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'Miracle' weight-loss drugs could have reduced health disparities. Instead they got worse

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'Miracle' weight-loss drugs could have reduced health disparities. Instead they got worse

The American Heart Assn. calls them “game changers.”

Oprah Winfrey says they’re “a gift.”

Science magazine anointed them the “2023 Breakthrough of the Year.”

Americans are most familiar with their brand names: Ozempic, Wegovy, Mounjaro, Zepbound. They are the medications that have revolutionized weight loss and raised the possibility of reversing the country’s obesity crisis.

Obesity — like so many diseases — disproportionately affects people in racial and ethnic groups that have been marginalized by the U.S. healthcare system. A class of drugs that succeeds where so many others have failed would seem to be a powerful tool for closing the gap.

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Instead, doctors who treat obesity, and the serious health risks that come with it, fear the medications are making this health disparity worse.

“These patients have a higher burden of disease, and they’re less likely to get the medicine that can save their lives,” said Dr. Lauren Eberly, a cardiologist and health services researcher at the University of Pennsylvania. “I feel like if a group of patients has a disproportionate burden, they should have increased access to these medicines.”

Why don’t they? Experts say there are a multitude of reasons, but the primary one is cost.

The injectable drug Ozempic sparked a revolution in obesity care.

(David J. Phillip/Associated Press)

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Ozempic, which is approved by the Food and Drug Administration to help people with Type 2 diabetes control their blood sugar and reduce their risk of serious cardiovascular problems like heart attacks and strokes, has a list price of $968.52 for a 28-day supply. Wegovy, a higher dose of the same medicine that’s FDA-approved for weight loss in people with obesity or who are overweight and have a weight-related condition like high blood pressure or high cholesterol, goes for $1,349.02 every four weeks.

Mounjaro is a similar drug approved by the FDA to improve blood sugar levels in Type 2 diabetes patients, and it comes with a list price of $1,069.08 for 28 days of medicine. Zepbound, a version of the same drug approved for weight loss, has a slightly lower price tag of $1,059.87 per 28 days. For now, at least, all the new drugs are meant to be taken indefinitely.

Few health insurance programs cover the medications when prescribed to help people reach and maintain a healthy weight. Federal law requires that weight loss drugs be excluded from basic coverage in Medicare Part D plans, and as of early 2023, only 10 states included an antiobesity medication in the formularies for their Medicaid programs.

“If everybody had equal access, then this would be a way to help,” said Dr. Rocio Pereira, chief of endocrinology at Denver Health. “But without equal access — which is what we have now — it’s likely this is going to increase the disparity we see.”

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U.S. obesity rates have been rising for decades, and they’re consistently higher for Black and Latino Americans. Among adults 20 and older, 49.9% of Black Americans and 45.6% of Hispanic Americans have a body mass index of 30 or greater, compared with 41.1% of white American adults and 16.1% of Asian American adults, according to age-adjusted data from the Centers for Disease Control and Prevention.

Obesity rates are also associated with income. In 2022, the age-adjusted rate was 38.4% for adults with household incomes between $15,000 and $24,999, compared with 34.1% for those with household incomes of $75,000 or more.

The two are related, said Pereira, who studies health disparities in diseases related to obesity. Black and Latino Americans are more likely to live in lower-income neighborhoods, where fast food is usually cheaper and more convenient than grocery stores.

“If you look at a map of the U.S. and plot out the neighborhoods where there’s no grocery store within a mile and there’s a high percentage of people who have no car, those are the areas where there’s the highest rates of obesity,” she said.

There’s also the time factor, she said: “Can you afford to cook your own meals, or do you have to work two jobs?”

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An unusual experiment by the Department of Housing and Urban Development demonstrated the degree to which physical surroundings can influence obesity risk, Pereira said. In the 1990s, hundreds of mothers who were living in public housing were offered housing vouchers they could use only in wealthier neighborhoods. Ten to 15 years later, the women randomly assigned to receive the windfall had significantly lower rates of severe obesity (14.4%) than women in a control group who weren’t offered vouchers (17.7%). They were also less likely to have a body mass index of 35 or higher (31.1% vs. 35.5%).

