Hannah Jones credits paid medical leave with helping her survive an aggressive form of breast cancer.

Her employer provided time off for chemotherapy treatments and to recover from surgery. Most importantly: Jones didn’t have to delay care for work, something doctors warned against.

“I am cancer-free because I followed the treatment plan,” the 35-year-old said. “I am an example of how paid (medical leave) makes a huge difference in the life and survival of a cancer patient.”

More states are passing or considering laws that require employers to offer leave like this. Advocates say these laws can reduce financial stress and make workers more productive. But some measures also stress employers, and the patchwork nature of different state laws can create frustration.

Paid family and medical leave allows workers time off to undergo a treatment or care for a family member or a new child.

Separately, more states and cities also are requiring paid sick time, which helps people deal with shorter-term illnesses like the flu. Nineteen states plus Washington, D.C., have laws requiring paid sick time, as do 17 cities and four counties, according to the non-profit National Partnership for Women and Families.

Many employers also offer paid sick time without a government mandate.

Laws requiring longer-term paid family and medical leave are less common. Thirteen states and D.C. require some version of it, according to the National Partnership.

Details of these laws can vary by state. Some, for example, allow employers to provide only partial pay for certain types of leave.

Some states or municipalities also have laws requiring specific types of paid time off. New York recently enacted a paid leave law for prenatal medical checkups. Some laws also give people time off to care for themselves or a family member dealing with domestic violence or sexual assault.

There is no federal law requiring paid leave. The Family and Medical Leave Act guarantees only unpaid time off. It also doesn’t apply to a large chunk of the workforce, including employees of small businesses that are exempt.

This makes the U.S. a “major outlier” globally, according to Aleta Sprague of UCLA’s World Policy Analysis Center. She said that 95% of countries provide some kind of paid leave for personal health.

“And in most countries that are our economic peers, it’s a substantial amount of leave,” she said.

Advocates say providing paid sick time can reduce the spread of disease.

It also can improve production by cutting down on “presenteeism,” or people showing up for work sick and unable to focus on their jobs, said Jessica Mason, a senior policy analyst with the National Partnership.

Paid leave for longer-term illnesses can help people focus on care and recovery.

Jones said she was able to take every Friday off for weeks during treatment to get chemotherapy. That gave her the weekend to be a “couch zombie” and recover before returning to work.

Paid leave also helped Jones and her husband stay afloat financially. They faced around $14,000 in medical bills even with insurance.

“We might have had to cash out our 401(k)s,” she said. “We might have had to sell our house if I hadn’t had that paycheck continue.”

Skye Nevada has cancelled plans to hire about 30 or 40 temporary employees for her Anchorage, Alaska, catering company and seasonal restaurant, The Bridge Co. She says she can’t afford her state’s new paid sick leave law.

Nevada said that when someone calls in sick, she would have to pay that person and their replacement, who would likely get overtime.

“To expect small businesses to just absorb this cost is crazy,” Nevada said, adding that the business will only host private events instead of opening to the public this summer during tourist season.

Small businesses often don’t have a separate human resources department to track compliance with mandated leave policies, noted Beth Milito of the National Federation for Independent Business.

“The paperwork is time, and time is money to a small business owner,” she said.

Experts say the patchwork nature of the laws can be an additional hassle for multi-state employers.

It affects patients too.

Jones, who is helping the nonprofit Children First advocate for a Pennsylvania family leave law, had paid leave through her New York-based employer.

But her husband’s Pennsylvania company didn’t offer it. That left the suburban Philadelphia resident cobbling together help from family members during treatment after her husband used his vacation time and had to return to work.

Sprague doesn’t see a federal law requiring paid leave happening anytime soon. But momentum is building in the states.

Voters in Missouri, Nebraska and Alaska approved paid sick leave laws in November.

At least seven states are considering paid family and medical leave laws this year, according to the National Conference of State Legislatures.

Mason says interest in paid leave has been building since the COVID-19 pandemic.

“The pandemic really brought to the forefront of everyone’s mind how important paid sick leave is,” she said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.