was
that cost calculated? What individual(s) or organization(s) calculated
these direct private sector costs, what was the methodology utilized,
and has the study, calculation and/or estimate been fully peer-
reviewed?
Answer 3. Please see answer 4.
Question 4. What is the indirect cost to the private sector of the
paid leave mandate contained in the Healthy Families Act? How was that
cost calculated? What individual(s) or organization(s) calculated these
indirect private sector costs, what was the methodology utilized, and
has the study, calculation and/or estimate been fully peer-reviewed?
Answer 4. In response to questions 3 and 4: During the testimony,
you received cost estimates from Heidi Hartmann. The details on these
estimates including methodology are publicly available through the
Institute for Women's Policy Research. In carrying out these estimates,
they have received input from a wide range of researchers in the field.
The bigger question is what do we know about the affordability of
paid sick days? First, half of all employees in America currently work
for businesses which provide paid sick days. These businesses have been
able to successfully compete both locally and globally while providing
paid sick days. This is true of firms of every size category, from the
smallest to the largest. The problem is that the lack of a Federal
mandate has left nearly half of American workers in the private sector
with no paid sick days. Countries around the world have shown they can
compete while mandating paid sick days. All of the most competitive
countries, with the exception of the United States, guarantee paid sick
days. In short, we have excellent evidence that it is affordable.
Question 5. Do you believe that the bill's 15 employee coverage
threshold is appropriate? Why shouldn't the threshold be 50 employees?
Why shouldn't the threshold be 2 employees?
Answer 5. Providing sick days to employees is feasible for
businesses of all sizes. While absences due to illnesses can be
challenging, businesses already deal with these absences. In companies
that provide paid sick days, employees are not even absent a day more a
year on average than in companies which do not provide sick days.\2\
The real difference is that it's paid and your job is protected.
Moreover, we know from practical experience that the smallest companies
in the United States are able to provide paid sick days and remain
economically competitive. In businesses with only one to nine
employees, 42 percent of employees are currently eligible for paid sick
days. Lastly, countries around the world have ensured paid sick days
for firms of all sizes. Thus, limiting this benefit to businesses with
more than 15 employees is a conservative approach.
---------------------------------------------------------------------------
\2\ Lovell V. (2005). Valuing Good Health: An Estimate of Costs and
Savings for the Healthy Families Act. Washington, D.C. : Institute for
Women's Policy Research. Available online at: http://www.iwpr.org/pdf/
B248.pdf.
Question 6. Do you believe that the bill's entitlement of 7 paid
sick days is appropriate? Why shouldn't the entitlement be 3 paid sick
days? Why shouldn't the entitlement be 14 paid sick days?
Answer 6. A national standard of 7 guaranteed paid sick days is a
minimum compared to international norms. At least 136 countries provide
a week or more of paid sick days annually.\3\ All of the most
competitive countries, with the exception of the United States,
guarantee paid sick days, and 18 of the top 20 provide 31 or more sick
days with pay.
---------------------------------------------------------------------------
\3\ Heymann J., A. Earle, & J. Hayes. (2007). The Work, Family, &
Equity Index: How Does the United States Measure Up? Boston/Montreal:
Project on Global Working Families. Available online at: http://
www.mcgill.ca/files/ihsp/WFEIFinal2007.pdf.
Question 7. As I am sure you are aware, under the Fair Labor
Standards Act, Federal workers can enter into voluntary arrangements
with their employers to establish flex-time schedules, i.e. 80 hour bi-
weekly schedules, as a means to better balance work, personal and
family life. Would you be in favor of extending this to workers in the
private sector? What is [are] the reason[s] for your view?
Answer 7. There is a range of alternative work schedules that can
help employees balance work, personal, and family life that are already
possible for all employers in the United States to offer, including
flexible work hours and part-time schedules as examples. Some countries
go further and have laws requiring employers to make flexible hours
schedules available to their workers. The United Kingdom has a law that
facilitates flexibility by providing working parents with the right to
request flexible schedules in order to care for children. A law in New
South Wales, Australia, gives employees in companies with more than
five people the right to have reasonable accommodations made, including
flexible scheduling, in order to allow them to care for any immediate
family member in need of care. Laws in the Netherlands and Germany give
employees the right to request a reduction or extension in the number
of hours worked. While these laws only require companies to consider
requests and to enact them if feasible, I would be happy to put you in
touch with other experts on these new approaches to flexibility.
questions of senator coburn
Question 1. In your review of other countries and their government-
mandated leave policies, how many of the countries had Federal
constitutions like the U.S. Constitution which limits the role of the
Federal Government unless specifically authorized to act?
