Science
California hospitals scramble on earthquake retrofits as state limits extensions
More than half of the 410 hospitals in California have at least one building that probably wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming that they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.
Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Assn. that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural or “distressed” hospitals to get an extension of up to three years.
“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a$25-million retrofit of its hospital in Alameda, on an island beside Oakland.
The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.
The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.
Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.
“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”
The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.
Hospital administrators have long complained about the steep cost of seismic retrofits.
“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” Carmela Coyle, president and chief executive of the California Hospital Assn., wrote in a letter to Newsom before he vetoed the CHA bill. A 2019 Rand Corp. study paid for by the CHA pinned the price of meeting the 2030 standards at $34 billion to $143 billion statewide.
Labor unions representing nurses and other medical workers, however, say that hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.
“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Assn., said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”
In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”
He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.
But he signed a third bill, which allows small, rural and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.
The state designates 37 hospitals as providing “critical access.” An additional 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.
Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.
The Rand study estimated the average cost of a retrofit at more than $92 million per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.
Small and rural hospitals can get some aid from the state through grants financed by the California Electronic Cigarette Excise Tax, but Andrew DiLuccia, spokesperson for the Department of Health Care Access and Information, said that would yield just $2 million to $3 million total annually. He added that the Small and Rural Hospital Relief Program also has received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.
Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”
Stebbins has had to help her district figure out a plan.
After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back a loan.
The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled-nursing facility. The construction work is set to be completed in 2027.
“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler of Alameda Health System said. “How do we make sure that they get what they need to stay open?”
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.
Science
A push to end a fractured approach to post-fire contamination removal
The patchwork efforts to identify and safely remove contamination left by the 2025 Eaton and Palisades fires has been akin to the Wild West.
Experts have given conflicting guidance on best practices. Shortly after the fires, the federal government suddenly refused to adhere to California’s decades-old post-fire soil-testing policy; California later considered following suit.
Meanwhile, insurance companies have resisted remediation practices widely recommended by scientists for still-standing homes.
A new bill introduced this week by state Assemblymember John Harabedian (D-Pasadena) aims to change that by creating statewide science-based standards for the testing and removal of contamination deposited by wildfires — specifically within still-standing homes, workplaces and schools, and in the soil around those structures.
“In a state where we’ve had a number of different wildfires that have happened in urban and suburban areas, I was shocked that we didn’t have a black-and-white standard and protocol that would lay out a uniform post-fire safety standard for when a home is habitable again,” Harabedian said.
The bill, AB 1642, would task the state’s Department of Toxic Substances Control with creating standards by July 1, 2027. The standards would only serve as guidance — not requirements — but even that would be helpful, advocates say.
“Guidance, advisories — those are extremely helpful for families that are trying to return home safely,” said Nicole Maccalla, who leads data science efforts with Eaton Fire Residents United, a grassroots organization addressing contamination in still-standing homes. “Right now, there’s nothing … which means that insurance companies are the decision-makers. And they don’t necessarily prioritize human health. They’re running a business.”
Maccalla supports tasking DTSC with determining what levels of contamination pose an unacceptable health risk, though she does want the state to convene independent experts including physicians, exposure scientists and remediation professionals to address the best testing procedures and cleanup techniques.
Harabedian said the details are still being worked out.
“What’s clear from my standpoint, is, let’s let the public health experts and the science and the scientists actually dictate what the proper standards and protocol is,” Harabedian said. “Not bureaucrats and definitely not insurance companies.”
For many residents with still-standing homes that were blanketed in toxic soot and ash, clear guidance on how to restore their homes to safe conditions would be a much welcome relief.
Insurance companies, environmental health academics, and professionals focused on addressing indoor environmental hazards have all disagreed on the necessary steps to restore homes, creating confusion for survivors.
Insurance companies and survivors have routinely fought over who is responsible for the costs of contamination testing. Residents have also said their insurers have pushed back on paying for the replacement of assets like mattresses that can absorb contamination, and any restoration work beyond a deep clean, such as replacing contaminated wall insulation.
Scientists and remediation professionals have clashed over which contaminants homeowners ought to test for after a fire. Just last week, researchers hotly debated the thoroughness of the contamination testing at Palisades Charter High School’s campus. The school district decided it was safe for students to return; in-person classes began Tuesday.
Harabedian hopes the new guidelines could solidify the state’s long-standing policy to conduct comprehensive, post-fire soil testing.
Not long after the federal government refused to adhere to the state’s soil testing policy, Nancy Ward, the former director of the California Governor’s Office of Emergency Services, had privately contemplated ending state funding for post-fire soil testing as well, according to an internal memo obtained by The Times.
