Science

The L.A. wildfire cleanup was fast. Residents eager to rebuild worry officials chose speed over safety

Published

1 month ago

December 3, 2025

The L.A. wildfire cleanup was fast. Residents eager to rebuild worry officials chose speed over safety

The devastation left in the wake of January’s Eaton and Palisades fires was unimaginable. The firestorms engulfed 59 square miles of Southern California — more than twice the size of Manhattan — transforming entire city blocks in Altadena and Pacific Palisades into corridors of ashes, twisted metal and skeletal trees.

Federal disaster officials rapidly deployed thousands of workers to gather up the wreckage across the burn scars. Armed with shovels and heavy construction equipment, crews quickly collected fire debris from rugged cliffsides, dusky shorelines and sprawling burnt-out neighborhoods. In a matter of months, they transformed the heaps of charred rubble into mostly vacant matchbox lots, ready for rebuilding.

Recently, the U.S. Army Corps of Engineers reported that it had finished clearing roughly 2.6 million tons of wreckage from nearly 9,700 properties, an astonishing eight-month federal cleanup that has been extolled as the largest and fastest in modern American history. Private contractors removed fire debris from an additional 2,100 parcels.

However, many experts worry that the rapid pace of federal cleanup resulted in sloppy work, time-saving measures and lax oversight that may ultimately cost homeowners.

The Army Corps has largely demobilized and contractors have cleared out, and they’ve left serious questions for disaster victims who are preparing to embark on one of the region’s largest reconstruction campaigns in the past century.

Mandana Sisco, right, and her husband, Justin, visit the site where their home once stood as their children, Marley, 5, and her brother, August, 7, play in Pacific Palisades. The Siscos, who had their lot independently tested for toxins, were relieved when tests revealed there was no contamination to the soil.

(Genaro Molina / Los Angeles Times)

Federal officials also notably disavowed the need to conduct soil testing, insisting it would be too time-consuming. But soil sampling performed by university researchers, local public health authorities and Los Angeles Times journalists have found excessive levels of toxic metals at properties already cleared by the Army Corps.

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A team of university scientists from UCLA, Loyola Marymount and Purdue tested soil samples from 47 already-cleaned homes in Altadena, finding 49% of already-cleaned homes still had elevated levels of lead above California’s standards for residential properties.

“It’s not a recovery if you leave 50% of the properties unsafe.”

— Andrew Whelton, Purdue University

“This recovery cannot be credibly compared to any other wildfire cleanup in recent memory,” said Andrew Whelton, an engineering professor at Purdue University who studies natural disaster recovery. “And that is because of deliberate decisions by government officials at all levels to skip soil testing. They did not determine that when the contractors left a property, the property was safe to use.

“It’s not a recovery if you leave 50% of the properties unsafe. While the federal government may demobilize, the onus now has been pushed to the property owners to either finish the job. Or they can ignore it, because L.A. County doesn’t require your property to be safe to rebuild.”

Despite such concerns, many praise the effort for its efficiency. The speedy recovery has allowed some survivors, including Altadena resident Carlos Lopez, to rebuild much earlier than they anticipated.

“It’s hope,” Lopez said about his homesite, where, on Sept. 10, workers have already built a wooden frame. “Neighbors that I talked to, we just wanted something to grasp onto that we’re actually moving forward. There’s some realization that we can get back home sooner rather than later.”

Line chart showing the percent of cleanup for both the Eaton and Palisades fires

Col. Jeffrey Palazzini, who oversaw debris removal operations for the Palisades fire, said the Army Corps and its contractors have largely received positive feedback from property owners, like Lopez. He said the speed is a reflection of the urgency of the public health threat, not necessarily an indication of poor workmanship.

Signs are posted as construction is underway on the home of Carlos Lopez in Altadena.

The L.A. County wildfire cleanup marks the maturation of a federal wildfire response that has tackled a barrage of historically destructive fires in Oregon in 2020, New Mexico in 2022 and Hawaii in 2023 — each of which were the largest wildfires in their state’s history.