Answer 1. Congress has passed labor legislation on a wide variety
of important issues that range from prohibitions on child labor, to
ensuring occupational safety, to passing a minimum wage. All of these
have been accomplished while respecting the American Constitution. The
Healthy Families Act is quite similar to the minimum wage and other
legislation that has already been passed to ensure basic decent working
conditions for Americans. With respect to other countries, as 145
countries ensure paid sick days or paid sick leave, these represent the
full range of constitutional and non-constitutional systems--including
Federal Governments, as well as governments that are not based on a
Federal system--and the full political and economic spectrum.
Question 2. Section 5(d)(3) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress sets out that leave
can be used for the ``purpose of caring for a child, a parent, a
spouse, or any other individual related by blood or affinity whose
close association with the employee is the equivalent of a family
relationship. . .'' (emphasis added) Please explain what situations and
who Section 5(d)(3) could encompass.
Answer 2. The definition of family used in the Healthy Families Act
comes from the regulations covering Federal employees issued after
passage of the Federal Employees Family Friendly Leave Act of 1997.
(See 5 CFR 630.201.) Just like Federal employees, Americans have a
wide range of close family relationships, and it is crucial for
legislation to honor American families in all the ways they care for
each other.
The Widening Gap reports evidence from a study that asked working
Americans in every State across the country when they had to disrupt
work to care for a family member. While care for children accounted for
42 percent of work disruptions that were related to family, 15 percent
were to care for parents, 12 percent to care for spouses or partners, 7
percent for grandchildren, and 24 percent for other family members.
This should not come as a surprise to us. When a grandparent is caring
for a grandchild whose parents are serving in the military, they need
to be able to take time from work to care for that grandchild. When an
American is caring for an aging aunt who has no children and becomes
gravely ill, the niece or nephew may be the only person available to
provide care. These are only two of a number of crucial circumstances
that need to be covered. It will be important to have specific
guidelines on the interpretation of this clause, but this is best done
in regulation, not in law, to ensure that it covers American families
well as their circumstances change.
Recognition of the breadth of family commitments is shared by many
other countries. Just to cite a few examples of countries that ensure
leave to care for sick family members: Austria's coverage includes all
persons in need of care living in the same household; New Zealand
similarly includes people who depend on the employee for care. Nor is a
full understanding of family limited to high-income countries. El
Salvador, for example, covers spouses, ascendants, descendants, and
others who depend economically on the worker.
Question 3. Section 5(e) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress, sets out that ``An
employee shall make a reasonable effort to schedule leave under
paragraphs (2) and (3) of subsection (d) in a manner that does not
unduly disrupt the operations of the employer.'' (emphasis added)
Please explain what the term ``reasonable effort'' could encompass.
Answer 3. Clearly, there are some health care needs that working
Americans have flexibility in scheduling. Examples of these include
routine checkups and annual preventive medical tests. While employees
will face some constraints due to the health care system in scheduling
these, it makes sense that they should make a reasonable effort to
schedule these at a time that is not unduly disruptive to work. Other
health care needs, such as caring for a sick child, addressing one's
own serious acute illness, or caring for a dying parent, clearly cannot
be scheduled. The Healthy Families Act has been drafted to require
employees to make the important effort to meet schedulable health care
needs while trying to minimize any unnecessary impact on work.
Question 4. Are you aware of any States or localities (other than
San Francisco) that are considering legislative action to address this
issue?
Answer 4. Numerous States and localities--from Maine to Montana,
from Maryland to Massachusetts, to the city of Madison, Wisconsin,
among many others--have or are considering legislative action on paid
sick days or paid family leave, because of the current vacuum that has
been left at the Federal level. Yet, an increasing number of companies
are noting that it will be far easier for them to comply if this is
addressed at a Federal level with more uniform standards. Until these
basic needs are met by Federal legislation, it makes sense that State
and local governments will and should pass legislation to protect the
health of their residents. At the same time, the best solution, both
for ease of administration for companies and for ensuring a level
playing field for all Americans, is Federal passage.