“That debate, internally, should have never happened,” Harabedian said. “Obviously, if we have statewide standards that say, ‘This is what you do in this situation,’ then there is no debate.”
Science
Expiration of federal health insurance subsidies: What to know in California
Thousands of middle-class Californians who depend on the state-run health insurance marketplace face premiums that are thousands of dollars higher than last year because enhanced federal subsidies that began during the COVID-19 pandemic have expired.
Despite fears that more people would go without coverage with the end of the extra benefits, the number enrolling in Covered California has held steady so far, according to state data.
But that may change.
Jessica Altman, executive director of Covered California, said that she believes the number of people dropping their coverage could increase as they receive bills with their new higher premiums in the mail this month. She said better data on enrollment will be available in the spring.
Altman said that even though the extra benefits ended Dec. 31, 92% of enrollees continue to receive government subsidies to help pay for their health insurance. Nearly half qualify for health insurance that costs $10 or less per month. And 17% of Californians renewing their Covered California policies will pay nothing for premiums if they keep their current plan.
The deadline to sign up for 2026 benefits is Saturday.
Here’s help in sorting out what the expiration of the enhanced subsidies for insurance provided under the Affordable Care Act, often called Obamacare, means in the Golden State.
What expired?
In 2021, Congress voted to temporarily to boost the amount of subsidies Americans could receive for an ACA plan. The law also expanded the program to families who had more money. Before the vote, only Americans with incomes below 400% of the federal poverty level — currently $62,600 a year for a single person or $128,600 for a family of four — were eligible for ACA subsidies. The 2021 vote eliminated the income cap and limited the cost of premiums for those higher-earning families to no more than 8.5% of their income.
How could costs change this year for those enrolled in Covered California?
Anyone with income above 400% of the federal poverty level no longer receives subsidies. And many below that level won’t receive as much assistance as they had been receiving since 2021. At the same time, fast-rising health costs boosted the average Covered California premium this year by more than 10.3%, deepening the burden on families.
How much would the net monthly premium for a Los Angeles couple with two children and a household income of $90,000 rise?
The family’s net premium for the benchmark Silver plan would jump to $699 a month this year from $414 a month last year, according to Covered California. That’s an increase of 69%, costing the family an additional $3,420 this year.
Who else could face substantially higher health bills?
People who retired before the Medicare-qualifying age of 65, believing that the enhanced subsidies were permanent, will be especially hit hard. Those with incomes above 400% of the federal poverty level could now be facing thousands of dollars in additional health insurance costs.
How did enrollment in Covered California change after the enhanced subsidies expired on Dec. 31?
As of Jan. 17, 1,906,033 Californians had enrolled for 2026 insurance. That’s less than 1% lower than the 1,921,840 who had enrolled by this time last year.
Who depends on Covered California?
Enrollees are mostly those who don’t have access to an employer’s health insurance plan and don’t qualify for Medi-Cal, the government-paid insurance for lower-income people and those who are disabled.
An analysis by KFF, a nonprofit that provides health policy information, found that nearly half the adults enrolled in an ACA plan are small-business owners or their employees, or are self-employed. Occupations using the health insurance exchanges where they can buy an ACA plan include realtors, farmers, chiropractors and musicians, the analysis found.
What is the underlying problem?
Healthcare spending has been increasing faster than overall inflation for years. The nation now spends more than $15,000 per person on healthcare each year. Medical spending today represents about 18% of the U.S. economy, which means that almost one out of every five dollars spent in the U.S. goes toward healthcare. In 1960, health spending was just 5% of the economy.
What has California done to help people who are paying more?
The state government allocated $190 million this year to provide subsidies for those earning up to 165% of the federal poverty level. This money will help keep monthly premiums consistent with 2025 levels for those with an annual income of up to $23,475 for an individual or $48,225 for a family of four, according to Covered California.
Where can I sign up?
People can find out whether they qualify for financial help and see their coverage options at the website CoveredCA.com.
What if I decide to go without health insurance?
People without insurance could face medical bills of tens of thousands of dollars if they become sick or get injured. And under California state law, those without coverage face an annual penalty of at least $900 for each adult and $450 for each child.
Science
Department of Education finds San Jose State violated Title IX regarding transgender volleyball player
The U.S. Department of Education has given San José State 10 days to comply with a list of demands after finding that the university violated Title IX concerning a transgender volleyball player in 2024.
A federal investigation was launched into San José State a year ago after controversy over a transgender player marred the 2024 volleyball season. Four Mountain West Conference teams — Boise State, Wyoming, Utah State and Nevada-Reno — each chose to forfeit or cancel two conference matches to San José State. Boise State also forfeited its conference tournament semifinal match to the Spartans.
The transgender player, Blaire Fleming, was on the San José State roster for three seasons after transferring from Coastal Carolina, although opponents protested the player’s participation only in 2024.