Two women talk in New York.

(Mark Lennihan / Associated Press)

The American Medical Assn. recognized obesity as a disease in 2013. People with the chronic condition are at heightened risk of cardiovascular disease, Type 2 diabetes, 13 types of cancer, osteoarthritis, asthma and other health problems. Researchers have pegged the annual medical costs associated with obesity at $174 billion in the U.S. alone.

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Some people with obesity are able to lose weight by changing their diets and burning more calories through exercise. But that doesn’t work for people who have developed resistance to leptin, a hormone that suppresses appetite.

“If you try to lose weight with diet and exercise, your body is going to fight you,” said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. “Your leptin levels go down, and when leptin goes down, a signal goes to the brain that you don’t have enough fat to survive.” That prompts the release of another hormone, ghrelin, that triggers feelings of hunger.

Leptin resistance also makes exercise less worthwhile.

“Your body fights you by decreasing your total energy expenditure,” Apovian said. “When your muscles work, they work more efficiently. If you want to lose 10 pounds, you’re going to get really, really hungry. And you can’t fight that. Your body thinks it’s starving to death.”

The “breakthrough” drugs counteract this by impersonating a hormone called glucagon-like peptide 1, or GLP-1, that’s involved in appetite regulation. Inside cells, the drugs bind with the same receptors as GLP-1, reducing blood sugar and slowing digestion. They also last longer than their natural counterparts.

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Oprah Winfrey credits the new generation of medications for helping her keep her weight under control.

(Chris Pizzello / Associated Press)

The first so-called GLP-1 receptor agonist was approved in 2005 to treat diabetes, and early versions had to be injected once or twice a day. Ozempic improved on this by requiring an injection only once a week. After clinical trials showed that the drug helped people with obesity achieve substantial, sustainable weight loss, the FDA approved Wegovy as a weight management drug in 2021.

Mounjaro and Zepbound also mimic GLP-1, along with a related hormone called glucose-dependent insulinotropic peptide, or GIP.

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Linda Morales credits Ozempic and Mounjaro for helping her lose 100 pounds and drop from a size 22 to a size 14. The 25-year-old instructional aide at Lankershim Elementary School in North Hollywood said she started to become overweight in middle school and carried 293 pounds on her 5-foot, 5-inch frame when she was referred to the Center for Weight Management and Metabolic Health at Cedars-Sinai two years ago.

She is no longer breathless when she climbs stairs, has an easier time when she goes bowling and fits comfortably into the seat on the Harry Potter ride at Universal Studios. Thanks to the medications, she is no longer on a path toward Type 2 diabetes.

Her job with the Los Angeles Unified School District comes with health insurance that covers the pricey drugs and charges her a copay of $30 a month for her Mounjaro prescription. She said she could swing a monthly payment of up to $50, but beyond that she’d have to stop taking the drug and hope the lifestyle changes she’d made would be enough to sustain the weight loss she’s achieved so far.

“It would definitely get hard for me, for sure,” Morales said.

Indeed, even when the drugs are covered by insurance or patients qualify for discounts from pharmaceutical companies, researchers have found that they often remain out of reach.

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In one study, Eberly and her colleagues examined insurance claims for nearly 40,000 people who received a prescription for GLP-1 copycats. Patients who had to pay at least $50 a month to fill their prescriptions were 53% less likely to get most of their refills over the course of a year compared to patients whose copayments were less than $10. Even patients whose out-of-pocket costs were between $10 and $50 were 38% less likely to buy the medicine regularly for a full year, the team found.

In another study of insured patients with Type 2 diabetes, those who were Black were 19% less likely to be treated with these drugs than those who were white, while Latino patients were 9% less likely to get them, Eberly and her colleagues reported.

