Congress has debated health-care reform for generations. Our much-debated and historic legislation is finally ready to go to work, hopefully delivering expanded coverage, making health care more affordable, and holding insurance companies accountable. But we still need to keep an eye on some of the best ideas in this arena, which are often born at the state level.

Indeed, states serve as working laboratories when it comes to pursuing measures that advance quality health care. A good example is Massachusetts, where nearly 98 percent of its population has health insurance (interestingly, that law passed with the support of Scott Brown, a Republican who was a state senator at that time and is now occupying the Senate seat previously held by the late Ted Kennedy.).

How about Maine? In the past year alone, Maine legislators passed one bill that requires insurance companies to pay for health-care services provided by “telepractice,” an increasingly important trend that marries states with large rural areas with doctors who can “see” patients and prescribe treatment via broadband. And another bill passed by Maine legislators allows pharmacologists to administer vaccinations–a minor measure, perhaps, but one that was quite sensible in the face of the H1N1 pandemic.

More broadly, Maine gradually but significantly has moved toward the idea that everyone should have access to health care. Seven years ago, Maine ranked 19th in terms of the number of people with health insurance. Today, it ranks fifth.

An initiative debated earlier this year in Maine would have required employers to provide sick leave for their workers. The public policy arguments for such a law are obvious. For starters, do you want the person flipping your burger or preparing your salad to have H1N1? And how many of us share office space with “the hero” who insists on dragging himself and his germs to work despite suffering from a raging head cold? Everyone knows that sick employees infect their coworkers.

Although they were ultimately unsuccessful, for this year at least, a broad coalition led by groups such as the Maine Women’s Lobby and Maine People’s Alliance led the push for reform. Their campaign pointed out that 214,000 workers in Maine–36 percent of the state’s workforce–have no sick leave. Their proposal would have guaranteed workers at larger businesses up to about six paid sick days per year, while workers at smaller businesses could have earned approximately three paid sick days per year.

Under their plan, the earned paid sick time could be used for routine illness, to care for a family member during a public health emergency, to receive preventive care, or used in relation to domestic violence, sexual assault, or stalking.

The proposal ultimately died in committee. But one interesting thing about it is that it would have saved employers money. On the one hand, employers would have had to pay an additional $56 million a year for wages, payroll taxes and payroll-based employment benefits and administrative expenses. On the other hand, employers would have saved $93 million annually, primarily from reduced costs of turnover. That’s an overall savings of $37 million–meaning the earned sick leave measure wasn’t just good for employees but good for business as well.

Maine is hardly alone in pushing for this reform. Three cities–Milwaukee, San Francisco, and Washington, DC–already have passed limited forms of mandatory sick leave, and although no state as of today has approved sick leave, 14 states besides Maine have active campaigns at the grassroots. Those states, from the west to the east, are Alaska, California, Washington, Montana, Colorado, Minnesota Wisconsin, Illinois, Pennsylvania, North Carolina and almost all of the New England states–Connecticut, Massachusetts, New Hampshire and Vermont.

Many advocates who have worked on health care reform at the national level are rightfully proud that Congress is now on record as saying that all Americans deserve access to quality, affordable health care. But we remain ever mindful that some of the best ideas in this arena–perhaps most of them–begin in the local and state “laboratories” and advance to Congress. Hopefully, the notion that every worker should have access to earned sick leave when they need it is one such idea.

David Elliot is the communications director for USAction, a grassroots network with partners and affiliates in 27 states.

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