In sickness and health: the influence of paid leave on employee commitment

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George Mason Associate Professor of Health Administration and Policy discusses the importance of job-protected paid leave.

Priyanka Anand
Priyanka Anand, PhD

According to surveys conducted by the U.S. Department of Labor in 2018, only 56 percent of Americans have access job-protected leave afforded by the Family and Medical Leave Act (FMLA), leaving 44% of Americans ineligible for this coverage because they haven’t been employed long enough or their workplace is too small.

The FMLA grants employees the ability to take an unpaid leave of absence to care for loved ones in the event of an unforeseen illness or disability. Because many Americans cannot afford to hire professional care providers when a family member falls ill or has a disability, they are often left with the responsibility of providing the care themselves, which is referred to as informal care. For this reason, many people are forced to reduce hours working a paying job to attend to their informal care duties, causing severe loss in income and risking losing their job entirely. 

Associate Professor in the Department of Health Administration and Policy at George Mason University Dr. Priyanka Anand’s research centers on social safety net programs with a particular focus on disability policy and paid leave. Her most recent research, titled “The role of paid family leave in labor supply responses to a spouse’s disability or health shock,” was featured in the 2022 Economic Report of the President.

Anand’s research provides insight into the influence of paid leave on labor supply decisions and labor force participation. She shares her knowledge of how health shocks affect families and disrupt employment and is available for further comment.

What is difference between FMLA, parental leave, and paid family or caregiving leave?

The Family and Medical Leave Act (FMLA) was established in 1993 to guarantee 12 weeks of job-protected leave for individuals who are away from work due to medical conditions. FMLA is most known for maternity leave, but also covers long and short-term health conditions and caring for a sick or disabled family member. Job-protected leave, like FMLA, means their job will be available when they return from leave; however, employers are not required to compensate employees while on leave.

Parental leave can be paid or unpaid depending on an individual’s place of employment. Parental leave is given on a company-by-company basis and is not guaranteed in the United States. Paid family or caregiving leave, on the other hand, allows employees to take compensated leave to care for a family member experiencing a health condition. 

What factors should someone consider when deciding whether to take time off to care for a family member?

When faced with the prospect of caring for a family member, individuals should closely consider their options and understand the potential outcomes of each. My research provides a framework of three pathways people generally take after a family member’s health shock. The first is to continue working and either provide informal care in addition to working or rely on formal care, which can be costly. The second is to take a short period of leave (either paid or unpaid) and eventually return to work. The third pathway is leaving the workforce entirely to provide full-time informal care.

Individuals oftentimes have to choose between the lesser of evils when faced with what to do about a loved one’s care, all of which result in some form of financial consequence both in the household and on the broader economy. The availability of paid leave can play an important role in this decision as well.

What would the addition of state or federal paid leave policies mean for American workers?

In states that have paid leave policies, the length of paid leave ranges from six to 12 weeks, but most states do not have any paid leave policies at all. In April 2021, President Biden proposed the American Families Plan which would have federally ensured all workers in the U.S. are guaranteed 12 weeks of paid family leave. Unfortunately, it did not pass through Congress in the Inflation Reduction Act.

The availability of paid leave and job protection is designed to offset the financial burden of the health shock. Paid family leave allows workers to maintain a steady income while finding a permanent solution for their long-term caregiving needs, rather than choosing between losing earnings or paying for formal care. The ultimate goal of paid family leave is to alleviate the emotional and financial burdens that come hand-in-hand with a family member experiencing an illness or disability, allowing the individual to maintain their participation in the labor force and improve their overall well-being.

In addition to the cost-saving benefits, paid family leave policies have the potential to alleviate gender workforce disparities given that the burden of caregiving often falls onto women.


Priyanka Anand is an associate professor in the Department of Health Administration and Policy at George Mason University. She is a renowned researcher whose work includes estimating the effect of the ACA Medicaid expansions on federal disability insurance applications, examining the relationship between rising health insurance costs and employee compensation, and analyzing the time use of people with disabilities. Anand’s novel findings on paid family leave, which are in the 2022 Economic Report of the President and published in the Journal of Health Economics, identify implications for the future of federal paid leave policies.

For more information, contact Michelle Thompson at 703-993-3485 or

About Mason

George Mason University, Virginia’s largest public research university, enrolls 39,000 students from 130 countries and all 50 states. Located near Washington, D.C., Mason has grown rapidly over the last half-century and is recognized for its innovation and entrepreneurship, remarkable diversity, and commitment to accessibility. In 2022, Mason celebrates 50 years as an independent institution. Learn more at

About the College of Health and Human Services

The College of Health and Human Services prepares students to become leaders and to shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. The College enrolls more than 1,900 undergraduate and 1,300 graduate students in its nationally-recognized offerings, including 6 undergraduate degrees, 13 graduate degrees, and 6 certificate programs. The college is transitioning to a college of public health in the near future. For more information, visit