In some parts of the country, Black patients with diabetes are only half as likely as white patients to get GLP-1 drugs, according to research by Dr. Serena Jigchuan Guo at the University of Florida, who studies health disparities in pharmaceutical access. The disparity was greatest in places with the highest overall usage of the medications, including New York, Silicon Valley and South Florida.

“In those places, the drug is actually widening the gap,” she said.

Researchers have spent years documenting racial disparities in the use of effective treatments for obesity, such as bariatric surgery. Newer drugs like Ozempic simply bring the problem into sharper focus, said Dr. Hamlet Gasoyan, an investigator with the Cleveland Clinic’s Center for Value-Based Care Research.

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“We get excited every time a new, effective treatment becomes available,” Gasoyan said. “But we should be equally concerned that this new and effective treatment reduces disparities between the haves and have-nots.”

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New FireSat satellites promise faster wildfire detection over California and beyond

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New FireSat satellites promise faster wildfire detection over California and beyond

A trio of satellites set to launch early Tuesday will give wildland firefighters more time to respond and scientists more information about fire-prone regions across the globe.

The launch from Vandenberg Space Force Base is the first phase in a constellation called FireSat that will eventually cover the globe with 50 satellites collecting high-resolution imagery of fires and conditions on the ground every 20 minutes.

Earth Fire Alliance, the nonprofit group behind FireSat, got the project off the ground with $69 million in grants from the Bezos Earth Fund, Google and the Gordon and Betty Moore Foundation.

San José-based Muon Space built the satellites. Muon and the California Department of Forestry and Fire Protection are both FireSat partners.

The satellites use advanced thermal sensors to detect heat and can pick up signals from fires as small as a beach bonfire, as well as cooler fires that have been smoldering for days, according to Michael Falkowski, lead scientist at Earth Fire Alliance. That information will help fire officials, including the Los Angeles and Los Angeles County fire departments, understand whether blazes are growing, where they are headed and how much soot and smoke they are generating.

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FireSat’s infrared instruments detected this small roadside fire in Medford, Ore., during a 2025 test flight.

(Muon Space)

“If we can differentiate between a smoldering fire and a flaming combustion fire, it really has a big impact on how we can understand the air quality emissions coming off the fire,” Falkowski said.

Fires that burn at low temperature produce more harmful gases than hot fires. Think about a campfire. When it’s burning hot with bright flames, there is relatively little smoke. When it’s smoldering, it produces lots of thick, white or gray smoke.

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Wildfires work the same way.

A hot, fast-burning fire has enough oxygen and heat to burn with more complete combustion, producing less smoke for every pound of wood burned.

Earth Fire Alliance will provide data from these first three satellites in the next few months to Cal Fire and fire agencies in Oregon, Texas, Australia and Portugal. Cal Fire will share it with Southern California fire agencies.

The network will also turn its sensors on in the Amazon Basin for the Brazilian nonprofit Amazon Environmental Research Institute.

Cal Fire should begin receiving data from the scientists later this year, according to Falkowski, who joined Earth Fire Alliance last year from NASA, where he was an earth science program manager running the agency’s fire science program.

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Instruments on the satellites will be able to detect fires the size of a shipping container.

Instruments on the satellites will be able to detect fires the size of a shipping container, and distinguish between hot, intense wildfires and cooler, smoldering ones.

(Muon Space)

Falkowski said the new FireSat satellites are a big improvement over existing ones because they will be able to see smaller fires with better resolution and distinguish low-intensity “cool” fires from high-intensity hot ones.

“The satellites are really designed to measure fire across the entire temperature profile, so we can see cool fires all the way up to really hot fires,” he said.

That kind of granular information is important for emergency responders in the field and planners who make decisions about calling for extra help or ordering evacuations.

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The National Oceanic and Atmospheric Administration operates three satellites that can detect a fire somewhere inside a square 1,230 feet across.

In contrast, instruments on the FireSat satellites will be able to detect small brush and roadside fires 16 feet across.

