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The debate over health insurance has pushed aside another congressional effort that relates to your health. Congress had been considering legislation that would require employers to offer paid sick leave to their workers. Now, with the swine flu epidemic, the idea of paying people to stay home if they're sick has become more pressing.

NPR's Joanne Silberner explains.

JOANNE SILBERNER: Back in the first wave of the swine flu pandemic, last April 29th, President Obama had some advice.

President BARACK OBAMA: If you are sick, stay home. If your child is sick, keep them out of school.

SILBERNER: Not so easy for Marcy(ph), who lives in Southern California and doesn't want her last name being used.

MARCY: Nine times out of 10 when I do get sick, I will go into the office anyway and work.

SILBERNER: Even if she thinks what she has is infectious.

MARCY: I'm conflicted, you know, because I don't want other people who get what I have. You know, I really don't.

SILBERNER: Like seasonal flu, the H1N1 swine flu virus is thought to spread by touch and by inhaling coughed-out or sneezed-out air. Every time Marcy gets sick, she thinks about her co-workers.

MARCY: I bring hand sanitizer and I try not to touch things that people - other people use, but I still come in because paying the bills to me is more important. You know, I don't really have a choice.

SILBERNER: Her husband only recently got a job and they depend on her income. Various estimates put the number of American workers without sick leave at just under 60 million. Last spring, Senator Edward Kennedy and Representative Rosa DeLauro introduced legislation that would require employers with more than 15 workers to offer seven days of paid sick leave. The health overhaul plans have pushed those bills aside. Not a good thing, says Susan Eckerly, head of public policy for the National Federation of Independent Business. She says about three-quarters of NFIB's business owners do offer some sick leave, but...

Ms. SUSAN ECKERLY (Head of Public Policy, National Federation of Independent Business): If they don't offer paid sick leave, it's probably because they can't afford it.

SILBERNER: And she says, we may be in the time of swine flu, but it's also an era of a struggling economy. And that's not a good time for mandates.

Ms. ECKERLY: You don't solve a short-term problem by imposing a long-term mandate on business, especially at a time when we are just seeing our way out of the economic recovery.

SILBERNER: Yes, you do, says Jeff Levi, head of Trust for America's Health, a group that advocates for public health policies. Not all businesses make the right decisions, he says.

Mr. JEFF LEVI (Director, Trust for America's Health): We desperately need to move out that mandated sick leave. We're in the middle of a pandemic and we have people having to make very difficult choices about whether they should protect the public's health by staying home from work when they have an infection or potentially spreading the virus even more because they don't have sick leave.

SILBERNER: Levi says it's the lower-paid workers who tend not to have sick leave. They're the ones least able to afford taking leave without pay. A handful of communities around the country have some sort of paid sick leave rule. San Francisco was first a few years ago, and there are pushes in several states as well. As for Marcy in Southern California, she plans on getting a swine flu vaccination this year if she can find one. And she's asking her boss to consider allowing her sick leave.

Joanne Silberner, NPR News.

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