Comprehensive, universal Paid Family and Medical Leave (PFML) programs are powerful tools to safeguard and improve the economic well-being and overall health of workers and their families. Research shows that PFML improves health for both mothers and infants, reduces poverty and economic insecurity for low-income families, and increases labor force participation rates for mothers for up to five years after the birth of their child. In states that do not have a PFML program, workers lose an estimated $34.3 billion annually in wages due to leave-related absences from work, including $18.8 billion lost by women. 

PFML programs also benefit employers and the broader economy, in part by improving recruitment of talented workers, especially among small businesses, reducing turnover, and increasing worker productivity. The National Partnership for Women and Families estimates that U.S. women’s lower labor force participation—due in part to a lack of paid leave—has cost the broader U.S. economy more than $6.7 trillion in economic activity over the last decade. This is economic activity the U.S. economy would have experienced if American women’s labor force participation rates were the same as those of women in Canada.

Despite PFML’s clear benefits, the U.S. is the only OECD country that does not provide a national paid family and medical leave program—leaving it to states to ensure workers are protected when they need to take time off from work to care for themselves or a family member. 

Lawmakers in 13 states and D.C. have met this responsibility by passing comprehensive paid family and medical leave programs that guarantee coverage. Lawmakers in 10 other states have chosen weaker, much less effective voluntary approaches that defer to employers, leaving many workers uncovered. Vermont and New Hampshire, for example, have implemented public-private voluntary paid leave models where the state contracts with private insurance companies to provide paid leave for public-sector workers and private-sector employers may opt in voluntarily.1 

Across the South, Alabama (2023), Arkansas (2023), Florida (2023), Kentucky (2024), South Carolina (2024), Tennessee (2023), Texas (2023), and Virginia (2022) have adopted voluntary private insurance models of paid leave that allow private insurance companies to sell insurance policies directly to employers and/or workers themselves. 

While the private insurance model has been embraced by the insurance industry—the National Conference of Insurance Legislators adopted a voluntary paid family leave model bill in 2022 at its annual meeting—it fails workers and families. Not only do these programs fail to require employers to provide any coverage to their workforce, but the relevant laws in these states also typically provide few, if any, requirements for what types of leave are covered, the duration of coverage, or wage replacement rates.

This approach to paid family and medical leave provides less coverage, provides it for fewer workers, increases already large disparities in access, and is likely to be more expensive than comprehensive state PFML plans. 

Less coverage 

State PFML programs typically provide workers with 8–12 weeks of paid, job-protected leave to bond with a new child (birth, adoption, or foster), to care for themselves or a family member with a serious illness or injury, or for military caregiving and exigency leave. Wage replacement rates are typically at 90% or higher, at least for low-wage workers, in most states with a paid leave program, including California, Colorado, Connecticut, Minnesota, Oregon, Washington, and the District of Columbia. Maine and Maryland will also pay out at this rate when they begin paying benefits later in 2026. 

Because voluntary models do not require employers to provide coverage for their workers, there is no guarantee that they will. And when employers do purchase paid leave insurance for their workforce, they are unlikely to provide the same level of coverage as comprehensive state programs. The amount of leave provided, the wage replacement rate, and even what life events are covered depend on the employer and/or the insurance company. The New Hampshire plan, which does provide details on requirements for paid leave coverage, only requires 6 weeks of paid leave with wage replacement of just 60%. 

Finally, in direct contrast to comprehensive, universal state paid leave programs, it is unclear how voluntary insurance models of paid leave could provide a job guarantee for workers taking paid leave. In the public-private model offered in New Hampshire, workers are not provided with job protection but may qualify for protection under the federal Family and Medical Leave Act (FMLA), so long as they meet the requirements of FMLA (i.e., they must work at a firm with 50+ employees, and must have worked for the employer for 1,250 hours over the preceding 12 months). 

Covering fewer workers

An estimated 46.2 million workers—almost one-third (32%) of the private-sector workforce in the U.S.—are eligible for coverage under one of the 14 PFML programs in the country. That leaves tens of millions of workers without a guarantee of paid time off when they need to provide for their family’s needs. This reflects, in large part, the lack of a federal universal, comprehensive PFML program and the failure of most states to implement such a plan. Unfortunately, when participation is voluntary, many employers are unlikely to offer this benefit to their workers. 