Cal Fire officials have long embraced new technology to get ahead of wildfires in recent years, testing autonomous firefighting helicopters and partnering with UC San Diego to use artificial intelligence to filter images from a network of more than 1,200 cameras on lookout towers and mountain tops. The Alert California program is able to spot smoke in a video and sends automated messages to one of 21 agency command centers across California.

In 2025, Alert California sent out automated warnings before authorities even received 911 calls from the public 51% of the time, according to Phillip SeLegue, staff chief of Cal Fire’s intelligence program.

A worker at Mountain View-based Muon Space puts the final touches on a wildfire-detection satellite.

A worker at Mountain View-based Muon Space puts the final touches on a wildfire-detection satellite scheduled to launch Tuesday on a SpaceX rocket. The satellites will be tracking fires across the globe.

(Muon Space)

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FireSat will help incident commanders get better information more quickly, and, unlike fire-spotting aircraft, the satellites can linger over a fire for days or weeks and aren’t hampered by high winds or smoke.

Travis Medema, chief deputy for the Oregon State Fire Marshall, said his office will use FireSat to plan escape routes and monitor fires. “If we can fight these when they are small, we feel we will be more efficient and can protect Oregonians,” he said.

One expert noted that turning satellite data into information useful to firefighters and forestry managers will take some time. The FireSat data will “be amazing for fire nerds, but how and whether it helps individual fires remains to be seen,” said Joe H. Scott, founder of Pyrologix, a wildfire analysis firm based in Missoula, Mont. “Right now, we are not basing decisions on where satellites tell us a fire is,” Scott said.

Pyrologix develops wildfire risk management models for federal agencies, local governments and utilities. Scott said FireSat’s high-resolution data will help him build better prediction models that take into account weather, drought, plants and the history of fires in a region.

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14 propositions that could remake California taxes, housing, healthcare and elections

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14 propositions that could remake California taxes, housing, healthcare and elections

California voters will decide 14 statewide propositions in the Nov. 3 election, measures placed on the ballot mostly by either powerful interest groups or lawmakers that will affect the lives of millions of Californians.

While a proposed tax on state billionaires has dominated headlines, voters will also have a chance to weigh in on a number of consequential issues, from healthcare to voter identification requirements and more.

Californians are accustomed to legislating by the ballot and often face a list of propositions. But even by the standards of the state’s direct democracy process, the 2026 election stands out. The campaigns supporting and opposing the ballot measures have already collected more than $100 million in contributions, and are expected to use their money to inundate the television airwaves, livestreams and social media feeds and to flood mailboxes with glossy campaign mailers over the coming months.

Here are the measures on the Nov. 3 ballot:

Proposition 1: The Veterans and Affordable Housing Bond Act of 2026

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Spurred by the state’s affordable housing shortage, state lawmakers are asking voters to approve an $11.25-billion bond to boost affordable housing construction around the state.

Advocates say the funds would help build more than 40,000 shovel-ready affordable homes that are unable to move forward because of a financing gap and help preserve thousands of other existing units.

Proposition 1 includes specific funding for high-need groups, including $1.25 billion for a veterans’ home loan program, $1.15 billion for supportive housing for homeless people, $350 million for student housing at state universities, $450 million for farmworker housing and $200 million for Native American tribes.

“In California, we don’t turn away from the needs of our people — we meet them head-on,” said Gov. Gavin Newsom in a statement about the measure. “We are giving voters the power to help shape the future of housing in our state. This bond is about building communities, expanding access and affordability in California, where every family has a fair shot at a place to call home.”

Some Republicans took issue with the measure’s title — “The Veterans and Affordable Housing Bond Act of 2026” — arguing that it included veterans to have broader appeal while doing little to actually help homeless veterans.

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“It’s a sad thing to say that you have to use the veterans as bait to get the people of the state of California to approve an $11-billion bond, and I just think that’s shameful,” said Sen. Shannon Grove (R-Bakersfield), an Army veteran. “Call it what it is. It’s a homeless bond, and it does include some veterans’ benefits, but it is not a veterans bond.”