Response to Questions of Senators Kennedy, Enzi, and Coburn
by Rajiv Bhatia, M.D., MPH
questions of senator kennedy
Question 1. The Healthy Families Act covers only businesses with 15
or more employees, which is also the threshold set in the ADA and Title
VII. Would you please comment on why you think 15 employees is an
appropriate threshold, and why you think that businesses of that size
are likely to be able to readily provide paid sick leave?
Answer 1. As a public health physician, I believe providing paid
sick leave has benefits to employees, employers, society, and
government with regards to economic well being as well as physical and
mental health. As sickness does not discriminate based on the number of
employees in a business, all employees, irrespective of the size of the
business need and should have the ability to access paid sick days.
With regards to feasibility, San Francisco's paid sick day law requires
all employers to provide sick leave to all employees regardless of the
size of the business. Smaller businesses are allowed to cap the accrued
leave to 40 hours while all other businesses may cap accrued leave at
72 hours. Businesses of all sizes are currently complying with this law
in San Francisco. Internationally, businesses in countries that require
universal paid sick leave benefits appear to be competitive and
successful.
Question 2. Mr. King asserted that employers will likely reduce
benefits in response to the act's paid sick days requirement. Would you
please comment on why that may or may not be the case?
Answer 2. It is not clear specifically which benefits Mr. King is
referring to. In theory, some employers may conceivably reduce benefits
that they already provide (e.g. vacation) in order to provide paid sick
days leave. I don't believe many employers would reduce existing
benefits for two reasons. First, I believe the number of employers
which provide substantial benefits without providing paid sick day
benefits is relatively small. In general, the provision of diverse
benefits appears to be correlated positively. For example, employers
who provide vacation benefits also provide sick day benefits. Employers
who do not provide paid sick days also do not provide vacation and
other benefits. Second, sick leave benefits are not comparable to other
benefits in that they are not utilized uniformly by all employees.
Typically, vacation benefits are used or accrued. Health care insurance
benefits are paid by the employer irrespective of utilization of care.
Paid sick days are utilized only when there is an illness or need for
care. In a particular time period, paid sick leave benefits are
typically not utilized completely by all employees who have them. Many
employees may utilize little or no sick leave. Only a minority of
employees have chronic or acute care needs requiring full utilization
of all leave. I believe few employers would be likely to reduce an
existing benefit (like vacation) for all employees as a trade-off for a
new benefit whose utilization may vary substantially among employees.
questions of senator enzi
Question 1. Your testimony about the public health value of
mandating sick leave referenced infectious diseases such as influenza,
stomach flu, and viral meningitis that are indeed very dangerous for
the general population. I am concerned that the Healthy Families Act as
introduced last Congress would cover many more far less compelling
cases. The paid leave mandated under this bill could be applied for any
``absence resulting from obtaining professional medical care.'' As a
Doctor, you know that ``professional medical care'' could apply to
numerous cosmetic health procedures and a host of other plainly
elective options. Under this bill, an employee, working for a small
employer, could choose to have a teeth-whitening procedure done in the
middle of the work day. This employee would have to be paid for the
time away from work, and the employer would have to find a replacement
employee to fill in for the absence with very little notice. Do you
think this type of sick leave utilization is appropriate? If not, why
doesn't the bill restrict sick leave to medically necessary conditions
and procedures?
Answer 1. In my testimony, I articulated the benefits with regards
to both acute infectious diseases as well as more chronic diseases.
There are additional potential benefits of paid sick days mediated
through the care and prevention of chronic diseases, prevention of
cancers, and treatment of functional disabilities; and care for
children. Sick leave would be appropriate for some elective procedures
however, it may be appropriate to limit paid sick leave for procedures
that do not have a medical necessity, a preventative health purpose, or
a functional benefit. With regards to elective procedures, I would
personally make the distinction between (1) elective procedures that
prevent or ameliorate an existing or potential functional disability
(knee surgery to improve or preserve the range of motion of the knee);
(2) elective procedures that screen for or prevent more serious
preventable conditions (colonoscopy for colon cancer); and (3) elective
procedures that has no relationship to a disease or disability (e.g.
cosmetic surgery for purely aesthetic purposes). With regards to this
latter sub-category of elective procedures (3), paid sick days would
not appear to have a compelling public health benefit.
