Tagged States

Tennessee Reveals $7.9B Plan To Shift Medicaid Into Controversial Block Grant System

The plan’s likelihood of ever being implemented, however, remains largely unknown. To date, no state has been given permission to rely solely on block grants to cover Medicaid expenses. Gov. Bill Lee, however, remains hopeful, pointing to the fact that the Trump administration has been encouraging states to take more control of their programs.

As Texas Cracks Down On Abortion, Austin Votes To Help Women Defray Costs

Austin is about to become the nation’s first city to fund groups that help women seeking abortions pay for related logistical costs, such as a babysitter, a hotel room or transportation.

The move pushes back against a Texas law that took effect Sept. 1. The state law bans local governments from giving money to organizations that provide abortions — even if that money doesn’t pay for the procedure.

Last week, the Austin City Council approved the related line item in the city’s latest budget. Starting Oct. 1, it sets aside $150,000 to be passed along to nonprofits that provide “logistical support services” for low-income women in the city seeking an abortion.

None of the groups provide abortion, so supporters of the new city budget item describe it as a unique workaround to the state’s law.

“The city has to find creative ways to help vulnerable communities in our city, and I see this as just another way,” said Councilwoman Delia Garza.

John Seago, the legislative director for Texas Right to Life, said that though Austin is not violating the letter of the state law, its leaders are clearly violating “the principle” behind it.

“The legislature did not believe that it is ethical to use taxpayer dollars to benefit the abortion industry,” Seago said. “So whether it is the clinic itself, whether it is paying for the procedure itself, there is an industry built around that that we don’t want to use taxpayer dollars to benefit.”

Shortly after the city’s budget passed, former Austin Councilman Don Zimmerman sued the city in an effort to block the funding. In his lawsuit, filed in a Travis County district court, Zimmerman claimed “this expenditure of taxpayer money violates the state’s abortion laws.”

Supporters of Austin’s effort say the budget item is on solid legal ground. They also say it’s an important step to ensure that low-income women, at least locally, can obtain legal abortions in a state that has been steadily restricting access to the procedure in the past decade.

Erika Galindo, an organizer with the Lilith Fund, told the Austin City Council during a meeting this summer that Austin should take a stand as some cities pass all-out bans on abortion. Earlier in the summer, Waskom — a small city in East Texas — banned the procedure and declared itself the state’s first “sanctuary city for the unborn.”

“The city of Austin has an opportunity to set a new standard for creative and equitable solutions for communities at a time when state lawmakers and local governments like Waskom’s city council have turned their backs on low-wage workers and women of color,” Galindo said.

Austin’s city leaders said the makeup of their city council likely played a role in the decision to fund programs that provide logistical support. While Waskom’s ban was passed by an all-male council, Austin has a majority-female city council.

“I don’t think it’s any coincidence that you have a majority-female council making these kinds of issues a priority,” Garza said. “We have seen how this right has been chipped away at — all kinds of barriers being placed in front of women who are simply seeking an option that is still a constitutional right in this country.”

More than half of the abortion clinics in Texas have closed since 2013, going from 40 clinics to 17. Broad swaths of the huge state have no abortion providers.

City leaders and staff in Austin are still working out how women will qualify for the money and what groups to contract with, but groups already doing this work across the state will likely get some of the city funding.

Among those groups is Fund Texas Choice, a statewide nonprofit that provides travel arrangements for abortion appointments for women in Texas who can’t afford them. Organizer Sarah Lopez said the group’s help can include providing women with gas money, bus tickets or ride-sharing — and sometimes a hotel room to recuperate in.

More often than not, Lopez said, she’s helping women who are already parents and who can barely afford the abortion procedure itself — let alone the costs that come with making it to the appointment. For many of these women, she said, a little help goes a long way.

“I was chatting with someone yesterday,” Lopez said. “She had just made her appointment but then rescheduled because she was like, ‘Oh, I didn’t realize I would have to be gone for three or four days — so I had to push my appointment another week and a half in order to find child care.’”

Texas law requires at least two office visits before a woman can get an abortion. And women living in rural parts of the state often have to travel 200 miles away, or more, to the closest abortion clinic.

In 2013, Texas lawmakers passed a controversial law that imposed strict restrictions on abortion providers in the state. That law, known as House Bill 2, required clinics to be equipped and staffed like surgical centers, and it required doctors who provide abortions to have admitting privileges at a nearby hospital. Following that law’s passage, many clinics around the state shut their doors.

