(Bloomberg) -- Three decades after the US adopted a policy that let people keep their jobs while taking time off for an illness or new baby, almost half of US workers aren’t eligible, and advocates in individual states are still struggling to make sure that those who do take leave can also get paid.

In the next two years, paid leave programs will start paying out claims in Oregon, Colorado, Maryland and Delaware, home to some 9 million workers. Such policies already exist in nine other states plus Washington, DC, and are part of a growing movement of states trying to fill the gap as nationwide action stalls.

“There is broad bipartisan support across all constituencies for paid family and medical leave,” said Jocelyn Frye, president of the National Partnership for Women & Families. “The only place where we encounter opposition is in Congress, and part of that opposition has to do with whether we are willing to invest in care.”

On Feb. 5, 1993, President Bill Clinton signed the Family and Medical Leave Act into law. It had taken nine years to get it passed, with the bill blocked every year since it was originally offered in 1984.

Today, the law is little changed from its original form: It allows some Americans to take up to 12 weeks of leave if they have a baby, get sick or need to care for an ill relative. It doesn’t guarantee pay, or apply to those who work for small businesses (fewer than 50 employees within 75 miles) or themselves. About 44% of US employees — including those who work part time or have been in their role less than a year — are ineligible.

Jon Gromek, 37, still thinks about the time off he took when his youngest son was born three years ago. 

The Ohio dad of two had just started a new nonprofit job after being laid off. He hadn’t hit the 12 months of service required before employers have to offer FMLA, or the six-month threshold at his new company for paid time off. But even if he had qualified for the unpaid leave, his family couldn’t afford it.

“I was able to negotiate one special day to be present for the birth of my son, on a Friday,” Gromek said. “The following Monday I went back to work.”

The US is an outlier globally for its lack of paid time off for new parents or illness. It’s one of just seven countries that doesn’t guarantee any paid maternity leave. Only about one in four private sector workers has access to paid family leave. The absence of national work-family policies for parental, temporary disability and caregiving leave cost Americans $22.6 billion in lost wages annually in the decade through 2018, according to data from the Center for American Progress, a progressive think tank.

One study by Moody’s Investors Service, a global credit ratings and research organization, found that additional policies could boost US economic output by almost $1 trillion in the next decade by making it easier for women to participate in the labor force.

Some conservatives say a federal paid leave program would cost taxpayers too much, place a burden on small businesses and open the door to fraudulent claims. There are also diverging opinions on how it should be funded: Democrats usually propose tax-funded plans, while recent Republican proposals call for tax credits or borrowing from Social Security funds. 

Opposition to paid leave in President Joe Biden’s social spending plan from Senator Joe Manchin, a West Virginia Democrat, ultimately killed it. Manchin said that a paid leave policy should be done “in regular order” and not through budget reconciliation, a process that can speed certain measures through Congress with a simple majority vote.

More than a decade after FMLA was passed, California was first to put in place a statewide initiative to try and subsidize federal policy. Workers in the most populous US state began collecting on claims in 2004.

Since then, companies in the state with 25 or fewer workers saw a 14% drop in labor costs per employee when their staff used the program. Researchers found that women who had babies or whose spouses got sick were less likely to leave their jobs. And more men took advantage of paternity leave: In 2004, male claimants made up only 17% of all claims, but by 2020 that share was 40%. 

Other states are trying to follow suit. 

In New Mexico, a task force recommended the state put in place a program that would pay workers up to 12 weeks. Maine lawmakers are putting together a similar proposal. In a December address, South Dakota Governor Kristi Noem called paid leave one of her administration’s priorities. Michigan and Minnesota are two other states where similar efforts could take shape, said A’shanti F. Gholar, president of Emerge America, which recruits and trains Democratic women to run for office.

“This is a health-care issue, an economic issue and an equality issue,” Gholar said.

But state plans, like existing federal benefits, leave people out. Pay and wealth gaps also mean that women of color are less likely to be able to afford to take unpaid time off. Every year, about 1.1 million leaves needed by Black female workers aren’t taken. 

In 2018, Sadé Dozan, 33, was working at a nonprofit too small to have to comply with New York’s paid leave regulations, which came into effect that year.

When her daughter was born in May, she used a mixture of vacation time and unpaid leave to take about three months to recover from an emergency C-section.

Six months later, her mother had a heart attack, but Dozan didn’t have any more time off. 

“I have my daughter, I have two parents, I could need three sets of paid leave in a year,” said Dozan, who is now chief of operations and development at Caring Across Generations, which advocates for family caregivers. “What’s really telling about that story is it isn’t that uncommon.”

On a national level, there has been little progress in the 30 years since FMLA was passed. A proposal in Biden’s Build Back Better plan, which would have guaranteed at least some paid time off, came as close as it ever has before it was dropped. It would have provided four weeks of paid leave for new parents, sick and caregiving US workers, and extended protections to gig and contract workers.

Some lawmakers want to try again.

Representative Chrissy Houlahan, a Pennsylvania Democrat, and Representative Stephanie Bice, an Oklahoma Republican, are leading a bipartisan working group with the aim of getting a national policy in place. The group will convene for the first time on Feb. 7. Separately, a Congressional Dads Caucus launched in January with paid leave listed as one of its priorities.  In an event marking FMLA’s 30th anniversary this week, Biden said he’d keep pushing for a national paid family and medical leave program.

“It’s a tragedy that we’re so behind on this, but our goal is more leave for more people and that’s something we are committed to,” Houlahan said.

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