“Over the past seven to 10 years, I think there has been — sadly — enough experiences for this process to be streamlined and improved upon with lessons learned each time it happens,” said Laurie Johnson, a renowned urban planner who specializes in natural disaster recovery. “And I think L.A. has been a benefit of that.”

Lindsey Horvath, L.A. County supervisor representing the Palisades, expressed cautious optimism for the road ahead. “Throughout the cleanup, we’ve followed all recommended best practices and will continue to follow the advice of experts throughout our recovery,” Horvath said in a statement. “I continue to call for soil testing to give homeowners greater peace of mind before rebuilding, and support efforts to make recovery assistance more accessible so we can rebuild faster and safer. Recovery doesn’t end here.”

Early days

In Pacific Palisades and Malibu, the wildfires turned some of the region’s most famous stretches of roads — including Sunset Boulevard and Pacific Coast Highway — into an unrecognizable labyrinth of debris. Mansions with picturesque views of the Pacific Ocean were obliterated into charred slabs of stucco, broken concrete and dust.

In Altadena, a middle-class melting pot tucked into the foothills of the San Gabriel Mountains, the inferno consumed century-old cottages and family-owned businesses on Lake Avenue, the community’s main commercial drag.

In the wake of these twin disasters, Gov. Gavin Newsom’s administration asked the federal government to take the lead on recovery. In the final days of his administration, President Biden approved funding and deployed federal agencies to start removing and disposing the most dangerous materials from affected properties.

Jan. 9 aerial view of neighborhoods destroyed by the Palisades fire.

In mid-January, neighborhoods were a literal minefield of explosive materials, including propane tanks, firearm ammunition and large lithium-ion batteries in electric vehicles, e-bikes and blackout-ready battery storage systems. There were also a plethora of household items that contained corrosive acids and toxic ingredients that needed to be collected to prevent them from polluting soil and groundwater.

On Jan. 16, the Environmental Protection Agency deployed its first teams to assess the damage and presence of hazardous materials. The agency ultimately identified about 13,600 properties, mostly single-family homes, that had been damaged or destroyed in the fire, and probably rife with hazardous materials.

Within days of taking office, President Trump signed an executive order instructing the EPA to expedite the removal of hazardous materials. EPA administrator Lee Zeldin later said Trump had directed the agency to complete the mission in 30 days — a demanding directive for work that typically takes several months.

In response, the Federal Emergency Management Agency increased disaster funding by nearly $179 million, money used to “surge” 850 contractors to collect the most dangerous materials from the burn scars by that deadline, according to records obtained by The Times.

In white coverall suits and full-face respirators, hazmat workers went property by property sifting through the ashes to dredge up lead-acid batteries, tins of paint thinner and pesticide canisters.

EPA personnel and agency contractors converted popular community gathering spots, including the driving range of Altadena Golf Course and the parking lot of Will Rogers State Beach, into hazmat stockpile sites. Workers laid down multiple layers of plastic liners where materials could be sorted and eventually hauled to hazardous waste dumps.

EPA crews comb the ruins of a home on Miami Way that was burned in the Palisades fire.

On Feb. 25 — two days ahead of schedule — the EPA announced it had completed that work. Its hazmat crews had overseen the removal of 300 tons of hazardous debris from 9,400 properties — making it the largest-ever hazardous materials cleanup for a wildfire the EPA had ever executed.

However, the EPA had also passed over 4,500 parcels, or 30% of properties, deeming them unsafe to enter. A Times analysis of residential properties found that workers balked at accessing 1,336 homes damaged or destroyed in the Palisades fire, and 1,453 homes in the Eaton fire.

EPA spokesperson Julia Giarmoleo said the deferred properties had hazardous trees, dangerous obstructions, steep slopes and unstable walls that prevented the EPA field teams from safely accessing the property.

“EPA’s operations are always based on completing the entirety of our work as quickly, efficiently, and safely as possible,” Giarmoleo said. “In the case of the L.A. fires, EPA encountered a higher percentage of properties that required deferral due to partial structural destruction compared to previous EPA wildfire responses.”