Proposition 2: Save for California’s Future Act

Icon illustration of California in a crystal ball.

This measure would give California lawmakers more flexibility over state spending and allow them to save money that could otherwise go back to taxpayers.

The measure, supported by Newsom, seeks to exempt deposits into state savings accounts from a spending limit that voters adopted through a series of ballot measures dating back to the late 1970s, and to increase the share of tax revenue that can be put into the rainy day fund.

Under an existing state appropriations restraint, also known as the Gann Limit, lawmakers cannot spend more than an amount determined by a formula that takes annual tax proceeds, changes to the population and cost of living into consideration. Tax revenue above the limit must be divided between schools and refunds to taxpayers.

The measure could incentivize lawmakers to save more money because funds tucked away in the rainy day fund would no longer be considered expenditures counted toward the spending limit. By allowing lawmakers to set aside more money that is not subjected to state spending limits, it could also allow them to hold onto money that otherwise would be returned to taxpayers under current law.

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This proposed constitutional amendment was placed on the ballot by state lawmakers.

Proposition 3: Fund schools and healthcare

Icon illustration of books, an apple, a hospital and stacks of coins.

If passed, this proposition would make permanent an existing tax on high-income Californians.

The existing tax, passed by voters in 2012 and extended in 2016, is set to expire in 2031. It applies to people who earn more than $360,000 for single filers, $721,000 for joint filers, and $490,000 for heads of household. It adds between 1% to 3% to these high earners’ personal income tax rates.

According to the initiative text, the funds are largely earmarked for local school districts and community colleges, with some portion of the money going to California’s rainy day reserves — which the state uses to prevent cuts to healthcare and other services when revenues decline. The measure says revenues cannot be spent on state bureaucracy or administrative costs.

The state’s nonpartisan Legislative Analyst’s Office expects the measure to bring in between $5 billion and $15 billion annually, depending on how the stock market is performing, with the amount expected to grow over time.

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Proposition 4: Public financing of campaigns

Icon illustration of money inserted into a ballot box.

This measure would allow the state and local governments to offer public campaign financing to candidates running for elected office. Candidates receiving the funding must abide by expenditure limits and adhere to the criteria set by statute, ordinance or charter to demonstrate broad support, such as demonstrate a large number of small dollar contributions.

None of the public campaign financing can come from funds designated for education, transportation or public safety. The financing cannot discriminate based on party or whether a candidate is a challenger or an incumbent. The public funds cannot be used for legal costs, fines or to pay back personal loans to a campaign.

This measure was placed on the ballot by the California Legislature and governor.

Proposition 5: Recall elections

Icon illustration of a ballot box being yanked offstage by a large hook.

This measure would change the way recall elections are conducted in California. Under this proposed constitutional amendment, during a recall election, voters would decide solely whether a politician should be removed from their elected position. If the recall is successful, that office would remain vacant until it is filled in accordance with existing law — either by a separate election or by appointment.

Under current law, voters make two separate decisions during a recall election: Whether to remove the subject of the recall from office and, if they are booted, which candidate running to replace them should fill the position. The candidate who receives the most votes wins, even if they receive far less than 50% of the vote.

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The proposed constitutional amendment would also allow the recalled politician to run in the next election to fill the vacancy, though they cannot be appointed to their former post. Under the current system, office holders targeted in a recall are barred from being a candidate to replace themselves in that same election.

The proposal comes in the wake of the unsuccessful, Republican-led recall campaign against Gov. Gavin Newsom in 2021, which in part tested voter sentiment about his response to the COVID-19 pandemic. One of the sponsors of the recall-reform measure was Sen. Josh Newman (D-Fullerton), who was recalled from office in 2018 after he voted to increase gas taxes for road repairs, legislation pushed by then-Gov. Jerry Brown. Newman won back his seat in 2020.

This proposed constitutional amendment was placed on the ballot by the California Legislature.