Question 2. Do you believe sick leave should be limited to full day
increments? How small should the allowable time increments be?
Answer 2. I do not believe that sick leave should be limited to
full day increments. Full day increments do not correspond to common
health care needs in a variety of circumstances. For example, for some
disease conditions, an individual may need frequent but brief
appointments with his or her physician, appointments with a physical
therapist, or appointments for laboratory work. In these situations the
medical care could be short (e.g. 1 hour). Thus, an employee could take
sick leave to attend a routine medical appointment and also potentially
work for the majority of a workday. This is advantageous for both
employees and employers.
Question 3. Assuming that employer resources are not limitless,
from a public health perspective, do you think employer benefit dollars
are best spent on providing accessible and affordable health insurance
or on paid sick leave programs for employees?
Answer 3. I do not view the two types of benefits comparable with
regards to type of benefit or fiscal implications for employers;
therefore, it is not possible for me to evaluate the tradeoffs
suggested by the question. Health care insurance benefits are typically
paid as insurance premiums and there is no rebate to employees for
healthy employees who do not utilize resources in any premium period.
In contrast, there is variable utilization of paid sick day benefits
and potential employer benefits on productivity, employee retention,
and health care costs. Furthermore, paid sick leave and heath care
insurance benefits are complimentary. Health insurance can prevent some
illness among employees and reduce the need for paid sick days. Paid
sick days had potential to increase the utilization of primary and
preventive care and reduce the utilization of more expensive
therapeutic and hospital care, thus reducing the health care cost
burden borne by employers collectively.
questions of senator coburn
Question 1. Section 5(d)(3) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress sets out that leave
can be used for the ``purpose of caring for a child, a parent, a
spouse, or any other individual related by blood or affinity whose
close association with the employee is the equivalent of a family
relationship. . .'' (emphasis added) Please explain what situations and
who Section 5(d)(3) could encompass.
Answer 1. In my opinion, typical situations could include care for
an individual who is suffering from, under evaluation for, or under
treatment for an illness, disease, injury, or infirmity, whether
permanent, temporary, acute, or chronic. I believe the subjects being
cared for could include: a child, stepchild, foster child, or adopted
child; parent or step-parent; spouse; grandparent or grandchild;
domestic partner; or a sibling.
Question 2. Section 5(e) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress, sets out that ``An
employee shall make a reasonable effort to schedule leave under
paragraphs (2) and (3) of subsection (d) in a manner that does not
unduly disrupt the operations of the employer.'' (emphasis added)
Please explain what the term ``reasonable effort'' could encompass.
Answer 2. In my opinion, a reasonable effort on the part of the
employee could encompass the following: conferring with the employer to
learn when medical appointments may be least disruptive; scheduling
routine or preventative medical care on a day or at a time of day that
is least disruptive to the employee's business if care is available at
that time; scheduling more immediate or acute health care needs at a
time of day least disruptive to the employer's business if care is
available; providing the employer timely advanced notice of routine or
preventative care. Caring for a family member with an acute or
emergency health condition, of course, cannot be scheduled in advance,
but notice should be provided to the employer as soon as practicable.
Question 3. Are you aware of any States or localities (other than
San Francisco) that are considering legislative action to address this
issue?
Answer 3. I understand that in the United States, the States of
California, Connecticut, Vermont, Washington, and Massachusetts
currently have pending legislation to provide paid sick days to
employees, and initial work on policy development is underway in
several others.
Response to Questions of Senators Enzi and Coburn by G. Roger King
questions of senator enzi
Question 1. I know that many large employers voluntarily offer
their employees paid Family and Medical Leave Act time in an effort to
remain competitive. In your experience working with employers who are
covered by FMLA, is there a higher likelihood of abuse among employees
who have access to paid vs. unpaid leave? Can you offer any suggestions
as to why this may be the case?
Answer 1. There is the potential for abuse among employees who have
access to paid vs. unpaid sick leave. This is likely because certain
employees who receive paid sick leave often view this leave as an
``entitlement'' or part of their compensation, rather than a benefit
that is to be used only when necessary. As evidence of this, some
clients who have traditional sick leave programs have advised us that
they see an increase of sick leave on Mondays and Fridays or around
national holidays or traditional vacation periods (i.e., Christmas or
Independence Day). Some employees will take ``mental health'' days and
call in ``sick'' when they are not actually ill. The problem with using
sick leave in this manner is that the leave is often unscheduled and
thus creates staffing issues and considerable increased expenses for
employers.
