California's pioneering paid family leave program has largely failed to reach one of its major target groups, according to a new study by RAND Corporation researchers.
Few parents of children with serious chronic illnesses have used the program, despite having paid into the program through payroll withholdings, and the vast majority of these parents aren't even aware that the program exists, according to researchers.
Studying parents of chronically ill children, researchers found that just 18 percent of those surveyed were aware of the program and only 5 percent had used the benefits, according to the RAND Health study published in the Sept. 3 edition of the Journal of the American Medical Association.
Most parents who took enough leave to qualify for payment through the program simply didn't know about it. Perhaps more disturbingly, most parents who did not take leave even when they felt their child's illness required it didn't know about the program, according to researchers.
"We focused on parents with chronically ill children because they were a major target of the California legislation," said Dr. Mark Schuster, a RAND researcher and chief of general pediatrics at Children's Hospital Boston. "These children spend a lot of time in the hospital or stay home from school because of illness. Parents often face a tough decision between going to work and taking care of their ill child."
Adopted in 2004, the California program is the nation's first paid family leave law. It is funded by employees through an automatic payroll deduction (averaging about $1 a week) that goes into a state insurance pool. After a one-week waiting period, the program annually provides most employees six weeks of non-job-protected paid leave (paying up to 55 percent of an individual's salary) to care for ill family members. Congress and many other states are considering proposals to create similar programs.
"We thought these parents would learn about the law and would use it to spend more time with their seriously ill children," said Schuster, also a professor of pediatrics at Harvard Medical School. But the law had virtually no impact.
Parents of chronically ill children remained at work because they feared losing income, losing their jobs and damaging their careers.
Six months before the paid family leave program began, about 81 percent of the parents surveyed reported taking at least one day off in the proceeding year to care for their child and 21 percent of parents reported taking at least four weeks of leave. About 18 months after the program began, there was no significant change in these percentages, even when compared with similar groups of parents in Illinois, a state without paid family leave.
"We were surprised that the vast majority of these parents didn't even know about the program," Schuster said. "Parents seem to have no idea that they are paying for this benefit. They're leaving money on the table at a time when they could really use it to be with their sick kids."
The researchers said that the California law failed to require employers to notify all employees about paid family leave, and the state never adopted a comprehensive public education campaign about the program. The payroll deduction is not identified on the paycheck, but is rather added into the temporary disability insurance line, so employees are unlikely to realize that they are paying for state-mandated paid family leave insurance.
In contrast, the federal Family and Medical Leave Act, which since 1993 has provided 12 weeks of job-protected unpaid leave to most full-time employees in large companies, was supported by strong reporting requirements and a vigorous two-year public awareness campaign. After the public-awareness campaign ended, over half of employees knew about the law.
The researchers also noted that awareness may not be the only issue preventing use of paid leave.
"The lack of job protection could be raising legitimate fears among some employees that taking leave may cost them their jobs," said Dr. Paul Chung, a RAND researcher and assistant professor of pediatrics at the David Geffen School of Medicine at UCLA. "The fact that employees receive half their salary during leave might also be a disincentive to those who don't feel they can afford to lose any income."
The other authors of the study are Marc N. Elliott and David J. Klein of RAND, Dr. Craig F. Garfield of Northwestern University's Feinberg School of Medicine, and Katherine D. Vestal of Children's Hospital Boston.
Support for the RAND study was provided by the National Institutes of Health, the U.S. Centers for Disease Control and Prevention, the California Endowment, and both RAND Health and the RAND Institute for Civil Justice.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.
The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. To sign up for RAND e-mail alerts: http://www.rand.org/publications/email.html
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JAMA