Proposition 37: Homeownership loan program

Icon illustration of a home with magnifying glass, pen and contract.

Proposition 37 would create a down payment assistance program to help middle-class Californians buy a new home.

The measure, spearheaded by former state Senate Majority Leader Bob Hertzberg, would allow middle-class California residents — defined as anyone who makes less than 200% of an area’s median income — borrow most of their down payment for a new home that they plan to live in. It is designed to boost construction of single-family homes.

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A down payment is traditionally about 20% of the purchase price of a home. If passed, the measure would create a state-administered loan program that offers qualified homebuyers a second mortgage of up to 17% of a home’s sale price.

The proposition would allow the California Housing Finance Agency to issue up to $25 billion in revenue bonds to administer the program.

The Legislative Analyst’s Office does not anticipate the measure to result in direct state or local costs because the costs are meant to be covered by homeowners’ mortgage payments.

Proposition 38: Immunology research bond

Icon illustration of several viruses and bacteria.

Proposition 38 asks voters to approve an $8.4-billion bond to support research in the burgeoning fields of immunology and immunotherapy, which study the human immune system and how it can be used to prevent, treat and cure diseases.

If approved, half of the funding would go toward the creation of a new immunology and immunotherapy research institute affiliated with the University of California. The other half would fund research grants for other California-based universities and nonprofit medical research institutions to study potential treatments for cancer, Alzheimer’s disease and heart disease.

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The measure has a built-in discount program for Californians — it requires that any technology or drugs developed from bond-funded research be sold to California patients for a price at least 20% below the national average.

Backers of the proposal include the Alzheimer’s Assn., National Multiple Sclerosis Society and other healthcare groups. Supporters argue the funding would facilitate research that could save lives and save patients “billions of dollars in health care costs by preventing and curing a range of debilitating diseases and illnesses,” according to the initiative text.

Proposition 39: Voter identification

Icon illustration of a California driver's license, photo and Real ID.

Proposition 39 would require Californians to show government-issued identification every time they vote at the polls.

Currently, Californians must affirm under penalty of perjury that they are U.S. citizens and provide information to verify their identity, such as their birth date, driver’s license or Social Security number, when registering to vote, but they don’t have to present identification when they cast their ballot.

Under this measure, voters would also need to present government-issued ID each time they vote in-person at the polls or, if voting by mail, provide the last four digits of a “unique identifying number from government-issued identification” that matches the one they provided when they registered to vote. California would be required to provide free voter ID cards on request, and state and county election officials would be required to verify registered voters are U.S. citizens by using government data.

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The voter ID measure has support from Assemblymember Carl DeMaio (R-San Diego), who has framed it as necessary to prevent voter fraud and restore trust. It comes as President Trump is pushing for stricter voter identification requirements and severe limits on voting by mail.

Democrats and voting rights groups, including the American Civil Liberties Union, oppose the measure, saying California’s elections are already secure — voter impersonation and noncitizen voting cases are rare — and that it would make voting harder for many eligible voters, including people who have changed names, move frequently or face housing instability.

According to the Legislative Analyst’s Office, the measure would make election administration more expensive, costing state and local governments anywhere from tens of millions to low hundreds of millions of dollars annually, plus tens of millions in upfront implementation costs.

Proposition 40: Billionaire tax

Icon illustration of a hand with cufflinks pinching a money coin.

This proposition, supported by a healthcare worker union, would impose a one-time tax of 5% on taxpayers and trusts with assets valued at more than $1 billion.

According to a state-prepared summary of the measure, 90% of the tax revenues would be spent on healthcare and 10% would fund food assistance or education-related programs. California’s richest residents would be able to spread the payments over five years.

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The Legislative Analyst’s Office estimates it would generate “tens of billions of dollars” spread over several years, but would lead to an annual decrease in state income tax revenues of “hundreds of millions of dollars or more.”

