It has been legal to smoke pot for fun in Colorado since January 2014, and the state modeled itsÌýmarijuana driving-under-the-influence law on the one for alcohol. If a blood test shows aÌýcertainÌýlevel ofÌý, the mind-altering compound in marijuana, the law says you shouldn’t be driving.

It sounds straightforward, but consider the case of Abby McLean,Ìýa stay-at-home-mom from the Denver suburbs.

McLean, 30, was driving home from a late dinner with a friend two years ago when she came upon a DUI roadside checkpoint.

“I hadn’t drank or smoked anything, so I was like, ‘Let’s go through the checkpoint,'” she recalled.

McLean is a regular marijuana user but she insists she never drives while high.

It may sound like an open and shut case that could have resulted in any number of penalties. But McLean’s attorney, , had a field day in court with Colorado’s .

“Even the state’s experts will say that number alone is something, but generally not enough, and we really hammered that home,” he said.ÌýAschner got a hung jury and McLean pleaded to a lesser offense.

Still, McLean’s trip through the criminal justice system is emblematic of numbers that suggest a sharp increase in marijuana DUI arrests in Colorado. So far this year, State Patrol data show that total DUI citations this year rose to 398 through early July, compared with 316 in for the same period 2015.

It turns out, measuring a person’s THC is actually a of intoxication. Unlike alcohol, THC gets stored in your fat cells, and isn’t water-soluble like alcohol, saidÌý, co-director of the Center for Medicinal Cannabis Research at the University of California, San Diego.

“Unlike alcohol, which has a generally linear relationship between the amount of alcohol you consume, your breath alcohol content and driving performance, the THC route of metabolism is very different,” Marcotte said.

That’s why adapting drunk driving laws to marijuana makes for bad policy, saidÌý, a professor of public policy at New York University. “You can be positive for THC a week after the last time you used cannabis,” he said. “Not subjectively impaired at all, not impaired at all by any objective measure, but still positive.”

Still, Colorado and five other states have such laws on the books because pretty much everyone agrees that driving stoned can be dangerous, especially when combined with alcohol.

What police say theyÌýreally need is a simple roadside sobriety test. Scientists at UCSD are among researchers on several apps that could measure how impaired a driver is. One has a person follow a square moving around a tablet screen with a finger, which measures something called “critical tracking.” Another app measures time distortion, because things can slow way down when a person is high.

Those tests are still experimental.

Denver District Attorney Mitch Morrissey said the uncertainty doesn’t mean Colorado should throw out its THC blood test. He said it may not be perfect, but it gives juries another piece of evidence to consider at trial.

“I think that putting in a nanogram level makes sense,” said Morrissey. “I can’t tell you what level it should be. I don’t think Colorado’s is right. I don’t think it should be as high as it is. I think it should be lower.”

Morrissey remembers trying alcohol DUI cases as a young prosecutor. The science wasn’t settled then either, the blood alcohol standard was about twice as high as it is now, and it took years for it to be lowered.

“I think that has to do with better testing better technology,” which Morrissey said will improve eventually for marijuana too.

In the meantime, some regular marijuana users, like Abby McLean, are scared to drive for fear of failed blood tests.

“I haven’t gone out really since then, because I’m paranoid to run into the same surprise, ‘Oh oh, there’s a DUI checkpoint.'”

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When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.

But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.

Her assertions greatly distressedÌýDr. Pamelyn Close, a palliative care specialist in Los Angeles.

“It did terrible damage to the concept of having this conversation,” she said.

Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.

“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”

“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.

“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.

But patients seem to want these talks. A 2012 study by the California HealthCare Foundation found thatÌýÌýof Californians would like to have an end-of-life conversation with their physician, but fewer than one in 10 has done so.

Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, saidÌý, an internist with Cedars-Sinai Medical Center in Los Angeles.

“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.

, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.

“What it does is, it gives this really important conversation dignity and standing,” she said.

In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a , which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.

Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.

“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.

She did it, she said, to make sure her last hours are as comfortable as possible.

“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”

In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.

, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.

“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.

From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.

“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”

Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.

“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”

Farwell wants her sons to be in a better position when it comes to carrying out her wishes.

The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.

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“I felt like I was beating up people up at the end of their life,” she says.

It looks nothing like what people see on TV. In real life, ribs often break and few survive the ordeal.

Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.

“I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew it very likely was not going to be successful. It just seemed a terrible way to end someone’s life.”

Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford UniversityÌýÌýshows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.

It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us.

“He had died at home, and it occurred to me that I couldn’t remember any of our colleagues who had actually died in the hospital,” Murray says. “That struck me as quite odd, because I know that most people do die in hospitals.”

Murray began talking about it with other doctors.

“I fit with the vast majority that want to have a gentle death, and don’t want extraordinary measures taken when they have no meaning,” Murray says.

A majority of seniorsÌýÌýfeeling the same way. Yet, they often die while hooked up to life support. And only about one in 10 doctors report having conversations with their patients about death.

One reason for the disconnect, says Dr. Babak Goldman, is that too few doctors are Ìýabout death with their patients. “We’re trained to prolong life,” he says.

Goldman is a palliative care specialist at Providence Saint Joseph’s Medical Center in Burbank, Calif., and he says that having the tough talk may feel like a doctor is letting a family down.

“I think it’s sometimes easier to give hope than to give reality,” Goldman says.

Goldman read Murray’s essay as part of his residency. Goldman too would prefer to die without heroic measures, he says, and knowing how doctors die is important information for patients.

“If they know that this is what we’d want for ourselves and for our own families, that goes a long way,” he says.

In addition, Medicare does not pay doctors for end-of-life planning meetings with patients.

Nora Zamichow wishes she had read Murray’s essay sooner. The Los Angeles-based freelance writer says she and her husband, Mark Saylor, likely would have made different treatment decisions for Saylor’s brain tumor if they had.

Zamichow says that an arduous regimen of chemotherapy and radiation left her 58-year-old husband unable to walk, and ultimately bedridden, in his final weeks.

“At no point,” she says, “did any doctor say to us, ‘You know, what about not treating?’ ”

Zamichow realized after reading Murray’s essay that doing less might have offered her husband more peace in his final days.

“What Ken’s article spelled out for me was, ‘Wait a minute, you know, we did not get the full range of options,’ ” she says.

But knowing how much medical intervention at the end of life might be most appropriate for a particular person requires .

Murray says he hopes his essay will spur more physicians to initiate these difficult discussions with patients and families facing end-of-life choices.

This story is part of a partnership that includesÌý,ÌýÌýand Kaiser Health News.

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The unit has become a vital resource for the 10,000-person police force in Los Angeles.

Officer Ted Simola and his colleagues in the unit work with county mental health employees to provide crisis intervention when people with mental illnesses come into contact with police.

On this day, Simola is working the triage desk on the sixth floor at LAPD headquarters.

Triage duty involves helping cops on the scene evaluate and deal with people who may be experiencing a mental health crisis.

He gets a call involving a 60-year-old man with paranoid schizophrenia. The call is typical of the more than 14,000 fielded by the unit’s triage desk last year.

“The call came out as a male with mental illness,” says the officer on the scene to Simola. “I guess he was inside of a bank. They said he was talking to himself. He urinated outside.”

If it were another department, this man might be put into the back of a police car and driven to jail, so that the patrol officer could get back to work more quickly. But LAPD policy requires all officers who respond to a call in which mental illness may be a factor to phone the triage desk for assistance in evaluating the person’s condition.

Officer Simola talks to the officer on the scene. “Paranoid? Disorganized? That type of thing?” The officer answers, “Yeah, he’s talking a lot about Steven Seagal, something about Jackie Chan.”

Simola replies, “OK, does he know what kind of medication he’s supposed to have?” They continue talking.

The triage officers are first and foremost a resource for street cops. Part of their job entails deciding which calls warrant an in-person visit from the unit’s 18 cop-clinician teams. These teams, which operate as second responders to the scene, assisted patrol officers in more than 4,700 calls last year.

Sometimes their work involves high-profile interventions, such as helping S.W.A.T. teams with dangerous standoffs or talking a jumper off a ledge. But on most days it involves relieving patrol officers of time-consuming mental health calls like the one Simola is helping to assess.

The man involved in this call has three outstanding warrants for low-grade misdemeanors, including public drinking. Technically, any of them qualifies him for arrest. But Simola says he won’t be carted off to jail.

“He’ll have to appear on the warrants later,” Simola says, “but immediately he’ll get treated for his mental health.”

That’s the right approach, saysÌý, legal director at the American Civil Liberties Union of Southern California. “The goal is to make sure that people who are mentally ill, who are not a danger to the community, are moved towards getting treatment and services as opposed to getting booked and taken into the jail.”