In a news release Wednesday, the Education Department warned that San José State risks “imminent enforcement action” if it doesn’t voluntarily resolve the violations by taking the following actions, not all of which pertain solely to sports:
1) Issue a public statement that SJSU will adopt biology-based definitions of the words “male” and “female” and acknowledge that the sex of a human — male or female — is unchangeable.
2) Specify that SJSU will follow Title IX by separating sports and intimate facilities based on biological sex.
3) State that SJSU will not delegate its obligation to comply with Title IX to any external association or entity and will not contract with any entity that discriminates on the basis of sex.
4) Restore to female athletes all individual athletic records and titles misappropriated by male athletes competing in women’s categories, and issue a personalized letter of apology on behalf of SJSU to each female athlete for allowing her participation in athletics to be marred by sex discrimination.
5) Send a personalized apology to every woman who played in SJSU’s women’s indoor volleyball from 2022 to 2024, beach volleyball in 2023, and to any woman on a team that forfeited rather than compete against SJSU while a male student was on the roster — expressing sincere regret for placing female athletes in that position.
“SJSU caused significant harm to female athletes by allowing a male to compete on the women’s volleyball team — creating unfairness in competition, compromising safety, and denying women equal opportunities in athletics, including scholarships and playing time,” Kimberly Richey, Education Department assistant secretary for civil rights, said.
“Even worse, when female athletes spoke out, SJSU retaliated — ignoring sex-discrimination claims while subjecting one female SJSU athlete to a Title IX complaint for allegedly ‘misgendering’ the male athlete competing on a women’s team. This is unacceptable.”
San José State responded with a statement acknowledging that the Education Department had informed the university of its investigation and findings.
“The University is in the process of reviewing the Department’s findings and proposed resolution agreement,” the statement said. “We remain committed to providing a safe, respectful, and inclusive educational environment for all students while complying with applicable laws and regulations.”
In a New York Times profile, Fleming said she learned about transgender identity when she was in eighth grade. “It was a lightbulb moment,” she said. “I felt this huge relief and a weight off my shoulders. It made so much sense.”
With the support of her mother and stepfather, Fleming worked with a therapist and a doctor and started to socially and medically transition, according to the Times. When she joined the high school girls’ volleyball team, her coaches and teammates knew she was transgender and accepted her.
Fleming’s first two years at San José State were uneventful, but in 2024 co-captain Brooke Slusser joined lawsuits against the NCAA, the Mountain West Conference and representatives of San José State after alleging she shared hotel rooms and locker rooms with Fleming without being told she is transgender.
The Education Department also determined that Fleming and a Colorado State player conspired to spike Slusser in the face, although a Mountain West investigation found “insufficient evidence to corroborate the allegations of misconduct.” Slusser was not spiked in the face during the match.
President Trump signed an executive order a year ago designed to ban transgender athletes from competing on girls’ and women’s sports teams. The order stated that educational institutions and athletic associations may not ignore “fundamental biological truths between the two sexes.” The NCAA responded by banning transgender athletes.
The order, titled “Keeping Men Out of Women’s Sports,” gives federal agencies, including the Justice and Education departments, wide latitude to ensure entities that receive federal funding abide by Title IX in alignment with the Trump administration’s view, which interprets a person’s sex as the gender they were assigned at birth.
San José State has been in the federal government’s crosshairs ever since. If the university does not comply voluntarily to the actions listed by the government, it could face a Justice Department lawsuit and risk losing federal funding.
“We will not relent until SJSU is held to account for these abuses and commits to upholding Title IX to protect future athletes from the same indignities,” Richey said.
San José State was found in violation of Title IX in an unrelated case in 2021 and paid $1.6 million to more than a dozen female athletes after the Department of Justice found that the university failed to properly handle the students’ allegations of sexual abuse by a former athletic trainer.
The federal investigation found that San José State did not take adequate action in response to the athletes’ reports and retaliated against two employees who raised repeated concerns about Scott Shaw, the former director of sports medicine. Shaw was sentenced to 24 months in prison for unlawfully touching female student-athletes under the guise of providing medical treatment.
The current findings against San José State came two weeks after federal investigators announced that the California Community College Athletic Assn. and four other state colleges and school districts are the targets of a probe over whether their transgender participation policies violate Title IX.
The investigation targets a California Community College Athletic Assn. rule that allows transgender and nonbinary students to participate on women’s sports teams if the students have completed “at least one calendar year of testosterone suppression.”
Also, the Education Department’s Office of Civil Rights has launched 18 Title IX investigations into school districts across the United States on the heels of the Supreme Court hearing oral arguments on efforts to protect women’s and girls’ sports.
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