The U.S. Supreme Court eventually struck down those restrictions, but many of the clinics have yet to reopen ― especially the clinics that closed in rural parts of Texas.

Now women who live outside major cities often face big travel barriers when they seek an abortion. The new funds allocated by Austin are only for women who reside within the city.

Women living in parts of the state that don’t have a clinic will continue to rely on statewide programs such as the one run by Lopez’s group.

Lopez said Austin’s effort takes off some of the financial pressure on groups like hers and frees up more money for women living in rural areas.

“I think it’s incredible,” Lopez said of the Austin decision. “I really hope to see that other cities in Texas kind of follow suit.”

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

Abortion Rights Advocates Decry Oklahoma Judge’s ‘Rogue’ Decision To Allow Ban On Second-Trimester Procedure To Stand

However, Oklahoma has agreed not to enforce the ban until the state Supreme Court considers an emergency motion from the plaintiffs. Meanwhile, U.S. senators are asking Google to make sure its maps are accurately pointing users to abortion providers rather than crisis pregnancy centers. Abortion news comes out of Texas and Indiana, as well.

‘We Have Allowed This To Fester For Too Long’: NYC Police Force Lags Behind Peers In Addressing Mental Health Issues

Other major cities have lowered the number of suicides in their police forces with aggressive mental health initiatives, including efforts to remove the stigma of seeking counseling by making therapists visible and readily available. But an uptick in suicides this year has shined a light on where the department is falling short when it comes to addressing its mental health crisis. In other mental health news: a 3-digit suicide line, suicides in prisons, and mental health care on college campuses.

Small-Town Drug Bust Offers Intimate Glimpse Into The Vast And Shadowy Black Market For Vaping Supplies

As officials across the country are trying to pinpoint the cause of a lung illnesses outbreak linked to vaping, a look at a bust in Wisconsin shows just how sweeping the unregulated black market for the products is. Meanwhile, the outbreak highlights the dark underbelly of the rise in CBD oil’s popularity. More news on vaping looks at the Trump administration’s proposed ban on flavored e-cigarettes; movement in the states to crack down on vaping; and stories from the users themselves.

Discord Increases Over Severance Package, Confidentiality Clause Between Planned Parenthood And Fired President Leana Wen

“They want to silence my voice as a public health expert,” said Dr. Leana Wan. “I simply will not sign away my right to speak my mind. I won’t compromise my integrity.” Planned Parenthood disputed her charges. News on women’s health also reports on medication abortions and fetal remains.

Air Ambulances Woo Rural Consumers With Memberships That May Leave Them Hanging

FORT SCOTT, Kan. — On a hot June day as the Good Ol’ Days festival was in full swing, 7-year-old Kaidence Anderson sat in the shade with her family, waiting for a medevac helicopter to land.

A crowd had gathered to see the display prearranged by staff at the town’s historic fort.

“It’s going to show us how it’s going to help other people because we don’t have the hospital anymore,” the redheaded girl explained.

Mercy Hospital Fort Scott closed at the end of 2018, leaving this rural community about 90 miles south of Kansas City without a traditional hospital. The community has outpatient clinics run by a regional nonprofit health center and — at least temporarily — an emergency department operated as a satellite of a hospital in the next town over.

Since the hospital closed, air ambulance advertising has become a more common sight in mailboxes and at least one company’s representative has paid visits to a local nursing home and the Chamber of Commerce, offering memberships. A prepaid subscription would guarantee that if an AirMedCare Network helicopter comes to your rescue, you will pay nothing.

Nationwide, though, state insurance leaders, politicians and even one of the nation’s largest air ambulance companies have raised alarms about the slickly marketed membership campaigns.

The air ambulance industry expanded by more than a hundred bases nationwide from 2012 to 2017 and prices increased as well, according to a recent federal report. The median price charged for a medevac helicopter transport was $36,400 in 2017 — a 60% increase compared with the roughly $22,100 charged in 2012, according to the March report from the U.S. Government Accountability Office.

Insurance seldom covers the trips and consumers often are surprised to get a bill showing they are responsible for the bulk of the cost. However, both Medicare and Medicaid control the price of the service, so enrollees in those government insurance programs face much lower out-of-pocket costs or have none.

AirMedCare Network, which includes 340 bases across mostly rural America, has more than 3 million people enrolled in memberships, said Seth Myers, president of Air Evac Lifeteam, one of the medevac companies under the AirMedCare Network umbrella.