Human Resources professionals and clients have advised us that when
sick leave and vacation leave are provided as two separate benefits,
employees use sick leave because they have it. When employers switch to
using a paid time off (``PTO'') leave bank system they usually find
that utilization of unscheduled time off changes drastically. Instead
of using unscheduled ``sick days,'' employees will save their time and
use it for planned vacation and truly needed time off.
Question 2. It appears that Section 5(g)(2) of the bill would
freeze all leave policies upon enactment, and would effectively bar a
covered employer from ever changing those policies in the future.
Moreover, under Section 5(g) were those existing policies not deemed to
be ``equivalent'' it would appear that the mandated leave called for
under the bill would be in addition to that which an employer was
voluntarily providing. Is that a fair reading of Section 5(g)? Could
this wind up punishing employers that currently provide paid leave? Do
you believe the bill language is clear as to the meaning of
``equivalent''?
Answer 2. I agree with your reading of 5(g)(2) of the bill (which
states that an employer may not eliminate or reduce the leave that it
offers at the time the bill is enacted in order to comply with the
HFA). As discussed in my written testimony, this edict would appear to
contradict other sections of the HFA that will require employers to
substantially modify their leave policies to become compliant with the
HFA. Further, Section 5(g)(2) is troubling as it states ``an employer
may not eliminate or reduce leave in existence on the date of enactment
of this Act, regardless of the type of such leave, in order to comply
with the provisions of this Act.'' As noted above, does this subsection
prohibit even minor adjustments to an employer's current leave
programs? For example, it is unclear under the bill as currently
written whether an employer that has a paid time-off program \1\ that
does not specifically identify sick leave would be prevented from
changing in any manner how this paid time-off system works, including
the eligibility and accrual levels associated with such plan. The
``equivalency'' provision of the HFA raises serious questions as to how
such PTO and analogous programs would deem to be ``equivalent'' to the
7-day paid sick leave requirement of the HFA. Indeed, the cost of
regulatory staff and time associated with such ``equivalency'' reviews
no doubt would be considerable as would be the cost of the inevitable
litigation that will arise from such determinations.
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\1\ The term or phrase ``sick leave'' is a term or concept that is
no longer used by a substantial number of employers in this country.
Paid sick leave has been replaced or folded into comprehensive leave
programs such as paid time off (``PTO'') and other similar leave
policies and procedures. This approach combines traditional paid sick
leave days, vacation days and other paid leave time (e.g., personal
days, attendance incentive pay, etc.) into a consolidated or
comprehensive paid leave program. Under this approach, a worker is
given the option of when to take such paid leave time and may choose to
do so within general constraints for any reason for which he or she
chooses, including taking leave for personal or family illness
situations.
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questions of senator coburn
Question 1. In your testimony you mentioned the problems that have
arisen with FMLA. Please discuss some of the litigation trends related
to FMLA and whether you consider the Healthy Families Act as another
bill that could spur similar litigation?
Answer 1. If the HFA is enacted based on the experience of many
employers under FMLA, employers of all sizes may be discouraged from
implementing any additional improvements in their paid leave programs--
assuming after paying for their additional paid leave costs,
administrative expenses, and litigation costs associated with the HFA
that they would even have any resources left to make such improvements.
Indeed, in many instances it may be that the added administrative and
litigation costs and other compliance expenses associated with the HFA
will drain any resources that otherwise would have been available for
paid leave benefit improvements.
As an employment attorney, I have seen the following issues in FMLA
litigation that would likely arise with similar frequency under the
Healthy Families Act:
(1) The use (and abuse) of intermittent leave;
(2) The inadequacy of notice and certification before a leave period
begins;
(3) Impact on attendance incentive programs;
(4) Litigation costs associated with compliance;
(5) Potential class claims (such as those that are currently plaguing
employers in the wage and hour arena).
Intermittent leave is one area that particularly deserves this
committee's attention. Two different regulations, the regulation
permitting intermittent leaves when there is no planned and scheduled
medical treatment on the day of the absence and the regulation
embracing chronic conditions as covered ``serious health conditions,''
intersect to create one of the biggest problems for employers in terms
of day-to-day operations. Together, these regulations allow an employee
to have unscheduled absences of up to 60 single work days per year or
approximately 25 percent of all workdays for conditions that may not be
a serious health condition. This means that an employee could be absent
for 1.2 days every single week in a calendar year or a consecutive 12
month period.
