A growing number of liberal states have passed paid sick leave laws in recent years, assuring workers get paid time off to care for themselves or their loved ones when they’re ill. Now some conservative states might be getting in on the act, too.

Campaigns in Nebraska, Missouri and Alaska have secured enough signatures to put sick leave measures on their ballots this November. If voters approve them, the laws would let workers start accruing one hour of paid sick time for every 30 they work, capped at 56 hours per year at large employers and 40 at small ones.

More than a dozen states have similar mandates on their books, according to A Better Balance, a nonprofit advocate for fair and supportive workplaces. But none of those states are as red as Nebraska, Missouri or Alaska, all of which former President Donald Trump won handily in 2016 and 2020.

If the ballot measures succeed, it would demonstrate just how popular paid sick days are among the general public.

“What we’ve realized in talking to thousands of Nebraskans is that this is a really commonsense issue,” said Jo Giles, director of the Women’s Fund of Omaha, one of the advocacy groups backing the initiative in Nebraska. “Most people have been sick at some point in their working lives and have needed to take time off.”

Giles said the typical voter sympathizes with someone who has to choose between a day’s pay and taking care of a child who’s home sick from school. The campaign, called Paid Sick Leave for Nebraskans, includes small-business owners who haven’t balked at the idea of a new mandate, she added.

The U.S. is an outlier among wealthy countries in not guaranteeing workers sick leave or other paid time off. The lack of a federal mandate means employers don’t have to offer any paid time off unless there is a state or local ordinance dictating otherwise. (The Family and Medical Leave Act of 1993 guarantees extended leave under certain circumstances, but it doesn’t have to be compensated.)

About 80% of workers have access to paid sick days, meaning 1 in 5 don’t, according to estimates from the Bureau of Labor Statistics. And those who lack them fall disproportionately near the low end of the pay scale: Only 40% of workers in the bottom decile of wages can call out sick and still get paid.

Richard von Glahn, a spokesperson for the Missouri campaign, called Missourians for Healthy Families and Fair Wages, said the people who need the mandate most are those who were referred to as “essential” throughout the COVID-19 pandemic: child care workers, restaurant workers, retail workers, etc.

“Access to paid sick days is definitely something that has a class element to it,” said von Glahn, who’s also political director at the worker center Missouri Jobs With Justice. “For people who are making over $100,000 a year, it’s very common. … But it’s not as common for frontline workers who really drive the economy.”

Polling shows that voters tend to really like the idea of requiring employers to provide workers with paid leave and that support for the policy tends to cross party lines, much like boosting the minimum wage. A majority of states, including some red ones, now mandate a higher minimum wage than the federal level of $7.25 per hour, thanks in large part to statewide referendums.

This year’s sick leave initiatives in Missouri and Alaska pair the proposals with minimum wage hikes that would send the state rates to $15 per hour within a few years. The current state rates are $12.30 in Missouri and $11.73 in Alaska.

Using ballot measures makes a lot of sense for paid leave advocates since the strategy provides a way around Republican-dominated statehouses that won’t advance paid leave legislation. Such proposals have fared well when put directly to voters in other states, though not all states allow referendums.

Backers of the Nebraska and Missouri initiatives have been frustrated by how little traction paid-leave bills have gained in their legislatures, typically withering away in committees without debate. Republicans control both statehouses and tend not to put new mandates on businesses, even if the concepts might be popular.

“Our legislature just turns a blind eye to the bills that really are about people’s day-to-day struggles and what they need,” von Glahn said. “That’s why we’ve had to turn to the ballot initiative process.”

The paid-leave proposals have received backing not just from labor groups but from faith and public-health groups as well. The Missouri campaign says it has received endorsements from the Missouri Psychological Association, the state’s Episcopal diocese and the March of Dimes, among dozens of other entities.

So far, there have been no organized public campaigns against the initiatives in Nebraska, Missouri or Alaska. Businesses still have nearly two months to mobilize, but, given the polling, they may find it to be a losing battle not worth spending money on.

“I do expect once we see the outcome of these elections that there will be more interest in other states,” said Jared Make, vice president of A Better Balance, which advocates for paid leave.

Democrats have been pushing unsuccessfully for a federal paid leave law for years. Their latest proposal, the Healthy Families Act, would enable most workers to earn one hour of paid sick leave for every 30 worked, capped at 56 hours per year. But the legislation is unlikely to go anywhere so long as the GOP controls the House or can filibuster in the Senate. The Senate version of the bill has 43 Democratic co-sponsors but not a single Republican.

Make said so long as such roadblocks exist in Washington, advocates will continue pushing referendums and legislation on the state level.

“While we’re continuing to work for nationwide action, we also can’t wait,” he said. “Too many workers don’t have this basic right.”