One brightly colored AirMedCare advertisement mailed in southeastern Kansas promised entry in a summer vacation giveaway as an incentive to sign up. A one-year membership is $85 — unless you are 60 or older, which qualifies you for a discount. Buying multiyear memberships increases the odds of winning that summer trip.

“We’re a safety net for people in rural areas,” Myers said. “Generally, if I tell you the names of the towns that most of our bases are located in, you wouldn’t know them unless you lived in that state.”

Increasingly, though, state regulators have a skeptical view.

North Dakota Insurance Commissioner Jon Godfread called the memberships “another loophole” that air ambulance companies use to “essentially exploit our consumers.” The state banned the memberships in 2017, noting that the subscription plans don’t solve the problem of surprise medical bills as promised.

Too often, the company responding to a patient’s call for help is not the one the patient signed up with, Godfread said. North Dakota has nine different air ambulance operators who respond to calls and patients have no control over who will be called, he explained.

Air Evac’s Myers said his company, which operates mostly in the Midwest and Texas, doesn’t get many complaints from customers about other companies picking them up. He counted three this year.

Texas Rep. Drew Springer, a Republican, introduced a bill passed by the state legislature this year that would require companies to honor the subscriptions or memberships of other air ambulance companies.

But Texas Gov. Greg Abbott, also a Republican, vetoed Springer’s reciprocity bill, saying it would unnecessarily intrude on the operations of private businesses.

Myers said that AirMedCare Network was “very careful to educate the legislature and the governor’s office” in Texas. A letter signed by Myers and other industry executives noted that the 1978 Airline Deregulation Act — a law created for the commercial airline industry — protects them. The federal law limits states’ ability to regulate rates, routes or services. The law is at the core of the industry’s defense of its prices.

Like North Dakota, though, Montana used insurance regulations to limit the memberships. A 2017 law requires air ambulance subscriptions to be certified by the state’s insurance department. As of August, no company had applied for certification — essentially opting out of the state.

Air Methods, one of the nation’s largest private air ambulance companies, decided memberships “aren’t right for patients,” according to Megan Smith, a spokeswoman for the company.

While membership programs promise customers will avoid out-of-pocket expenses, in reality the contractual fine print “isn’t as cut and dry,” she said in an email.

Patients who sign up for memberships and have private insurance would still receive a bill and then must work through their insurance company’s claims, denial and appeal processes.

And while Air Evac’s Myers said the AirMedCare Network memberships or subscription fees replace copays and deductibles, Air Method’s email highlighted in bold print that “a membership is not necessary” for Medicare patients because federal law prohibits companies from charging more than copays and deductibles. Myers said having a membership offers peace of mind, particularly to those Medicare enrollees who do not have an added supplemental insurance plan that covers transportation.

Also, because the memberships are not officially insurance or a covered benefit, air ambulance companies can end them at any time “without obligation to notify the customer,” stated the Air Methods email. This means a patient could believe his or her emergency air transport was taken care of, only to face a rude awakening when the bill came.

Air Methods is the preferred helicopter service for Fort Scott’s dispatch service, according to city officials. Yet, Midwest AeroCare operated the helicopter that dropped in during the Good Ol’ Days festival.

Pilot Michael Samuelson has been flying for three decades, which, he jokes, is “why I got all the gray hair.” The Midwest AeroCare helicopter behind him flies about 130 mph and takes about 40 minutes to transport a patient the roughly 90 miles from Fort Scott, Kan., to the Kansas City metro area. “It’s pretty fast,” Samuelson says.(Sarah Jane Tribble/KHN)

Midwest AeroCare is part of the AirMedCare Network — not Air Methods. Families like the Andersons were there looking for reassurance that someone would come for them if needed, said Dawn Swisher-Anderson, Kaidence’s mom. Her son, Connor, has frequent and severe asthma attacks that require hospitalization.

“It’s obviously scary with a young one when he’s having breathing complications,” Swisher-Anderson said.

Once the helicopter landed, a tall pilot and two crewmembers stepped out and the onlookers quickly formed a line on the grass. Susan Glossip, who brought her grandchildren to see the helicopter, encouraged them to pose for a picture.

Midwest AeroCare representative Angela Warner stood nearby and asked if she could post the picture on the company’s Facebook page.

