Closing the Gaps on Paid Medical Leave

February 5 marks the 33rd anniversary of the passage of the Family and Medical Leave Act (FMLA), a landmark piece of federal legislation that has provided some level of basic security for many millions of workers. It is also grossly inadequate, and falls well short of what workers in other countries are provided.

The FMLA guarantees 12 weeks of unpaid leave due to illness or major life events like the birth of a child. But the availability of that leave depends on a number of factors, including a worker’s tenure at a job and the size of the employer’s workforce. As a result of eligibility rules, approximately 44 percent of the workers are ineligible for this unpaid leave. This gap impacts low wage workers: Data from the Bureau of Labor Statistics show that, as of 2025, about one-fifth of workers in the bottom 10 percent of wage earners do not have access to unpaid leave – compared to about 5 percent of the highest 10 percent of earners.

Even When Available, Unpaid Leave is Inadequate

Of course, being able to access unpaid leave is only a start. In most of the developed economies, workers are granted a range of paid leave options. The Organization for Economic Cooperation and Development (OECD) finds that the United States remains an extreme outlier, granting workers no guaranteed time off for medical leave, and none for maternity or paternity leave to care for the mother and bond with the newborn. The US is one of just six countries in the world without any form of national paid leave.

What the US does have, though, is a very limited patchwork system of state programs to help fill that gap. WIth Minnesota and Maine launching their own leave programs this year, there are now 13 states plus the District of Columbia that offer paid family leave of some sort. Still, this remains wholly inadequate; as the National Partnership for Women & Families estimates, Almost three-quarters (73 percent) of working people do not have access to paid leave. And the provisions in each state’s leave policy vary considerably  with respect to the maximum time available, worker eligibility requirements, and definition of family.

As with unpaid leave, the availability of paid leave in its current form is skewed to high earners; as the Department of Labor recently noted, only 27 percent of private sector workers had access to paid family leave, but “for lowest wage workers, who are predominately women and workers of color, 95 percent have no access to paid family leave.”

A more sensible and equitable solution would be a national paid leave system. In 2021, a proposal for a 12 week medical and family leave program was introduced as part of the Biden administration’s Build Back Better legislative package. It was eventually trimmed to four weeks, and then dropped entirely. A similar proposal surfaced in Biden’s 2024 budget plan as well. The need for paid leave isn’t going away, and it remains broadly popular with voters. Given that many Republican political leaders have been lately stressing the need to create policies that will support families, paid family leave should be on the table.

This first appeared on CEPR.

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