“It requires a lot more work,” he says.

For nearly a decade, the LAPD has helped train dozens of agencies both in and out of the U.S. in this type of specialized policing. Its emphasis is diversion over incarceration, for those who qualify.

Lt. Lionel Garcia commanded the unit for seven years until his retirement in April.

“Low-grade misdemeanors, we’ll try to divert them to placement rather than an arrest,” he says.

But, he continues, “if it’s a felony in this city, they’re going to jail.”

Last year, Garcia says, about 8 1/2 percent of the calls resulted in the person getting arrested and jailed. When that happens, he says the unit tracks the person through custody and then, upon their release, reaches out to them with links to services. “It’s just common sense,” he says.

“Jails were not set up to be treatment facilities,” saysÌý, who serves as criminal justice chairman for the LA County Council of the National Alliance On Mental Illness. “People get worse in jail.”

Gale and other mental health advocates praise the LAPD unit’s approach and call it a good first step. But for diversion to work well, they say, the city and county need to provide treatment programs at each point a mentally ill person comes into contact with the criminal justice system – from interactions with cops all the way through the courts.

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It’s the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of Northern California, opted to end her life via physician-assisted suicide in Oregon last fall. ÌýMaynard’s quest for control over continues to galvanize the “aid-in-dying” movement nationwide, with legislation pending in and a states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

“Wanting the pain to stop, wanting the humiliating side effects to go away – that’s absolutely natural,” Packer says. “I absolutely have been there, and I still get there some days. But I don’t get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn’t have to be.”

A recent spring afternoon in Packer’s kitchen is a good day, as she prepares lunch with her four children.

“Do you want to help?” she asks the eager crowd of siblings gathered tightly around her at the stovetop.

“Yeah!” yells 5-year-old Savannah.

“I do!” says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.

Diagnosis and pain

In 2012, after suffering a series of debilitating lung infections, she went to a doctor whoÌýÌý The autoimmune disease causes hardening of the skin and, in about a third of cases, other organs. The doctor told Packer that it had settled in her lungs.

“And I said, ‘OK, what does this mean for me?'” she recalls. “And he said, ‘Well, with this condition…you have about three years left to live.'”

Initially, Packer recalls, the news was just too overwhelming to talk about with anyone –including her husband.

“So we just…carried on,” she says. “And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant.”

Packer, 32, is on oxygen full time and takes a slew of medications.

She says she has been diagnosed with a series of conditions linked to or associated with scleroderma, including the auto-immune disease, lupus, and gastroparesis, a disorder that interferes with proper digestion.

Packer’s various maladies have her in constant, sometimes excruciating pain, she says, noting that she also can’t digest food properly and is always “extremely fatigued.”

Some days are good. Others are consumed by low energy and pain that only sleep can relieve.

“For my kids, I need to be able to control the pain because that’s what concerns them the most,” she adds.

Ìý

Even so, Brian says, life is good.

“I have four beautiful children. I get to spend so much more time with them than most head of households,” he says. “I get to spend more time with my wife than most husbands do.”

And it’s that kind of supportÌý from family, friends and those in her communityÌý that Stephanie says keeps her living in gratitude, even as she struggles with the realization that she will not be there to see her children grow up.

“I know eventually that my lungs are going to give out, which will make my heart give out, and ÌýI know that’s going to happen sooner than I would like — sooner than my family would like,” she says. “But I’m not making that my focus. My focus is today.”

Stephanie says she is hoping for a double-lung transplant, which could give her a few more years. In the meantime, next month marks three years since her doctor gave her three years to live.

So every day, she says, is a blessing.

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And they’re unlikely to. Many people are uninterested in health insurance, confused or skeptical. Here are some examples:

— Scott Belsha, from Long Beach, falls in the Ìý“skeptical” category. “I’ve been consumed with living my life, and I’m fortunate to be healthy,” he says. He works as a musician and carpenter, and he’s never had health insurance — not even as a kid. His parents, who own a small business, always paid cash for medical care — most of which they were able to get from a doctor friend. He adds: “I haven’t ever been to the hospital or broken a bone. But I’m 34, and I should probably start thinking about it.”

— Steven Petersen, 40, of Los Angeles said he looked into his options, but couldn’t afford $240 a month, the lowest premium he could find. “My mom’s been calling every day saying, ‘You need to get health insurance,'” said Petersen, who manages a West Hollywood health store. “But I’m a pretty healthy guy, so I really don’t see the point of it because it’s so expensive.” He’d prefer a cheap catastrophic coverage plan, but those are only offered to consumers under 30 years old or people with hardship exemptions.