After Glossip said yes, Warner began talking about the membership program emphasizing that “with Fort Scott losing its hospital … having a helicopter be able to fly in can mean the difference between living and dying for some people.”

Glossip agreed and asked for a membership brochure.

Attorneys General Discourage Use Of At-Home Rape Kits: ‘Sexual Assault Demands Real Response’

Attorney generals in at least four states have issued warnings about kits sold online that allow women to conduct their own sexual assault exam. “Proper medical attention and accurate evidence collection are of critical importance to supporting survivors,” said New York Attorney General Letitia James, a Democrat, said Thursday.

Few Things So Starkly Set America’s Health System Apart As How Much Patients Have To Pay Out Of Pocket

Nearly all of America’s global competitors — whether they have government health plans, such as Britain and Canada, or rely on private insurers, such as Germany and the Netherlands — strictly limit out-of-pocket costs. In more news on the health industry and insurance: hospital lawsuits against low-income patients; employer-based health care costs; price hikes and upcoding; America’s uninsured rate; and state marketplaces.

A Dubious Product: A Rape Kit For Home Use

Alongside other “essential” household supplies for sale on Amazon, there’s now a product offered that might give consumers pause: an at-home rape kit.

The “PRESERVEkit,” listed for $29.95, is intended for those who have been sexually assaulted. It is advertised as “containing all of the tools and step-by-step directions needed for the proper collection of evidence if going to the police or medical facility is not an option.”

Few people — prosecutors or advocates for sexual abuse victims — think this is a good idea because the evidence collected would be useless in court and expose the alleged victim to medical risks.

Oddly perhaps, the company behind the kit, the Preserve Group, is headed by a retired FBI special agent, Jane Mason. She was motivated to make the product, according to the company’s website, after working with survivors of sexual assault in her private investigations practice.

A New York startup has proposed a similar product called the “MeToo Kit.” This kit is not yet available, though individuals can place themselves on a waitlist for the product. No price has been made public.

Michigan Attorney General Dana Nessel was the first attorney general to release a statement saying the manufacturer of MeToo Kits was “shamelessly trying to take financial advantage of the ‘Me Too’ movement.” She said evidence in the kits would not stand up in court.

Nessel sent a notice of intended action to the Brooklyn-based company on Aug. 29, stating she had probable cause to believe the company was violating Michigan’s Consumer Protection Act. The MeToo Kits Co. was given 10 days to comply with the act, including agreeing not to sell the kits to Michigan consumers.

Nessel’s communications director, Kelly Rossman-McKinney, said the attorney general is aware of PRESERVEkit, the product already available on Amazon, and though “it’s not being marketed in as misinformed a way, we are likely to be pursuing them with similar requests as what we sent to MeToo Kits.”

North Carolina Attorney General Josh Stein also released a statement urging North Carolina consumers to avoid the MeToo Kits. His communications director, Laura Brewer, said the office has launched an investigation into the product.

And Jude Foster, the statewide medical forensic policy coordinator with the Minnesota Coalition Against Sexual Assault, said her organization has also been in conversation with Minnesota Attorney General Keith Ellison as well as state law enforcement officials about the kits.

Monica Beck, managing legal counsel for the Fierberg National Law Group in Traverse City, Mich., agrees with the attorney general’s assessment that at-home rape kits would not be allowed as evidence in court.

“It brings up very serious evidentiary problems,” said Beck, who represents survivors of sexual assault in civil litigations. “The kits bring up issues of chain of custody and whether the DNA evidence was properly collected.”

The chain of custody is a systematic process intended to show evidence has been collected properly by professionals and not been tainted. This provides a trail of every person who has come in contact with the evidence.

Beck said that evidence in sexual assault trials collected by trained personnel is routinely attacked in court by rape suspects’ defense attorneys.

“Imagine what defense attorneys would do with evidence taken at home,” she said. “Frankly, it’s hard enough for survivors to get justice, and this is just making it even harder.”

In an emailed statement, Mason of the Preserve Group said: “Crime victims give evidence to law enforcement that is admissible in court every day.” She said the reasons evidence is admissible in court vary and “a blanket statement that a victim collecting evidence of sexual assault with an at-home kit does not apply.”

Medical and forensic professionals say the kits leave out other aspects of sexual assault exams that are crucial to survivors.

“We look at the victim from the top of the head to the bottom of their toes,” said Julie Valentine, a forensic nurse and assistant professor at Brigham Young University who has conducted sexual assault evidence collection exams. “The majority of victims also have physical injuries, and a big part of our examination is the assessment, documentation and treatment of those.”

