Americans are a sick people. Among their economic peers they expect to live shorter lives, experience higher rates of chronic disease, and spend more on their care and upkeep. The baseline necessities for maintaining a healthy human body over the course of a lifetime are often a luxury. Nevertheless, one in five Americans lack the ability to take a paid sick day from work if they fall ill.

Health care — from ease of access to programs like Medicaid to a woman’s ability to access abortion care — is governed by a patchwork of increasingly complex state-level laws and policies. Sick leave is no different.

Across the private sector and state and local governments, around 26.5 million employees do not have access to paid sick time, according to the Bureau of Labor Statistics released this

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