— Lorenzo Hebert, 47, of Los Angeles works at a Pasadena thrift store that doesn’t provide job-based health insurance to part-timers. He, too, says he’s shied away from buying insurance, mostly because he just hasn’t had time to figure out exactly what he’s supposed to do. “I’ve seen it on TV, but never had the time I could do it,” Hebert says.

Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, said he wasn’t expecting every uninsured person to sign up during this first year. (Kaiser Health News is an editorially independent program of the foundation.)

“We’re really early on,” Levitt said. “The expectations are that enrollment will ramp up both in Medi-Cal and Covered California over a period of years.”

Under the health law, most people earning less than about $16,000 a year are eligible for low- or no-cost health insurance through

The Congressional Budget Office estimates that, even years from now, the number of uninsured will remain significant: about 30 million nationwide. Some portion will be those who live in states that have not opted to expand their Medicaid program to adults without dependent children; others will be immigrants who don’t qualify for coverage under the law. “But the biggest category are people who simply will choose either not to enroll in Medicaid or not to buy private insurance,” Levitt says.

-Beth Engel, in Ventura County, Ìýknows the tax penalty for those who don’t have insurance would be much cheaper than paying for premiums. The 32-year-old mother of a nearly 3-year-old daughter, describes herself as among the early supporters of the ACA. “I was very hopeful” when the Affordable Care Act passed, she said. “I thought, ‘Wow! I can have a job that I love that doesn’t’ necessarily have insurance but I get insurance affordably.'” Engel, works part time as a hotel clerk and qualifies for tax subsidies that reduce premiums for her and her toddler to about $200 a month.

But she chose not to buy insurance for herself this year. “I found that the premiums were still very high, and I just couldn’t afford them,” says Engel.

Even though now she’s armed with the knowledge she can take the subsidy upfront in the form of a reduced insurance premium each month, she says she’s hesitant without thoroughly understanding the plans offered through the state-run marketplace, Ìý

“Maybe I’m reading these incorrectly,” she said, “but it just didn’t make sense, and I thought I’m not going to put money I don’t really have to spend into a program that I don’t really understand.”Ìý

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It’s here in these edit bays that small feature films and episodic television dramas likeÌýGrey’s Anatomy,ScandalÌýandÌýPerson of InterestÌýget primped and polished for prime-time viewing.

But while about 45 employees work here to make Hollywood magic happen, general manager Sunder Ramani is focused on the less exotic work of paying the bills and figuring out how to provide insurance to about 15 employees who don’t have union-provided health coverage.

“Up until about two years ago, we had probably the Cadillac of plans for our employees,” he says. “We picked up 100 percent of that plan, which was, I think, a huge tool in our arsenal in terms of getting good people to come work for us.”

Double-digit premium increases in recent years have forced Ramani to downgrade his employee coverage, which his insurance broker has warned may soon soar another 25 to 35 percent above last year’s increase.

“Which is a significant hit,” Ramani says, “but they can’t tell me enough yet until we get closer to that time. So I’m here in a limbo world trying to decide what it is I’m going to do.”

One new option he’ll soon have is to buy insurance through Covered California’sÌý, theÌýSmall Business Health Options Program. It’s California’s version of a small-business insurance exchange that is part of the federal Affordable Care Act.

All states are offering similar small-business exchanges. These are marketplaces for employers with 50 or fewer full time workers, and are designed to offer more affordable insurance to mom-and-pop businesses that have long had to pay more than large companies for the same level of coverage.

“At Covered California we’re going to give small businesses a way to buy better,” according to Peter Lee, executive director of Covered California. The state has 500,000 small businesses.

Peter Harbage, president of the Sacramento-based health policy firmÌý,Ìýthinks Obamacare will benefit the nation’s small companies.

“Today, small businesses are horribly disadvantaged in terms of being able to purchase insurance,” he said. “If they’re even able to purchase it, they have to pay more and they get less.”

He thinks not only will SHOP plans have competitive prices, they will also offer tax benefits that for some smaller companies may cut premium prices in half.Ìý

‘A Lot Of Uncertainties?’

