Association for Public Policy Analysis & Management

The United States is one of only two OECD countries without a federal mandate requiring employers to provide workers with access to paid sick leave (PSL). Though it is not uncommon for firms to offer employees PSL in the absence of a federal or local mandate, estimates suggest that nearly 40 percent of private sector workers in the United States currently lack access to paid leave. Despite no national PSL mandate, between 2006 and 2014, San Francisco; Washington, DC; Seattle; New York City; Portland; Newark; and New Jersey City adopted PSL requirements at the municipal level, and Connecticut became the first state to enact PSL legislation.

In this paper, we evaluate the impact of these PSL mandates on labor market outcomes, the utilization of health care services, and health behaviors for private sector workers in the U.S. By exploiting geographic and temporal variation in PSL mandate adoption, we compare changes in outcomes for workers in counties affected by a PSL mandate to changes for those in counties with no mandate. Additionally, we rely on within-county variation in the propensity to gain PSL following a mandate to estimate policy effects for workers most likely to acquire coverage.

Our results indicate that PSL mandates lead to increased access to PSL benefits, especially for women without a college degree. Specifically, we find that mandates lead to a 12 percent increase in PSL access compared to counties with no such mandate in place and a 37 percent increase in PSL access for women with no college education. After establishing that workers in counties affected by a PSL mandate exhibit higher rates of PSL access than those in non-adopting counties, we focus on changes in labor market outcomes, health care utilization, and health behaviors. These findings suggest that PSL laws reduce average weekly hours worked and private sector employment, but appear to have no effect on job tenure or labor force participation. PSL mandates are associated with sizable reductions in emergency department utilization and increases in general practitioner visits. We find that ED utilization declines by nearly 23 percent for counties that adopt PSL mandates compared to our control counties and that visits to a general practitioner increase by 20 percent for those who are most likely to gain PSL access after mandate adoption. Finally, we examine effects of PSL mandates on alcohol and tobacco consumption and present suggestive evidence that PSL mandates lead to more days binge drinking.