2023 CHAS: Work-Related Barriers | Colorado Health Institute

Colorado workers sometimes need a few hours off work to seek preventive care services or a few days to recover from an illness, but some are unable to do so.

In 2023, the Colorado Health Access Survey (CHAS) found that 13.7% of Colorado workers could not access care because they could not take time off from work. Delaying medical care may lead to increased morbidity and mortality for people with treatable and preventable medical conditions. Those without the ability to take time off are more likely to continue working while ill, which is associated with long-term sickness and exacerbating already-existing health disparities. Even those who can technically take unpaid time off might face risks since doing so results in lost wages or might increase a person’s risk of losing their job .

In Colorado, CHAS findings indicate that workers who do not get time off to see the doctor were more likely to have poor health outcomes, live in rural areas, and have low to moderate household incomes.

Short-Term Leave vs Long-Term Leave: What’s The Difference?

Short-term and long-term leave serve different functions for Colorado employees, but both are important in ensuring workers have the ability to take time off when needed for a range of health concerns and family needs.

Click to Read Descriptions

Short-Term Leave

Paid Sick Leave

Definition. Paid sick leave refers to policies that provide employees time off for shorter amounts of time due to routine illnesses, such as a cold or the flu, or to access medical care for themselves or a family member while receiving their normal pay. There is no federal law guaranteeing employees access to paid sick leave, but many states have passed their own laws.

Colorado Policy.

Healthy Families and Workplaces Act (HFWA)

The HFWA went into effect in 2021 and provides all workers with at least one hour of paid sick leave for every 30 hours worked. This time can be used for treating a medical condition, receiving preventive care, or caring for a family member and their medical condition.
The act, which covered companies with 16 or more employees beginning in 2021 and all employers beginning in 2022, requires employers to provide up to 48 hours for workers to accrue and use each year.
Colorado employers that provide paid leave policies that are more generous than Colorado’s HFWA do not need to provide additional basic paid sick leave if their policies provide the same amount of time off and allow the same reasons for use.

Paid Time Off

Definition. Paid time off (also known as PTO) policies provide employees with time off that can be used for a wide array of reasons, including emergencies, planned vacation, and personal time, while still receiving their normal pay.

Colorado Policy. Employers in Colorado are not required to offer their employees paid vacation days, but may do so based on individual company policies.

Long-Term Leave

Definition. Long-term leave refers to policies that provide employees with extended time off when they cannot work due to a serious health issue or caregiving needs. This leave can either be paid or unpaid and may last from a few months to a few years.

Colorado Policies.

Family and Medical Leave Insurance (FAMLI)

In 2020, voters passed Proposition 118, making Colorado the first state in the nation to enact paid family and medical leave benefits through a ballot initiative.
FAMLI began January 1, 2024, and guarantees workers the right to paid family and medical leave when they cannot work due to personal illness or family needs.
Colorado workers may take up to 12 weeks per year to bond with a new child, care for themselves or a family member with a serious medical condition, make military deployment arrangements, and address safety concerns from domestic violence and/or sexual assault.
Workers earn progressive wage replacement rates, meaning that lower-income workers receive a higher percentage of their income.

Paid Family and Medical Leave (PFML) Act

PFML began in 2021 and provides permanent full-time state employees with up to 160 hours of paid leave per 12-month period when employees are eligible and qualify for unpaid protected leave under the Family and Medical Leave Act (FMLA).
PFML functions simultaneously with FMLA and must be used first before employees use accrued paid sick leave and paid time off.

Federal Policy

Family and Medical Leave Act (FMLA)

FMLA provides covered employees up to 12 weeks of unpaid, job-protected leave each year.
Leave can be used for caring for a newborn, to care for oneself or a family member with a serious medical condition, or for adoption or foster care placement.

More 2023 CHAS Analysis

Expand

Time Off and Health Outcomes: The Connection

Colorado workers who could not get time from work to visit the doctor were almost three times more likely to report having fair or poor health compared with those who did not experience work-related barriers (22.9% and 8.3%, respectively).

Working while sick increases the risk of spreading illnesses to coworkers and customers. It can also take people longer to recover from an illness if they don’t have time to rest or go to the doctor. This may exacerbate existing health disparities for those without access to time off.

Work-Related Barriers to Care Are Increasing

The percentage of Coloradans who reported work-related barriers to care increased in the years before the COVID-19 pandemic. About one in seven workers (14.9%) could not get time off work for medical care in 2019, compared with one in 10 in 2013 (10.5%).

This rate dropped to 10.5% in 2021, likely due to many people working from home during the pandemic, an increase in telemedicine visits, and public health emergency leave for COVID-19 provided as a temporary provision under the Healthy Families and Workplaces Act that ended in June 2023. Workers may have also been forgoing care altogether due to the COVID-19 pandemic. As the pandemic began to slow down in 2023, the percentage of workers who did not get needed medical care jumped to 13.7%.

Download as a PNG file

Disparities

Rural Workers

Rural Coloradans already face barriers in accessing care. Fewer providers practice in rural areas, and residents must often travel greater distances to see a doctor. In addition, rural workers, especially on the Eastern Plains, experience some of the highest rates of work-related barriers to care (between 12.5% and 19.8%). Workers in some metro Denver counties experience some of the lowest (between 4.4% and 6.1%).

The Eastern Plains might be more affected by this barrier because research has shown that agricultural workers often have fewer paid-time-off protections than other types of jobs, such as management or professional services.

Workers Earning Low to Moderate Incomes

People earning low to moderate incomes were more likely to report work-related barriers to care than those earning higher incomes. About 15% of Colorado workers in households earning between 101% and 400% of the federal poverty level (FPL) — which in 2023 was $30,300 to $120,000 for a family of four — reported work-related barriers to accessing care.

For workers in households earning more than 400% of the FPL, this dropped to 9.6%. There is a social gradient between health and income, meaning that the lower a person’s socioeconomic status, the worse their health status and health outcomes tend to be. Colorado workers who earn incomes at or below the poverty level reported the lowest rates of good/excellent health, compared with those earning higher incomes.

Download as a PNG file

Looking Ahead

These CHAS data reveal that about one in seven Coloradans are not accessing care because of work-related barriers. These data show that rural Coloradans, especially on the Eastern Plains, and workers earning lower incomes are disproportionately impacted by work-related barriers to care. Coloradans over age 16 with work-related barriers to care report worse overall health compared to those without access barriers, highlighting the critical importance of paid time off and leave protections for workers.

While the recent passage of Colorado’s paid Family and Medical Leave Insurance (FAMLI) program and Healthy Families and Workplaces Act has the potential to reduce health disparities through expanding worker paid time off protections, more changes are needed at the employer, state, and federal levels to ensure that all workers, regardless of income level or industry, can take time off work to access needed care. Workplace protections are intertwined with a worker’s health. Paid leave not only provides workers with the ability to access needed care for themselves or a loved one, but can ensure someone does not have to choose between their health and pay.

Lead Author: Brooke Kritikos, Practicum Student, Colorado School of Public Health – CU Anschutz