ButÌýÌýis not so optimistic. He heads the National Federation of Independent businesses, which represents more than 22,000 small businesses statewide

“There are a lot of uncertainties as it relates to the law,” he said. “We are hopeful that they will find affordable coverage within the exchange. We are hopeful they will have the ability to pick and choose in the marketplace.”

But he thinks business owners will need to closely inspect the policies offered as some participating insurance companies have announced they’re keeping premiums lower by offering a smaller network of doctors and hospitals. And that means fewer choices for consumers.

And what’s more, he notes, whether or not a small business opts to provide workers health coverage, there’s really no way for them to avoid the extra time and cost it’ll take to navigate the new law’s reporting requirements.Ìý

That’s a concern shared by Westwind’s Sunder Ramani: “Small business doesn’t have scale. We don’t have a legal department we don’t have an HR department we navigate through mountains of regulations, not just about health care but about everything we do here. We’re just getting bombarded on all levels,” he said.

For now Ramani will sit tight and watch before deciding whether the SHOP marketplace will provide him a better way to buy affordable, quality health insurance for his employees.

Under Affordable Care Act, small businesses are not required to provide insurance to their workers. Only those with more than 50 employees must do so, beginning in 2015.

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

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The federal health law allows states to charge smokers up to 50 percent more for a health plan – but legislation that will make sure that doesn’t happen.

And unlike other efforts around the country to alter the law, this is one coming from a Democrat.

The Affordable Care Act is supposed to remove discrimination in the pricing of health insurance for things like gender and a person’s medical condition. And some say a tobacco surcharge creates a new category of discrimination that singles out smokers.

Furthermore, the surcharge would mean people who smoke would not get the benefit of the federal subsidy that’s supposed to make buying insurance more affordable for many, says Karen Pollitz of the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“So if you’re a low-income person and you would otherwise be buying a $6,000 policy but qualify for a subsidy that would buy it down to $3,000. Well, the tobacco surcharge would knock it back up to 6,000 again,” Pollitz says.

If state opted for the maximum surcharge, health insurance would become unaffordable for those with the lowest incomes, according to Rick Curtis, president of the Institute for Health Policy Solutions in Washington D.C. And, he points out, that is the group that’s most likely to smoke:Ìý“For somebody who is totally hooked after many years and older…and those kinds of people are more expensive and often do need more medical care – they have two bad choices: go without health insurance and be impoverished that way or get health insurance and be impoverished.”

The Centers for Disease Control and Prevention says tobacco use costs the nation about $190 billion in medical care and lost productivity each year.

And that’s exactly why health policy analyst Micah Weinberg, with the Bay Area Council in the San Francisco region, thinks higher rates for smokers make sense.

“If we’re ultimately interested in bringing down the price of health care for everybody, including low-income folks, then we need to make sure we get a handle on unhealthy behaviors such as smoking.”

Weinberg says higher insurance premiums for tobacco users – as long as they’re not too high – provide the type of financial penalties that work. Research shows a financial hit causes people to quit smoking. By contrast, he says, banning higher rates because smoking disproportionately affects the poor, reflects paternalistic policy-making that doesn’t fix the problem.

“I think we have to be very careful what types of favors we’re doing for people,” Weinberg says. “Because if the end result of this policy is greater numbers of smokers, then that’s not actually helping the populations that we’re trying to help.”

But California Democratic Assemblyman Richard Pan of Sacramento disagrees. He’s a pediatrician and he believes rate hikes of any amount on smokers’ premiums may dissuade some from buying health insurance all together.

“We want smokers to actually have health care coverage,” Pan says. “And through having health care coverage they will have access to smoking cessation treatment as well as, of course, health care.”

And for many – in California, at least – that . Pan’s proposed law has so far encountered no formal opposition – be it from anti-smoking groups, cigarette companies, insurance companies or the American Lung Association.

Officials at the American Lung Association’s California branch said in a written statement that because it’s so hard to quit smoking, it’s essential to provide tobacco users with affordable health insurance.Ìý

It is not the first time the California legislature has tackled the issue. According to , the surcharge has already been eliminated for people who work for small businesses, and a bill similar to Pan’s passed both chambers last year only to be vetoed by Gov. Jerry Brown, who was reluctant to establish rules for the new exchange too early. The new bill appears to be on track. “I expect it to pass,” Dylan Roby of the UCLA Center for Health Policy Research told the Star.

If it does, California will join Massachusetts, Vermont, Rhode Island and the District of Columbia in making sure smokers aren’t charged more under the federal law.

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