For example, in the New Hampshire voluntary program, public-sector workers are automatically covered, and private employers and individual workers can voluntarily participate. After three years, just 2.3% of private-sector workers are covered by this PFML plan through their employer. And in the eight states that authorize private insurance paid leave, researchers are unable to determine whether employers are actually purchasing insurance coverage for their workers, but it appears that few insurance companies are even selling policies in these states. It is therefore not surprising that fewer than 1 in 4 workers are covered by PFML through their employer in most of these states, including Alabama, Arkansas, Florida, South Carolina, and Tennessee. In contrast, the 14 state PFML programs cover 93% of all workers in their jurisdictions. 

Increasing disparities

It is not just that fewer workers are covered by voluntary paid leave models, but coverage rates vary dramatically by income, occupation, race and ethnicity, and other characteristics. According to the Department of Labor, 95% of the lowest-wage workers—mostly women and workers of color—lack access to paid family leave. Many of these workers are in occupations with low access to paid leave, including jobs in leisure and hospitality (8%), accommodation and food service (7%), and transportation and warehouse work (9%). 

American Indian/Alaska Native (18%) and Black (23%) workers have some of the lowest PFML coverage, while Asian American, Native Hawaiian, and Pacific Islander (55%) and Hispanic (41%) workers have some of the highest coverage rates. Racial differences reflect, in part, differences in where workers live. For example, more than half of the Black population lives in one of the 16 Southern states or the District of Columbia, where only two states and D.C. have a state paid leave program.

Higher costs

In states where PFML is voluntary, there is little transparency, especially related to costs. We know from the private health insurance model, however, that introducing a profit motive into the provision of care is a terrible way for policymakers to provide workers with the protection they need at affordable costs. A profit-seeking insurance company is going to look for ways to reduce its costs and maximize profits; this inevitably means seeking to reduce payouts, whether through claim denials or other means. There is no scenario in which the profit-seeking model results in both high-quality, comprehensive leave coverage and low costs for workers, employers, or the public. 

In New Hampshire, for example, only one insurance company bid for a contract to provide paid leave benefits, and its estimated rates were generally higher than the payroll contributions in states with PFML programs. 

Further, an insurance industry stakeholder expressed concern about the lack of incentives for private employers to participate in these plans. In both the New Hampshire and Vermont cases, they reported that the models were unsustainable because most employers did not participate in the plans and individual workers whose costs are capped by the state plans would only participate when they anticipated needing coverage—meaning that the insurance pools would never be adequately financed. 

A better model exists

In recent years, challenges facing workers with care responsibilities have rightfully garnered greater public attention, especially in the wake of the COVID-19 pandemic. Many policymakers have taken notice. Unfortunately, in some states—frequently those that have long opposed strong worker protections, a robust safety net, and workplace regulations—lawmakers have opted for voluntary models of paid family and medical leave that are fundamentally flawed. 

Voluntary models allow businesses to decide whether their workers should be paid when they need to take time to care for themselves or their families. Without mandatory coverage, too many workers will not have access to the leave they need, and this is especially the case for those workers who need paid leave the most. 

Instead, we should follow the model of proven success from 13 states and D.C. that have implemented comprehensive PFML programs, including some that have improved programs over time, incorporating lessons and best practices from other states. These programs provide more inclusive coverage for personal illness or injury, bonding with a child, caring for an ill or injured family member, and military deployment.

Universal programs also provide coverage for more workers, including employees, both full- and part-time, both public- and private-sector workers, and in some cases, independent contractors are allowed to opt in. The best programs provide workers with 12 weeks of job-protected leave—i.e., workers are guaranteed their same job or a substantially similar job with comparable pay and benefits when they return from leave and have wage replacement rates of at least 80% of the state median and 100% for low-wage workers. 

These programs have been proven to expand access at a reasonable cost and with a broad range of benefits for workers, businesses, and states overall.

These are benefits that voluntary private insurance models have failed to provide in part because the goal of private insurance is to make a profit, not to ensure the overall well-being of workers and families or their communities. 

---

1. Lawmakers in New Hampshire introduced a new bill in February 2026 that will extend paid family leave to a full comprehensive state paid leave program, if it is enacted.