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How lack of paid sick leave is complicating U.S. virus response

As COVID-19 spreads to communities nationwide, financial and logistical concerns about its impact are rising. Among the major questions are whether employers will require workers to take unpaid sick leave, and who will pay for potentially significant medical bills. William Brangham talks to Georgetown University’s Sabrina Corlette and Joseph Leitmann-Santa Cruz of Capital Area Asset Builders.

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  • Judy Woodruff:

    As the COVID-19 virus spreads to communities around the country, state and local officials are warning that a number of measures may have to be taken to prevent the outbreak from getting worse.

    But, as William Brangham explains, some of those steps, such as quarantines, could add even more economic stress.

  • William Brangham:

    One big concern is whether employers, schools, and communities will require workers to take unpaid sick leave.

    Roughly 25 percent of American workers have no sick days. In some lower-wage industries, that percentage is significantly higher. Another concern, those who get sick and need care could face hefty medical bills.

    We look at this with two people who know these issues well.

    Joseph Leitmann-Santa Cruz is executive director of Capital Area Asset Builders. They are a nonprofit that works with low-and moderate-income families in the Washington, D.C., region. And Sabrina Corlette, she is the co-director of the Center on Health Insurance reforms at Georgetown University.

    Welcome to you both.

  • Joseph Leitmann-Santa Cruz:

    Thank you.

  • Sabrina Corlette:

    Thank you.

  • William Brangham:

    Joseph Leitmann-Santa Cruz, to you two — first.

    People are being told, if you're sick, if you feel unwell, if you have any symptoms of coronavirus, stay home. Now, that's great public health policy. That's good advice. But, depending on your job, that might not be such an easy thing to do.

  • Joseph Leitmann-Santa Cruz:

    It is.

    And one of the biggest challenges is, when we focus on low-wage workers, right, 43 percent of all workers throughout the United States are low-wage.

    And, primarily, they're in the service industry that requires in-person engagement. So, for those individuals who are either driving an Uber, serving coffee, making food, we cannot ask them to work from home. So it's imperative that we look at a wakeup situation because of coronavirus as to how the economic system is set up to enable low-wage workers to also have an equitable opportunity at prosperity.

  • William Brangham:

    Because there's a clear conflict there, that if your governor or your public health official is saying, we need you, if you feel sick, to not go to work, but your boss saying, I need you on your shift, if you don't come, you might lose your job.

  • Joseph Leitmann-Santa Cruz:

    And, most importantly, that family's finances need for the individual to be generating income.

    What's really amazing is that 40 percent of all households in the United States are considered liquid asset poor. This means that their…

  • William Brangham:

    Liquid asset poor.

  • Joseph Leitmann-Santa Cruz:

    This means that they're only one economic disruption away, like not being able to show up for work, from an economic disruption.

    That could lead into eviction, homelessness, foreclosure, bankruptcy. So the system is currently not set up to enable a low-wage worker to have the ability to show up to work even in a situation like coronavirus.

  • William Brangham:

    Sabrina Corlette, let's talk about for people who are uninsured. Let's say they see these acknowledgments by their governor or public health officials, saying, if you have symptoms, go to the hospital.

    If you don't have insurance, and you go to the hospital, what happens to you?

  • Sabrina Corlette:

    Right. So we have in this country close to 30 million people who don't have any health insurance at all. And a lot of them are in the same industries and fields that Joseph was just talking about.

    They are our service workers. And these are folks who, if they don't have insurance coverage, they're less likely to go to the doctor if they get sick or go to the emergency room if they really, really need care. And they're…

  • William Brangham:

    Because of fear of a huge bill.

  • Sabrina Corlette:

    Because of fear of the costs.

    So, even though the coronavirus test itself may be covered by the government, that cost, there's the cost of going to the E.R. or seeing a doctor. And that can be hundreds or, in some cases, even thousands of dollars.

  • William Brangham:

    And again, if you think of it from a public health perspective, the idea that people being afraid of going to get a test that might be crucial for our ability to control an outbreak, that might be hindered by the fact that they don't have insurance.

  • Sabrina Corlette:

    Absolutely.

    And it's true not just for folks who are uninsured, but a lot of people who have insurance and even gold standard employer-based insurance will have high deductibles. And they will also face high out-of-pocket costs.

  • William Brangham:

    Do we have any sense — I understand that the president has signed this big $8 billion coronavirus piece of legislation to try to offer aid to states and to researchers and all of that.

    Are there any protections for people who are uninsured to help them defray some of these costs?

  • Sabrina Corlette:

    Not in the bill that just passed Congress this week.

    I think it's certainly possible that Congress could appropriate some money to help compensate hospitals and providers for treating the uninsured. But, right now, actually, a lot of the folks who are being treated in hospitals are on Medicare, because they're older.

    And so the government is probably picking up the tab in that respect.

  • William Brangham:

    Joseph, back to you.

    Your organization advocates for low-wage workers, and that's what we have been talking about here. But a mandate for an employer to suddenly allow their workers to stay home from work, that can have a huge cost on an employer as well, right?

  • Joseph Leitmann-Santa Cruz:

    It's a situation where I put two hats on right now, the advocate and the CEO of my nonprofit.

    The ability to cover the expenses associated with any kind of a worker, whether it's low-wage, or high-wage, is one where there is really a significant dependency on the ability of that business or that entity to generate income.

    If a business is not open, it will not get clients to come and spend money. A nonprofit organization like ours is not able to provide the services for which we are compensated, we cannot pass on that income to our employees.

    So there is no magic formula. But it's extremely necessary for us to remember that, to the best of my knowledge, that United States is the only industrialized economy without a national policy or national law that provides for sick — paid sick days.

  • William Brangham:

    And, Sabrina, would you imagine that there's going to be — given this urge that we need people to get care when it's required, but yet there might all be these concerns, do you see any sort of federal or state action that could remedy this concern?

  • Sabrina Corlette:

    Well, we are seeing some states take action. So, for example, New York, California, Washington state are requiring private insurance companies to cover the cost of the test, including the doctor's visit or hospital visit, without any cost-sharing, so you wouldn't have to face a deductible or something like that.

    But for the uninsured, we really don't have a system right now that works for those folks.

  • William Brangham:

    Really, really important issues.

    Sabrina Corlette, Joseph Leitmann-Santa Cruz, thank you both very much.

  • Joseph Leitmann-Santa Cruz:

    Thank you.

  • Sabrina Corlette:

    Thank you.

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