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The simple way to describe John Heimbuch’s job is to call him a theater artist. But he also performs, writes, directs, sings in a band and drives for Uber. The 41-year-old Minneapolis man considers himself to be healthy, but if he were to get sick, most of his income would disappear.

“Ultimately,” Heimbuch said, “I would be at the mercy of friends and family in terms of being able to pay my bills.”

Heimbuch is one of more than 30 million Americans who typically have little or no access to paid sick leave from their jobs.

As the country faces the threat of COVID-19, public health experts and advocates say the gaps in paid sick leave are a glaring weakness — especially where “essential” workers like nursing home aides and grocery store workers are concerned.

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Until last month, the federal government didn’t have any policy requiring employers to provide workers with sick leave. But in response the coronavirus, Congress passed 

 to provide up to two weeks of paid sick leave in some situations involving the coronavirus.

But to qualify, employees need to be ordered to be quarantined by a government or doctor, seek a diagnosis for symptoms, or be caring for someone else with COVID-19, among other conditions.

The stringent requirements of the federal bill leaves big gaps for workers who may already struggle with health coverage, said Sheila Maddali, co-director of the National Legal Advocacy Network.

”The reality is we’re dealing with a disease that’s not being properly tested and diagnosed and we’re dealing with a workforce that often lacks access to quality health care,” Maddali said.

Advocates say the emergency federal legislation also leaves millions of workers out because it provides exemptions for many small and large employers. It also doesn’t cover the more than 15 million Americans who work primarily as independent contractors, according to numbers from the U.S. Bureau of Labor Statistics.

While 11 states and 22 jurisdictions — including Minneapolis, St. Paul and Duluth — now require employers to provide paid sick leave, Maddali said many state governments and the federal government have been slow to address the issue.

The Minnesota House of Representatives passed a bill last month requiring employers to provide some paid medical leave for serious conditions. But the legislation stalled in the Senate over Republican concerns about burdening businesses.

In a statement, Laura Bordelon, senior vice president for advocacy at the Minnesota Chamber of Commerce, said the health of Minnesotans was of paramount concern and praised the federal government’s recent action related to paid sick leave.

“State action would either duplicate or conflict with the federal rules, leaving Minnesota employers to navigate a community-by-community or state-by-state patchwork of laws while many attempt to simply keep their operations afloat open during this unprecedented time,” Bordelon said.

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A 2019 study by the IRS found that workers who earned income from jobs where they were classified as independent contractors has grown by 22 percent since 2001, with most of the increases coming among lower earners.

As the economy has changed to include more workers classified as independent contractors, more families have lost access to benefits like paid sick time, said Pronita Gupta of the Center for Law and Social Policy, which advocates for low-income people.

“That has also led to a race to the bottom in many cases for cost-savings,” Gupta said. “Many of these subcontractors don’t provide benefits like paid sick days, paid family medical leave, health insurance.”

Advocates like Gupta argue that businesses have a long-term incentive for making sure employees can access paid sick leave.

”You don’t want to have employees coming in sick because you don’t want them to make their coworkers sick, you want them to get healthy,” Gupta said. “You also don’t want them to spread contagion, especially now with the coronavirus.”

There’s a glaring contradiction between the public policies in most states and federally around paid sick leave and the advice of public health experts on slowing the spread of the virus, she said.

“Just the CDC or some public health official coming out and saying people should stay home isn’t enough because people can’t afford to stay home when they’re sick if they don’t have paid sick days because their job isn’t guaranteed and they lose income and a lot of workers just can’t afford that,” Gupta said.

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There is evidence that offering paid sick time to employees can improve overall public health. A 

 by researchers from Cornell University and the KOF Swiss Economic Institute found that policies mandating sick pay reduced influenza transmission by 11 percent.

Dr. Rajiv Bhatia, who now works as a general practitioner at the Department of Veterans Affairs in Palo Alto, Calif., led San Francisco’s adoption of policies that mandate paid sick leave. It was the first major city in the country to take that step.

From a public health perspective, Bhatia said, policies like this can benefit everyone in society — not just the individual worker. Workers who don’t have access to paid sick leave have a disincentive to stay home when they’re sick and can lead to higher rates of transmission.

“Do you want the woman who is coming or the man who is coming to help bathe and clean your elderly father to have some recourse when they're not able to work because of sickness?” Bhatia said. “Or do you want them to work even with an illness because they need to pay rent?”

There’s a workplace culture in the United States where even many employees who do have paid sick leave may feel pressured not to use it, Bhatia said.

“Just suck it up and go to work? That’s not necessarily a healthy attitude,” Bhatia said. “It needs to be a national culture that it’s in everyone’s interest that this happens.”

The coronavirus pandemic isn’t the first time the U.S. has been confronted with the fact that many people don’t have access to paid sick time, Bhatia said, citing the SARS epidemic. He said that’s why the government needs to intervene for the benefit of the greater public health.

“Industries that consider their workers employment will offer lots of benefits, from paid sick leave to paid maternity leave and paternity leave, while industries that consider their employees redundant or disposable or easily replaceable may not,” Bhatia said. “It’s another dividing line, a place where there’s kind of clear inequality in the labor market.”

A bill was introduced in the U.S. Senate last year that would require many employers to provide up to 56 hours of paid sick leave each year, although it’s made little progress. Both U.S. senators from Minnesota are co-sponsors of the legislation.

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