Voters in Missouri, Nebraska, and Alaska will soon decide whether workers in those states should be entitled to paid sick leave.

If approved, the ballot measures would allow many workers to accrue paid time off, a benefit supporters say means workers — especially those with low-paying jobs — would no longer have to fear losing wages or possibly the jobs themselves for getting sick. Proponents say such policies benefit the broader public, too, allowing workers to stay home when sick or to care for ill family members to stem the spread of infectious diseases.

But opponents say the measures force new burdens on employers, who should be the ones deciding which benefits are best.

The coronavirus pandemic highlighted gaps in such benefits. At the height of the health crisis, the federal government provided temporary relief for sick workers, but those federal protections ended in 2021.

Fifteen states and the District of Columbia now have laws requiring at least some employers to provide paid sick time, according to the Center for American Progress, a left-leaning think tank based in Washington, D.C. They are largely Democratic-controlled places.

The three sick leave ballot measures up for vote are in Republican-led states. Ballot measures, which are allowed in 24 states, let voters amend state constitutions or enact laws by voting directly on an issue, allowing them to bypass state legislatures. For example, voters ushered in Medicaid expansion in Missouri and Nebraska in 2020 and 2018, respectively, after their legislatures wouldn’t pass it.

Still, as Election Day quickly approaches, the three sick leave ballot initiatives have flown under the radar, unlike higher-profile ballot measures — say, on abortion, which is on the ballot in 10 states, including Missouri and Nebraska.

Campaigns supporting the sick leave initiatives in Alaska, Missouri, and Nebraska raked in less than $9 million combined in cash contributions, according to a KFF Health News analysis of state campaign filings as of Oct. 28.

That’s significantly less than Missouri’s ballot measures on abortion and sports betting, which have amassed more than $55 million combined in cash contributions, according to state records. TV ads flood the airwaves on those two measures and yard signs on abortion saturate the region.

Most of the money for the sick leave measures has come from backers outside those three states, the filings show, with the Sixteen Thirty Fund, a D.C.-based advocacy group, being the top contributor to each of the three campaigns. “No one should have to choose between their health and a paycheck,” the group said in a statement.

The group, which funds progressive causes nationwide, does not disclose its donors, but in recent years nonprofits tied to George Soros and Swiss billionaire Hansjörg Wyss have reportedly given to it.

It appears no groups have organized formal campaign committees opposing the sick leave measures.

For Alana Ashmore, 18, paid sick leave would be welcome. The St. Louis woman works two jobs: one as a restaurant server and another at a gym. When she’s too sick to work, she said, she immediately worries about being able to afford her $800 monthly rent and starts thinking: “I better find a way to get money.” She said she plans to vote for the measure.

More than 930,000 Missourians lack paid sick time, like Ashmore, and the measure is expected to benefit 728,000 private-sector workers in the state, according to the Missouri Budget Project, a nonprofit focused on analyzing public policy. Some state or local government workers would not be eligible.

If the measures pass, many workers in these three states could accrue paid time off as they work, earning about a week of paid leave per year. In Missouri and Nebraska, workers for large organizations could earn one hour of paid sick time for every 30 hours worked. To earn one day of paid sick time, they would need to work 40 hours a week for six weeks. In Alaska, eligible workers could accrue a maximum of 56 hours of paid time each year.

In Missouri and Alaska, the measures also seek to raise the minimum wage.

In all three states, the measures have received broad support, including from major unions. Jodi Lepaopao, the campaign manager for Paid Sick Leave for Nebraskans, said her campaign has received support from at least 200 businesses, though not from the meatpacking plants whose workers she said stand to gain the most, as they often lack paid sick leave.

During the pandemic, meatpacking plants were heavily hit by covid-19. Nearly 1 in 5 meatpacking plant workers were infected from March to July 2020, “a profound burden of cases unparalleled in any other worker population,” researchers found.

“This is going to be a big win for them, if we can win,” Lepaopao said.

St. Louis-based Generate Health, a nonprofit that supports healthy outcomes for Black moms and their babies, has backed the paid leave proposition in Missouri for both its employees and its clients.

“To have a healthy baby, you have to have a healthy family and, ultimately, a healthy community,” said Lora Gulley, director of advocacy for Generate Health.

But not every employer has thrown support behind the push for paid sick leave.

Missouri’s Chamber of Commerce and Industry opposes the proposition because it would place mandates on employers that it has said would “increase the cost of doing business and increase liability for our state’s employers.”

The National Federation of Independent Business has also opposed paid sick leave requirements, and specifically has come out against the Alaska measure as a threat to small businesses.

Separately, ballot measures can boost voter turnout, said Adam Snipes, director of strategic partnerships at the Ballot Initiative Strategy Center, which works to pass progressive ballot measures around the country. Voters are often galvanized to head to the polls by the issues, causing ripple effects across all races.

“While they might be skeptical of politicians, they are highly participatory when it comes to ballot measures,” Snipes said.

KFF Health News Midwest correspondent Bram Sable-Smith contributed to this article.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.