Newsom has publicly opposed the tax, arguing it would lead wealthy residents to leave the state and lead to future budget problems. Other opponents include Planned Parenthood, the California School Boards Assn. and a nonprofit called Building a Better California that is backed by tech execs and venture capitalists.

Some billionaires have already proactively moved themselves or their businesses out of the state because of the proposal, which as written would retroactively apply to residents of the state as of Jan. 1.

Proposition 41: Requires limits and audits on new state special taxes

Icon illustration of scissors cutting a document in half with stacks of coins nearby.

This is one of two ballot measures crafted by opponents of the proposed initiative to impose a new tax on California billionaires, and it would in effect undercut or curtail that wealth tax.

This proposed ballot measure would also prohibit any new state taxes from being excluded from the state’s current voter-approved spending limit. The proposed billionaire tax would have such an exclusion. If the billionaire tax proposal is approved by voters but this proposal receives more votes, the billionaire tax measure would be voided.

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The measure would require the state auditor to conduct a financial and performance audit of proposed ballot initiatives and of the programs they fund. The measure would require audits of any program that would receive funding from the special tax in the proposed initiative to assess the efficiency of the program and recommend who ought to reduce its annual costs by 10%. If the measure passes, the costs of the audits would be paid via the revenues generated by the special tax.

This ballot initiative is one of two so-called poison pills to sink the billionaire tax that is being bankrolled by Building a Better California, which has raised well over $100 million from the state’s most affluent. The largest donor is Sergey Brin, a co-founder of Google, who has reportedly moved out of California because of the tax proposal. He donated at least $82 million to the group as of late June.

Proposition 42: Ban on new state personal property taxes

Icon illustration of scissors cutting a document in half with a house symbol. Stacks of coins nearby.

This is one of two ballot measures created by opponents of the proposed initiative to impose a tax on California billionaires, and it would in effect void that wealth tax.

This proposed ballot measure would prohibit new taxes on personal property, intellectual property, retirement accounts and other assets and would limit situations in which a ballot measure or state lawmakers can impose or raise taxes retroactively — both of which are essential parts of the billionaire tax initiative.

If the billionaire tax proposal is approved by voters but this proposal receives more votes, the billionaire tax ballot measure would be voided.

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This ballot initiative is one of two so-called poison pills to sink the billionaire tax that is being bankrolled by Building a Better California, which has raised well over $100 million from the state’s most affluent. The largest donor is Sergey Brin, a co-founder of Google, who has reportedly moved out of California because of the tax proposal. He donated at least $82 million to the group as of late June.

Proposition 43: Voting thresholds for special taxes

Icon illustration of two dollar bills with checkmarks and one dollar bill with a red X.

The measure would prohibit local governments from imposing new special taxes unless the proposed tax receives approval from two-thirds of voters. The restriction also applies to citizen initiatives, which currently only need a simple majority vote to be approved.

The Howard Jarvis Taxpayers Assn. supports Proposition 43. The advocacy group has characterized the measure as an effort to “save” 1978’s Proposition 13, the landmark initiative that capped California property tax increases and required a super-majority of votes to approve most future tax increases.

Assemblymember Buffy Wicks (D-Oakland), who authored the legislation that became Proposition 43 — ACA 22 — opposes the measure and has urged Californians to vote against it. She said the only reason she crafted the bill was because it was a necessary bargaining chip to torpedo another ballot measure backed by the Howard Jarvis Taxpayers Assn. that would have devastated revenues for local governments and retroactively rescinded some local tax increases.

“I authored ACA 22 not because I wanted it to become law — but because it was the only path left to get the more dangerous initiative off the ballot before time ran out,” Wicks posted on social media.

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Proposition 44: Regulate health clinic spending

Icon illustration of a stethoscope encircling stacks of coins.

If passed, Proposition 44 would require federally qualified health centers to spend 90% of their revenue on “program services advancing their charitable purpose” rather than management and overhead. Community clinics that fail to comply would be penalized, with fines placed in a state-managed fund to be spent on clinic workforce programs.

