Preemption or Premonition?

If allowed to mandate paid sick leave, counties could prevent up to 10% of deaths from external causes among working adults.

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Read Time: 2 minutes


Paid sick leave: workers desire it. More than a dozen states require it. But lawmakers concerned about the policies’ affordability for small businesses have kept a nationwide PSL mandate at bay. Is paid sick leave necessary?

Since there is no federal requirement for private employers to pay employees for missed work during short-term illness, paid sick leave is left to states to require, allow, or even obstruct. Twenty-three states now “preempt,” or prohibit, localities from requiring private businesses to establish paid sick leave policies.

Without PSL protection, workers are more likely to forgo needed medical care than workers with PSL. Douglas Wolf and his team used 21 years of state and county-level data to estimate how state preemption laws contributed to death rates among working-age adults. The mortality data came from death certificates that identified cause of death and county of residence among central metropolitan counties across 13 states.

First, the team estimated the association between paid sick leave policies and death rates. They found that mandating paid sick leave could reduce deaths among working-age adults from multiple causes, including suicide and homicide. If counties that had PSL preemption laws had instead been free to adopt PSL mandates, homicide mortality would have decreased by anywhere from 3% to over 10%, on average.

Next, the researchers estimated how many deaths could have been avoided had local policy expansions not been quashed by preemption laws. In other words, how many deaths could be attributed to state preemption laws?

The graph shows the estimated relationship between hours of mandated paid sick leave and predicted deaths in 21 counties that would have mandated paid sick leave if they weren’t impeded by preemption laws.

Without paid sick leave, all 21 counties sit at 0 mandated PSL hours. But if their preemption laws were lifted, death rates in those counties would fall as mandated hours of paid sick leave increase. If allowed to mandate paid sick leave, counties could prevent up to 10% of deaths from external causes among working adults.

Paid sick leave policies, if enacted, look like they could save lives.

Databyte via Wolf, D., Montez, J., & Monnat, S. US state preemption laws and working-age mortality. American Journal of Preventive Medicine, 2022.