Not All Paid Leave Policies Are Equal

Over the past 16 years, I’ve worked with advocates and policymakers across the country to expand U.S. workers’ access to paid family and medical leave, and the movement has made undeniable progress. Laws have been enacted in more than a dozen states across the country to fill market gaps as policymakers and the public have increasingly realized that the status quo—where only 27 percent of workers have paid leave through their jobs to care for a child or loved one—is inadequate and harmful. Left to the market without government intervention, workers’ access to paid leave is highly unequal: workers who are paid lower wages are significantly less likely than higher-paid workers to have access to paid leave.

​Relying solely on employers’ paid leave policies, without any public intervention, creates difficult or impossible choices for many working people and families who need to provide or receive care but also cannot afford to jeopardize their financial stability. This gap also hurts small businesses, hindering their ability to compete for talent and protect their bottom lines. State experimentation with comprehensive, universal paid leave policies has demonstrated the value of paid leave policies for workers and families, businesses, and the economy.

​Eager to understand the various state approaches to paid leave, researchers at the National Partnership for Women & Families and I conducted a new investigation and analysis and published a new report, Do Market Options Provide Time to Care? Evaluating Private Insurance-Based Approaches to State Paid Family Leave Access.

We examined the various ways some states have addressed paid leave gaps. Specifically, we focused on the newer pathways taken in states with more conservative political leaders, approaches that rely on private insurance products without any requirements for employers or the state to provide coverage.

​We reached out to every state agency involved in public-private partnerships and in authorizing the sale of private insurance, sent public records requests to those states, and examined insurers’ public filings with state insurance regulators. We also spoke with experts from companies currently offering paid leave products and those who have a background in the insurance industry, who very helpfully shared their insights and expertise with us.

​Our findings underscore that not all approaches to paid leave are equally effective; there are more effective and less effective ways to guarantee workers’ access to paid family and medical leave. These approaches differ in requirements related to transparency, public education, and the quality of benefits.

To better understand how these differences are impacting the efficacy of paid leave legislation, we analyzed two models that have emerged in states over the last few years:

(1) a private sector incentive approach adopted in New Hampshire in 2021 and Vermont in 2022. In these states, state employees form the base of a voluntary insurance pool, and employers and employees can opt in to coverage; and ​

(2) an authorization approach that eight states (Alabama, Arkansas, Florida, Kentucky, South Carolina, Tennessee, Texas, Virginia) adopted between 2022 and 2024. In these states, the legislature has authorized state insurance agencies to authorize the sale of paid family leave insurance products that complement short-term disability insurance (which addresses paid personal medical leave). ​

Our research makes clear that these newer, market-based approaches are not addressing paid leave gaps.

​We found that, in the New Hampshire and Vermont models, only a tiny share of the workforce is covered even when public sector workers’ participation (which is automatic rather than voluntary) is taken into account. What’s more, because individuals whose employers do not purchase policies have a right to buy into the program on their own, there’s evidence of adverse selection. This means that the individual workers who are most likely to need to use the program—and for whom prices are capped by statute—are disproportionately those who purchase and use it. This may make the product untenable for insurers to sell over time, as the need to raise prices makes the product unaffordable for employers.

In the eight states that have authorized the sale of insurance, it is extremely difficult to find information about whether insurers have sought to sell these policies, and impossible to learn systematically whether employers are purchasing policies to cover their workers. The evidence we collected suggests that few insurers are selling these products, and it is highly likely that very few employers are purchasing them to cover their workers. We also lack information about the quality and costs of these policies.

​If the goal of policymakers is to balance workers’ and families’ health and economic security with stability and cost-savings for businesses, it’s clear that the older, tested, and researched comprehensive, universal approach to paid leave that states have been innovating with and improving on for more than two decades is the better model.

Since 2002, 13 states and the District of Columbia have created comprehensive, universal approaches to guarantee workers in their states have access to paid time to care when a child is born or adopted, a loved one needs care, or a serious personal health issue requires attention. In these states, the vast majority of people with a modest recent work history can access paid family and medical leave when needed. Paid leave is available at a predictable, set cost to workers and employers with a well-defined benefit structure. State agencies are legally obligated to ensure fair access to benefits and, in most places, to provide educational materials and applications to the public. They follow a clear process for determining claims, issuing decisions, and providing appeal rights with due process protections.

Eleven of these jurisdictions (California, Colorado, Connecticut, the District of Columbia, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, and Washington) are delivering benefits now, and three of the four newest programs will begin delivering benefits in 2026 (Delaware and Minnesota in January and Maine in May). Maryland’s program will begin covering workers in January 2028.

​Additional states, including Hawaii, New Mexico, Pennsylvania, and Virginia, are well-positioned to adopt new comprehensive, universal paid leave programs in the near or middle-term future, and—if successful—would deliver paid leave to workers in those states before the end of this decade.

In most of these states, there is still a role for the private market and private insurers. In fact, insurance industry stakeholders shared that this approach incentivizes competition because there is a ready-made market, whereas in authorization states, substantial education of insurance sales representatives and employers is required to build a market.

It’s exciting to see lawmakers on all sides of the aisle begin to evaluate and address paid leave. I’m hopeful that those serious about expanding access to paid leave in meaningful ways will examine the evidence and recognize the benefits of comprehensive, universal social insurance approaches. This model delivers the affordable, predictable coverage that workers, families, and businesses need.