Until Portland, Oregon introduced legislation to protect paid sick days, a year ago, Paula Fisher couldn't afford to get sick and lose a day's pay at the mall jewelry kiosk where she worked for four years.
Fisher, whose husband is in school, is the only breadwinner for her family, and "even missing a few hours of work was felt at the end of the month," she told VICE News. If she could get out of bed, she would drag herself to work. "Even though I pierce people's ears at work, so if I'm sick that's not good," she said.
Fisher was one of dozens of workers who wrote letters to President Barack Obama asking for the right to stay home sick — a right currently not guaranteed to 40 percent of America's workforce.
Last night, Fisher missed Obama's State of the Union address because she doesn't own a TV — but the president responded to her call.
"Today, we are the only advanced country on Earth that doesn't guarantee paid sick leave or paid maternity leave to our workers," Obama said during the address. "Forty-three million workers have no paid sick leave — 43 million. Think about that. And that forces too many parents to make the gut-wrenching choice between a paycheck and a sick kid at home."
Obama called on Washington to pass legislation to address the issue, calling it "the right thing to do."
The only federal law that currently regulates sick leave is the Family and Medical Leave Act. Passed 22 years ago, the law excludes millions of workers, including those at companies that employ less than 50 people, those that have been on the job less than a year, or those that work less than 25 hours a week.
"There are many people in this country who work 45 hours or more but they work at two or three jobs and so they're not eligible," Ellen Bravo, head of Family Values at Work, a workers and families advocacy group, told VICE News. "There are some small employers who do it anyway because they know it's the right thing to do but we need to guarantee it for everybody — laws aren't written for the smart employers, they're written for the ones who won't do it otherwise."
Obama has backed the Healthy Families Act, a bill first put on the table by the late Senator Ted Kennedy in 2004. But with that legislation stalling, cities and states have been at the forefront of the push for paid sick days.
In 2014, advocates pushed for reform on sick leave and other issues — such as a minimum wage hike — at the local level, earning paid sick days for an additional 9.5 million workers. Proposals for paid sick leave won in every location in which they were on the ballot during the last midterms, including among Republican voters.
New York City passed its own strengthened paid sick days law last year — extending the right to 1.2 million New Yorkers who didn't have it before — and Mayor Bill de Blasio tweeted his support after the president said last night that paid sick leave should be a federal policy.
"Tonight, President Obama laid out his clearest vision yet for how the United States must tackle the greatest challenge of our time — income inequality," de Blasio said in a statement following the president's address. "Cities must act, as we have in New York City, on values like paid sick leave, immigration reforms, universal pre-kindergarten, and better wages."
In addition to New York, 14 other cities and three states — Massachusetts, Connecticut and California — have passed paid sick day legislation. California, New Jersey, and Rhode Island also passed family and medical leave insurance programs, allowing workers time off for maternity or paternity leave, or to care for sick family members or deal with extended health issues.
"Everybody gets sick every year, that's routine illness, but various people in this country literally lose their job or their pay if they do what they're told by the doctor and stay home," Bravo said. "And then, all of us occasionally need a longer period of time because of the joy of a new baby or the serious illness of ourselves or of a family member, and for that we need affordable family and medical leave."
Her group, a network of 21 state coalitions, is pushing for both policies — paid sick days and family and medical leave insurance programs to cover maternity and paternity leaves and other needs. They're also backing laws to protect workers who do have paid sick days — but who are punished for using them as companies adopt blanket policies penalizing all absences.
Bravo said these polices are unique to the US and called them "backwards."
"We don't want to hear talks about family values, we want policies that value families, these kinds of policies," she said. "We don't understand why people who say they care about family wouldn't support them."
But critics of Obama's call for paid sick leave dubbed the measure "a cure worse than the disease," and said that the benefits are overstated and the cost to employers is "real."
"Paid sick leave is part of a union agenda to make the job market less friendly for people with the least experience," said Michael Saltsman, research director of the Employment Policies Institute, a research group backed by the restaurant industry.
Saltsman dismissed stats showing overwhelming support for paid sick leave — with 86 percent of those surveyed by the National Opinion Research Center at the University of Chicago favoring the policy.
"It shouldn't be surprising that someone would answer in the affirmative if you ask them whether they support paid sick leave," he told VICE News. "It's like polling a free lunch — everyone supports it, until they know that it's not actually free."
Saltsman acknowledged the good intentions behind paid sick leave, but claimed the policy "ends up hurting the people it's meant to help."
"In this case, the evidence from both proponents of these laws and from neutral sources suggest that there's been little change in workplace illness, while employees have borne some costs via reduced workplace opportunities," he said. "That suggests to me that we shouldn't be so quick to discard the status quo."
But the status quo is already starting to shift, and labor advocates are pushing for more support for paid sick days and family and medical leave in Congress ahead of the 2016 elections, and at the local level — with Philadelphia, Chicago, and Tacoma, Washington, as well as Vermont, currently considering legislation.
"There's a growing body of evidence that shows that paid sick days and family leave days work and are not only important for women and for families but for the economy," Bravo said. "If we want to end poverty, if we want to build the middle class, if we want to end inequality, then these common sense policies have to be part of what we do."
Follow Alice Speri on Twitter: @alicesperi