The U.S. is the only high-income country without any national paid medical leave program, according to Sen. Kirsten Gillibrand (D-NY), who is proposing legislation based on programs in New Jersey and California to provide leave insurance.

Since 1993 American workers have been legally entitled to take time off to care for sick kids or parents or deal with their own serious medical problems, but they do it on their own dime. That could change if Sen. Kirsten Gillibrand, D-N.Y., gets her way. Last week Gillibrand proposed legislation to create a federal insurance program that would use a small payroll deduction to fund paid family and medical leave insurance. Based on successful experiments in New Jersey and California, the program would replace 66 percent of income for bona fide emergencies, subject to a monthly maximum. "The Family and Medical Leave Act was an important first step in changing our culture," said Vicki Shabo at the National Partnership for Women & Families, "but only 60 percent of workforce covered and most people can't afford to use it." The National Partnership spearheaded efforts to pass the Family and Medical Leave Act of 1993 and now leads a large coalition supporting Gillibrand's bill. The bill's supporters note that the U.S. is the only high-income country that lacks a paid leave program. They also argue that everyone is better off when workers can remain attached to the workforce through hard times. On the other hand, skeptics fear that a government insurance program will quickly become another federal entitlement, prone to abuse by employees who game the system to get paid leave as a free benefit. "Nations that have tried that find that when you get paid leave you all of a sudden find you are sick a lot more often," said James Sherk, a senior policy analyst with the Heritage Foundation. Supporters believe the bill is narrowly drafted enough to avoid the pitfalls, and they point to New Jersey and California, both of which proved to be cheaper and less subject to abuse in practice than was supposed beforehand. The Gillibrand proposal is not a paid sick leave program, notes Sarah Jane Glynn at the Center for American Progress. The proposal requires five days of unpaid absence before benefits kick in, she said, and is thus "intended for serious health conditions that require a larger chunk of time off." And because it would allow 60 work days in a given year, the bill would also not cover long-term debilitating conditions. For those, Glynn said, Social Security Disability is a better fit. While the 1993 FMLA has been a boon to many, Shabo said, most workers simply can't afford to take time off without any income, especially at times when family finances are already stressed. Income support is critical for lower wage workers, Shabo adds, especially allowing women to stay in the workforce and keep off public assistance. Research said that when women have paid leave they are far more likely to be working 9-12 months after the emergency and have higher wages than those who do return to work without paid leave: "Paid leave leads to more financial independence and less public assistance," she said. Paid leave also allows men to take a greater role in family caregiving without jeopardizing their role supporting the family, Shabo said, and fathers taking leave to care for family members has increased exponentially in California since its paid leave program began. In 2002 a Swedish government report found that Swedish sick leave was double the average of other European countries. The New York Times reported that in Sweden "paid sick leave averaged nearly 25 days, up from 14 days in 1998. An average of 430,000 Swedish employees, 10 percent of the country's work force, is on sick leave at any given time." Over the past decade, Sweden tightened its paid sick leave rules repeatedly, and absentee rates have fallen significantly, according to a report by the European Working Conditions Observatory. And it's not just paid leave. Sherk said that the FMLA, which became law in 1994, suffers widespread abuse from employers who want to get out of undesirable shifts, or take an impromptu vacation. Hospitals, he said, have had problems with nurses avoiding work on holidays, forcing more senior nurses to scramble to fill gaps. He points to a 2006 survey by the U.S. Labor Department, in which employers reported widespread abuse of the FMLA. "The major complaint employers have is 'chronic conditions,' like back pain," Sherk said. "And if you know what you are doing you just say 'ouch' and qualify for a chronic condition. And once you have a chronic on record, you can say it's hurting whenever you want." Glynn disputes Sherk's skepticism. She argues that the 2006 survey was a self-selected group of employers who had a beef with the system. A much more systematic study completed by the Labor Department in 2012 found abuse to be extremely rare, she said. Likewise, the track record of family and medical leave insurance in California and New Jersey - both of which user employer payroll deductions - has been very positive. New Jersey has even adjusted its payroll deductions downward because claims have been lower than expected. In California, surveys show employers are have not found the system disruptive. Asked if they were aware of instances of abuse, 91 percent of California employers said no, identical to the 91 percent who said that the system had no effect or a positive effect on profitability, performance and morale, in a survey conducted by the Center for Economics and Policy Research.%3Cimg%20src%3D%22http%3A//