Advocates say clinics spend too much on executive pay and other administrative costs and not enough on patient care. The measure, which would dictate how clinics spend money, is designed to fix that. The measure is backed by the Service Employees International Union-United Healthcare Workers West, an influential healthcare workers union, which argues it will help hold clinics accountable.

In May, the California Primary Care Assn., which represents more than 2,300 community health clinics, sued to block the ballot measure. The state’s powerful doctors’ lobby, the California Medical Assn., also opposes the measure, arguing it would ban clinics from keeping funding in reserves and hamper their ability to upgrade equipment or expand to new locations.

The Legislative Analyst’s Office estimates that enforcing the measure would cost the government up to the low tens of millions annually, and that much of the cost would be paid for through penalties and fees charged to affected clinics. The office says the measure has “uncertain” impacts and could lead to clinic closures.

Proposition 45: CEQA reform

Icon illustration of half of the Earth and half of a mechanical gear.

This proposition would amend the California Environmental Quality Act, or CEQA, and speed up the process for projects deemed “essential,” including certain housing, water, health, public safety, energy and transportation projects.

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Jails, detention facilities and oil or natural gas production facilities would not be considered “essential” projects, according to the measure text.

If passed, the measure would set deadlines for public agencies to complete environmental review, allow expedited review of a project’s environmental impacts — currently, public agencies are required to consider a range of feasible alternatives to reduce environmental impacts — and establish deadlines for filing and resolving lawsuits.

CEQA lawsuits have often been used to block construction of housing in the state. For instance, in Berkeley, neighbors used CEQA — citing potential noise impact from partying students — to delay, for years, UC Berkeley’s construction of student dorms on People’s Park.

The Legislative Analyst’s Office estimates that the state and local government implementation will cost in the tens of millions of dollars for the first several years. It notes the legislation would probably result in net savings in the long term due to reduced administrative and legal workload.

Times staff writers Seema Mehta and Phil Willon contributed to this report.

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July Fourth fireworks may bring ‘hazardous’ air quality to Southern California. What you need to know

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July Fourth fireworks may bring ‘hazardous’ air quality to Southern California. What you need to know

L.A.’s love of fireworks makes for a colorful Fourth of July, with dozens of official celebrations and countless illicit explosions expected for the holiday.

But as each sparkler, Roman candle, palm and peony dissipates, it leaves behind a cloud of noxious gases, soot and finely ground toxic metals — some of which ends up in the lungs of revelers and passersby below.

Hazardous levels of air pollution are expected across central and southern Los Angeles County, northern Orange County, and Riverside and San Bernardino counties from 5 p.m. Saturday evening through 3 p.m. Sunday, according to the South Coast Air Quality Management District. Unhealthy air quality is also expected in northern Los Angeles County and southern Orange County.

Pollution levels are expected to build from dusk onward Saturday, as light winds and increased firework activity lead to an increase in smoke, a South Coast AQMD advisory said. Soot and particulates will likely linger through Sunday afternoon before being dispersed by the wind.

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Firework-related pollution can trigger coughs, breathing problems, asthma flares and heart attacks, according to Los Angeles County Public Health, and anyone experiencing severe or worsening cardiovascular symptoms like chest pain or difficulty breathing should seek medical attention immediately.

Pyrotechnics set off at home are even more likely to trigger cardiovascular problems, the American Lung Assn. says, as the burst of pollutants takes place closer to the ground.

July 4 and 5 are traditionally two of the worst days of the year for the region’s air quality, according to South Coast AQMD. This year’s celebration comes on the heels of a late June warehouse fire in Boyle Heights that released extraordinary amounts of soot and smoke across the county, on par with pollution generated by the previous year’s wildfires.

To limit negative health effects, the L.A. County public health department recommends avoiding strenuous physical activity and keeping doors and windows closed. As whole house fans and swamp coolers can suck additional pollutants inside, the department recommends using air purifiers or air conditioners as alternatives when possible.

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