Valentine said nurses collect not only DNA evidence, but also debris, such as carpet fibers, grass and the individual’s clothing. They also might take photos of injuries. She said if cases are prosecuted, forensic nurses are called to testify.

A sexual assault exam can also include medication to prevent sexually transmitted infections and pregnancy. A psychological evaluation or referral to mental health and other support resources also might be involved, said Valentine.

“If we have victims who believe that they can collect evidence alone at home, not only do they collect evidence that is not admissible or helpful, neither do they get health care or the victim advocacy help,” Valentine said.

Foster expressed concern about the cost of the home kits. “In Minnesota, we have a state statute and also the Violence Against Women Act allows survivors to access a free medical exam after an assault,” she said. “I have great concern that someone is trying to profit off of people when they have access to a free exam.”

The federal Violence Against Women Act requires states to provide free sexual assault forensic exams if they want to stay eligible for grant funding.

In an emailed response to questions, the founder and CEO of the MeToo Kit Co., Madison Campbell, said if the company can raise enough money, she would like to give away the kits. But of the product’s price tag, she said, “It would be less than the cost of an Uber ride to the hospital.”

Campbell said she is a sexual assault survivor and believes it should be the survivor’s right to capture the evidence in the comfort of their home.

She also said her company was surprised at the backlash. “Our mission is to help survivors of sexual assault who do not have the ability or are willing to go to the police or the hospital to collect time-sensitive DNA evidence,” Campbell wrote via email.

An Amazon spokesperson declined to comment.

Vapers Seek Relief From Nicotine Addiction In — Wait For It — Cigarettes

Lucas McClain started smoking cigarettes in high school but switched to vaping after he heard e-cigarettes were a safer alternative.

His vape of choice became the Juul, the king of electronic cigarettes — which comes with a king-size nicotine hit.

Now 21, McClain wants to quit so badly that he’s turning back to the problem he fled in the first place: good old-fashioned cigarettes.

“Juul made my nicotine addiction a lot worse,” the Arlington, Va., resident said. “When I didn’t have it for more than two hours, I’d get very anxious.”

Even though McClain knows the dangers of cigarettes — lung cancer runs in his family — he thinks it might be easier to kick cigarettes than his Juul. Plus, his mom keeps warning him about the mysterious vaping-related illnesses that have sickened hundreds across the country.

So last month, McClain bought his first pack of cigarettes in years. Then he tweeted about it.

“Bought a juul to quit smoking cigarettes,” he wrote, “now I’m smoking cigarettes to quit the juul.” He ended with this hashtag: #circleoflife.

One Juul pod, which provides about 200 puffs, contains as much nicotine as a pack of cigarettes. On stressful days, McClain could finish a pod in three hours — and as he and others figure out just how potent these and other e-cigarettes are, many want out.

Some are turning back to combustible cigarettes — or taking them up for the first time — in a dangerous bid to lower their nicotine intake and ultimately get off their vapes.

“Isn’t it ironic that to quit juul I bought cigarettes,” says one Twitter user. Another points out that it’s “strange” that she used the device to quit smoking cigarettes but is now “far more addicted to my Juul than I ever was to cigs.”

“It sucks,” she said.

Lucas McClain holds a pack of cigarettes and his Juul at his home in Arlington, Va. McClain is back to smoking cigarettes in the hope of quitting the Juul. (Lynne Shallcross/KHN)

It isn’t a complete surprise that some young people are “going back to the product they were trying to quit in the first place,” said Pamela Ling, a professor of medicine at the University of California-San Francisco who studies tobacco and its marketing.

But it is worrisome because cigarettes contain toxins and chemicals that are dangerous to their health, she said.

Vaping may not be safe either. The Centers for Disease Control and Prevention is investigating more than 450 cases of lung disease in 33 states — mostly among young people — possibly linked to vaping nicotine and marijuana. Six people have died. California is investigating at least 60 cases.

The back-to-smoke trend flies in the face of the e-cig industry’s most insistent PR pitch: Vaping helps people quit smoking cigarettes. In fact, San Francisco-based Juul Labs, which commands 75% of the e-cig market, says in its mission statement that the company aims to eliminate cigarettes by giving adult smokers “the tools to reduce or eliminate their consumption entirely.”

