Lack of Paid Leave Hurts Americans’ Health

Without paid leave, Americans delay or forego needed health care, harming their health.

A person stands with their back to the camera in front of two people each pointing to an eye chart.
Volunteers administer vision tests at a free health care event in Seattle on February 16, 2024. (Getty/David Ryder)

When a major health need arrives—a bad biopsy, a chronic diagnosis, a serious accident—work should be the last thing on one’s mind. But, for too many Americans, getting needed health care means losing a paycheck they can’t afford to go without or even losing the job their family relies upon.

Without the paid leave they need, workers and their families put off or go without needed care at potentially devastating cost to their health. Nearly half (44 percent) of workers with an unmet need for leave—meaning those who needed leave but did not take it—report that they or their loved one postponed needed care. The most common reasons workers do not take a needed leave are inability to afford unpaid leave and fear of job loss. In other words, because workers lack continued income and job protection—the crucial protections provided by comprehensive paid leave—they and their families put off getting the health care they need.

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Delaying care means the potential for worse health, even when care is eventually received. For many conditions, early diagnosis and treatment is essential for the most effective results. For example, for multiple sclerosis, earlier treatment profoundly reduces disease progression and later disability. More broadly, people who delay care are roughly half as likely to report excellent or good health as those who don’t delay or forego care, after controlling for a range of health-related factors. Similarly, among adults who delayed care in response to the COVID-19 pandemic in 2020, more than a quarter (27.3 percent) reported the delay in care limited their ability to work or do other daily activities or worsened a health condition.

At the most pronounced, the consequences of delay can be dire. Delayed care can raise the risk of complications or even death for those with chronic conditions. Among cancer patients, a four-week delay in needed surgery increases the risk of death by 6 percent to 8 percent, a risk that may be more pronounced with other forms of delayed treatment. And with longer delays, the risk compounds: For example, for breast cancer patients, a 12-week delay in surgery increases the risk of death by 26 percent. For people dealing with serious illnesses, delays due to lack of paid leave may mean getting care too late to save their lives.

Spotlight on paid leave and preventive care

Care for serious health needs often takes weeks or months, requiring extended paid, job-protected leave. However, the related protection of short-term paid sick time is a critical link in getting regular, clinically recommended screenings and other health care services that are necessary for either preventing a serious illness or catching serious health needs when treatment can be most effective. For example, cancer survivors without access to paid sick time are less likely to get needed preventive care, undermining their future health. People without paid sick time are less likely to get mammograms, Pap tests, or colonoscopies. Conversely, people with access to paid sick time are more likely to get Pap tests and other forms of preventive care. As a result, for example, a 2023 study found statistically significant increases in mammogram and colorectal cancer screening rates when cities put in place paid sick time requirements.

Routine preventive screenings like these make early cancer detection and diagnosis possible, which in turn significantly increases the likelihood of survival. More broadly, among employed cancer survivors, those without paid sick leave are more than twice as likely (16.7 percent) to report delaying or foregoing care due to cost as those with paid sick leave (8.0 percent). Both paid sick time and paid family and medical leave are essential to ensuring timely, effective health care for serious health conditions such as cancer.

For too many workers, the lack of paid leave can mean going without needed care altogether. In 2022, about 15 percent of employed adults without access to paid sick or medical leave reported having foregone needed medical care in the last 12 months because it was too hard to take time away from work. In a separate study, nearly 40 percent of workers who did not take a needed leave reported they or a family member had gone without needed medical treatment in lieu of taking the needed leave. Simply put, lack of access to paid leave is a significant barrier to getting needed medical care—one that some are unable to surmount.

These gaps in care harm health. Among adults who forwent care due to the COVID-19 pandemic, more than 35 percent reported worsened health conditions and/or limited ability to work or do other daily activities. For patients with long-term health conditions, missing doctors’ appointments corresponds to a greater risk of death, especially for those with mental health conditions. Writ large, controlling for prior health, those who forego or delay needed health care report lower physical and mental health status.

Having the paid leave they need helps alleviate burdens associated with getting care for serious health concerns. For example, among cancer patients who used paid leave, nearly two-thirds reported positive impacts on their treatment decisions. In the same survey, an overwhelming 80 percent of cancer patients who used paid leave reported a positive impact on their ability complete treatment.

With respect to race and income, disparities in access to leave coincide with disparities in access to timely treatment. For example, Black patients experience greater treatment delays than white patients for multiple cancer types along with other serious diseases. These treatment delays are exacerbated by broader racial health disparities. At the same time, Black workers are twice as likely to have unmet leave needs as white workers. Prior Center for American Progress research found that Black women do not take a more than a third of the leave they need for their own health. Similarly, low-income people are dramatically more likely to delay or forego health care due to cost than higher income people. Low-income people are also much less likely to have access to paid leave or to job protection while taking leave.

Delaying or foregoing care can also lead to higher health care expenses. When the lack of paid leave forces people to put off or skip the treatment they need, they may face higher costs for less effective care when they eventually get care. Rising health care costs are already putting pressure on household budgets, and medical debt makes up the majority of consumer debt in collections. Continued failure to invest in paid leave pushes health care costs in the wrong direction.

Everyone deserves access to timely, effective health care to improve their health or even save their life. But without paid leave, too many Americans are not able to get the care they need when they need it—with profound consequences. Paid leave for all is the investment America needs in the future it deserves.

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The Women’s Initiative develops robust, progressive policies and solutions to ensure all women can participate in the economy and live healthy, productive lives.

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