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Monthly updates to Congress on RAND's work in health policy

Few Families with Chronically Ill Children Are Benefiting from Paid Family Leave Program

Prom couple

Paid family leave has garnered interest on Capitol Hill over the years. Currently there is no nationwide family leave law. In this Congress, several pieces of legislation have been introduced and one bill, which provided paid family leave specifically for federal employees, passed the House in June. As interest grows, more and more states are implementing their own paid family leave programs. In 2004, California became the first state to create a paid family leave program. About 18 months later, however, few parents of chronically ill children were using the program, according to an article by Mark Schuster and colleagues, published in the September 3, 2008, issue of the Journal of the American Medical Association. California’s Paid Family Leave Insurance Program, which is funded by employees themselves through a payroll deduction, offers six weeks of paid leave each year for most part-time and full-time employees in the state. The program provides up to 55 percent of a worker’s salary (with a maximum weekly benefit of $917 in 2008) for those who take time off from work to care for a child, parent, or spouse. The study found that only 5 percent of parents of children with serious chronic illnesses had used the program, despite paying into it through payroll withholdings, and only 18 percent of parents were even aware that the program exists. Before the law, 41 percent of parents did not miss work despite believing that their child’s illness required it; this percentage was unchanged after the program had been in place for about 18 months. Similarly, the percentage of parents who took leave and the amount of leave they took remained unchanged. Reasons cited by parents for not taking more time from work included concern over loss of income, fear of job loss, and potential damage to careers. The authors observe that, while California workers must be notified about the paid family leave program when they start a job, there has been no sustained effort to educate the public about the program.

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Q and A with Mark Schuster

Mark A. Schuster

Mark A. Schuster is Senior Natural Scientist at RAND and Chief of General Pediatrics and Vice Chair for Health Policy Research in the Department of Medicine at Children's Hospital Boston/Harvard Medical School. Prior to moving to Boston, he held similar positions at UCLA and was Director of Health Promotion and Disease Prevention at RAND, where he held the RAND Distinguished Chair in Health Promotion. He also founded and led the UCLA/RAND Center for Adolescent Health Promotion, a community-based participatory research center funded by CDC. Dr. Schuster received his BA summa cum laude from Yale, his MD from Harvard Medical School, his MPP from the Kennedy School of Government at Harvard, and his PhD from RAND Graduate School.

Why do you think public awareness of this program is low in California?

There are only limited requirements for the government or employers to inform workers about the new program. Most employees seem not to have noticed the relatively small increase in their payroll deduction, so they just don't know that they are paying for this benefit.

How is the California family leave insurance program funded?

The program is funded through a state payroll deduction that averages $1 per week for most workers. So funding comes entirely from employees, not from the state's general revenues. Yet many parents who were eligible for reimbursement because they took leave to care for sick children never knew they were entitled to file a claim for money from a fund that they had paid into. It's also likely that others who didn't take leave because they couldn't afford it might have taken it if they had known about the benefit.

What do your results imply for similar family leave proposals under consideration in other states and in Congress?

If states or the federal government pass paid family leave legislation and want families to use it, they should consider building in mechanisms for informing the public. They could institute a media campaign, as they typically do with other new programs; they could establish an annual notification policy for employers and require prominent postings at work; and they could list the deduction for the program as a separate line item on employee paychecks. Other areas that policymakers could explore include what percentage of their pay people should receive and whether employees should be protected from being fired for taking leave—the federal Family and Medical Leave Act provides such protection for some employees, but California's law does not.

Do you have further research under way on this topic?

Yes. A follow-up article will provide more detail on parents' assessments of how family leave affects their children's health and their job performance. Our team has also expanded our research to examine parents with newborns, who are also covered by California's law. In addition, we hope to develop programs that use clinical settings to teach parents about leave options.


Lindsey Kozberg
Vice President, Office of External Affairs

Shirley Ruhe
Director, Office of Congressional Relations

Kristy Anderson
Health Legislative Analyst

RAND Office of Congressional Relations
(703) 413-1100 x5395


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