Additionally, intermittent leave can be taken in as little as 10 or
15 minute increments with the potential, therefore, for an employee to
take off a portion of his or her workday everyday in the calendar year
or in a consecutive 12 month period. Further, if the employee manages
to work 1,250 hours in the previous 12 months, the employee will be
eligible to continue this cycle.
Similar concerns will arise with the Healthy Families Act if
employees use the 7 days of paid leave intermittently. The use of
intermittent paid leave will subject small employers (those not covered
by the FMLA) to similar scheduling and coverage issues as those
employers currently covered by the FMLA and will serve to exacerbate
the already difficult situation faced by employers who are covered
under the FMLA. The impact of unnoticed intermittent sick leave on a
small employer could be devastating to production and/or operations.
Question 2. Section 5(d)(3) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress sets out that leave
can be used for the ``purpose of caring for a child, a parent, a
spouse, or any other individual related by blood or affinity whose
close association with the employee is the equivalent of a family
relationship. . . (emphasis added) Please explain what situations and
who Section 5(d)(3) could encompass.
Answer 2. This is, in my estimation, one of the fundamental
definitional flaws in the act. This phrase is susceptible to a very
broad inclusion of a variety of individuals. It could be construed to
include frequent visitors to a household, a nanny or other domestic
help, domestic partners, friends who live together as roommates--the
list is potentially limitless. The potential litigation that might
arise from this definition will likely further increase employers'
burden in complying with the act.
Question 3. Section 5(e) of S. 932--the Healthy Families Act--
introduced by Senator Kennedy in the 109th Congress, sets out that ``An
employee shall make a reasonable effort to schedule leave under
paragraphs (2) and (3) of subsection (d) in a manner that does not
unduly disrupt the operations of the employer.'' (emphasis added)
Please explain what the term ``reasonable effort'' could encompass.
Answer 3. This open-ended and minimal requirement of notice to an
employer for unscheduled leave will pose significant practical,
financial, and operational problems. The term ``a reasonable effort''
is entirely subjective and most employers will be unwilling to
challenge any notice provided by an employee, even if that notice comes
too late for the employer to cover the employee's absence.
Question 4. Are you aware of any States or localities (other than
San Francisco) that are considering legislative action to address this
issue?
Answer 4. Yes. Currently there are State efforts to enact
legislation similar to that of San Francisco's in Maine, Maryland,
Massachusetts, Michigan, Montana, Wisconsin, Vermont, and Washington
and municipal efforts in Madison, Wisconsin and Washington D.C. Also,
the Federal Government and all State governments currently provide paid
sick leave to their workers. Seven States (California, Connecticut,
Hawaii, Maine, Minnesota, Washington, and Wisconsin) provide that
workers who have paid sick days must be permitted to use them to care
for family members. Many of these initiatives are quite recent and
largely untested. For example, it is interesting to note that numerous
problems have arisen regarding the San Francisco ordinance in this area
and this new law has therefore been delayed in its implementation.
Questions of Senator Kennedy to Heidi Hartmann, Ph.D.
Question 1. Please explain how you arrived at the estimated cost of
the Healthy Families Act, and address Mr. King's statement that the act
would cost employers approximately $80 billion a year.
Question 2. The Healthy Families Act covers only businesses with 15
or more employees, which is also the threshold set in the ADA and title
VII. Would you please comment on why you think 15 employees is an
appropriate threshold, and why you think that businesses of that size
are likely to be able to readily provide paid sick leave?
Question 3. The Healthy Families Act sets 7 paid sick days as a
minimum required national standard. Why do you think this is an
appropriate minimum? How does it compare with the standards set by
other countries?
Question 4. A statement was made at the hearing that some employees
do not need paid sick days because they could use flextime when they
become ill or need medical care. Would you please comment on whether
flextime is a workable substitute for paid sick days?
Question 5. Mr. King asserted that employers will likely reduce
benefits in response to the act's paid sick days requirement. Would you
please comment on why that may or may not be the case?
[Editor's Note: Responses to the above questions were not available
at time of print.]
[Whereupon, at 11:42 a.m., the hearing was adjourned.]