In an emailed statement, Juul didn’t directly address the decision by some of its users to revert to cigarettes, but again clung to the refrain that its products are “designed to help adult smokers switch from combustible cigarettes to an alternative nicotine delivery system.”

Ted Kwong, a Juul spokesman, said Juul is not designed to get people off nicotine or to treat nicotine dependence.

For those who criticize Juul’s high nicotine content, Kwong noted that pods come in two strengths — 5% and 3% nicotine concentrations — letting users customize their “switching journey.”

Monday, the Food and Drug Administration reprimanded Juul for promoting its products as being safer than cigarettes without FDA permission. It gave Juul 15 business days to respond.

Vaping has become big business, with the global market projected to hit $48 billion by 2023.

Smoke or vapor, cigarette makers win either way. Altria, which sells Marlboro and other tobacco brands in the U.S., invested nearly $13 billion in Juul for a 35% stake last year. Altria has proposed reuniting with Philip Morris International, a unit it sold off in 2008.

One Juul pod provides about 200 puffs and can contain as much nicotine as a pack of cigarettes. As young adults realize how potent the Juul and other e-cigarettes can be, some are turning back to combustible cigarettes. (Ana B. Ibarra/KHN)

Even though the industry says vaping is intended for adults, Juul and other vaping pens took off among young people about two years ago when teens began taking the devices to school and teachers mistook them for flash drives. Students took hits in campus bathrooms and halls, and even in class when teachers weren’t looking.

The e-liquids inhaled from the devices contain nicotine and come in thousands of fruity flavors that appeal to kids.

Michigan last week became the first state to ban sales of flavored e-cigarettes in an attempt to end teen vaping. In June, the San Francisco Board of Supervisors banned the sale of all e-cigarettes, beginning in early 2020. Juul is fighting back with a November ballot measure, Proposition C, backed by millions of its own dollars.

Many former smokers attest that vaping was the only thing that helped them quit cigarettes, but the science is mixed. Some studies have shown that many vapers continue to smoke cigarettes.

The FDA has approved seven treatments for smoking cessation, including patches, gums and lozenges. Vapes are not among them, said Dr. Elisa Tong, an associate professor of medicine at the University of California-Davis.

Tong said vapers may be using more nicotine than they realize. She understands why some choose to go back to cigarettes, but she doesn’t recommend it.

“What they’re doing is trying to taper down super high levels of nicotine,” she said. “Unfortunately, manufacturers don’t have a manual on how to quit their devices.”

Dr. Amanda Graham, senior vice president of innovations at the Truth Initiative, an anti-tobacco advocacy group, said she is seeing “desperation and misguided approaches” from teens and young adults trying to free themselves from nicotine.

“Young people are fumbling in the dark with what seems logical,” Graham said. “But there is no safe level of cigarette smoking.”

Early this year, Graham’s group launched a digital program to help teens and young adults quit their vaping devices. Since then, 41,000 people between 13 and 24 have enrolled in “This is Quitting,” which sends them tips and support via text messages.

Chris Gatus of Whittier, Calif., switched from traditional cigarettes to Juul because he thought the device would help him quit smoking, he said.

But because his Juul is always glued to his palm, he found himself using it everywhere and all the time.

“I’ve sort of forgotten what it’s like not to be on nicotine,” said Gatus, 21.

He switched back to cigarettes this year after noticing his growing addiction, but that only resulted in his using both. Now he’s trying different vaping pens, looking for something less harsh than the Juul or cigarettes, he said.

Last week, Ryan Hasson of New York City threw out his Juul after experiencing strong chest pains and labored breathing when exercising — and after hearing about the growing number of vape-related illnesses. He had never felt such strong symptoms when he smoked old-fashioned cigarettes, he said.

“I don’t plan on ever smoking again, but if I had to choose, I would much rather buy cigarettes over a Juul,” said Hasson, 25.

The same is true of his friends, he said.

“I think a lot of people are quitting completely or going back to cigarettes,” he said. “They’re waking up to the reality that maybe this isn’t as safe as we once thought.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Landmark Bill Offering Protections To Workers In California’s Gig Economy Heads To Governor’s Desk

“These so-called gig companies present themselves as the innovative future of tomorrow,” said state Sen. María Elena Durazo (D-Los Angeles). “A future where companies don’t pay Social Security or Medicare, workers’ compensation or unemployment insurance.” Democratic Gov. Gavin Newsom, who was initially on the fence, endorsed the bill earlier this month and has committed to signing it.