The remaining hazmat work was, instead, left for the Army Corps of Engineers, the agency tasked with handling the second phase of debris removal.

The Army Corps rolls in

The Army Corps and its primary contractor, Environmental Chemical Corp., were charged with removing millions of tons of ash, concrete and metal. They vowed to remediate upward of 12,000 properties by January 2026 — within a year of when the deadly wildfires first broke out. The ambitious timeline would outpace any wildfire debris removal mission the Army Corps had ever tackled, including the 18-month recovery for the 2023 Lahaina wildfire that destroyed 2,200 homes and buildings.

Jan. 14 photo of Eliot Arts Magnet Middle School burned by the Eaton fire in Altadena.

The Army Corps and ECC hired several subcontractors, and in early February dispatched the first cleanup crews to several schools that were ruined in the fires, including Pasadena Rosebud Academy Charter School in Altadena, where hazmat workers shoveled asbestos waste into thick plastic bags. They waded through a field of charred debris, gathering up fire-gnarled steel rods, metal door frames and structural beams into piles, which were later loaded onto dump trucks and hauled away to landfills.

Soon after, workers moved onto fire-destroyed homes. In mid-February, after a two-day delay due to heavy rainfall, crews finished clearing their first homesites in Altadena and Pacific Palisades.

A view of Eliot Arts Magnet Middle School after the federal cleanup.

As the cleanup progressed, one obstacle for public officials was tracking down the thousands of displaced survivors and getting them to sign paperwork that would grant federal cleanup crews permission to clear their properties. Because the fast-moving wildfires forced people to evacuate with little warning, many fled with only the clothes on their backs.

“Obviously, someone will have to be last. But we wanted to make sure that process was transparent.”

— Anish Saraiya, director of Altadena recovery director

Army Corps personnel tried to disseminate sign-up instructions and appeal to the public at press conferences and community meetings. Local officials helped by making phone calls to disaster victims in parts of Altadena where response had been lacking, according to Anish Saraiya, Altadena’s recovery director for L.A. County Supervisor Kathyn Barger’s office.

“Our office even started calling individual property owners, because there was already a concern about the disparity postfire west of Lake [Avenue],” Saraiya said. “One of the things we wanted to make sure is that this was an equitable process that got to everybody at once. Obviously, someone will have to be last. But we wanted to make sure that process was transparent.”

Wildfire victims seek disaster relief services at one of two FEMA Disaster Recovery Centers in Pasadena.

By April, with roughly 9,000 opt-ins, the federal cleanup had hit its stride. About 230 cleanup crews and 4,000 workers fanned out across the burn scars, working 12-hour shifts to remove debris from homes and haul it to landfills and scrapyards.

Following reporting by The Times, FEMA and the Army Corps drew criticism from environmental advocates and fire survivors for deciding not to perform soil testing after cleanups to ensure properties did not have toxic metals, such as lead, above California’s health standards for residential properties.

It would be the first major wildfire response in California since 2007 without a measurable goal for clearing toxic substances.

Homes destroyed by the Eaton fire were cleaned at a faster rate than those affected by the Palisades fire, according to a Times analysis of residential properties. Army Corps officials said they attempted to prioritize properties near schools, coastlines, waterways and occupied homes.

One such property belonged to Bronwen Sennish and her husband; their Spanish-style home had been a short distance from Palisades Elementary Charter School.

Sennish said she appreciated the sense of urgency and sensitivity with which the Army Corps approached her home. On one April morning, when she and her husband arrived at their lot, heavy machinery was already humming. Sennish said that the crew happily explained the parameters of their work. And the excavator operator took the time to sift through the rubble with the two in search for anything salvageable. “People who have been trained in the military are incredibly good at problem solving and logistics,” Sennish said.

But not everyone had a positive experience.

Cleanup crews, for example, excavated too much soil from Colten Sheridan‘s lot in northeast Altadena in April, according to internal Army Corps reports obtained by the Los Angeles Times. Sheridan, who is still displaced and living temporarily in Santa Cruz County, said he was never informed of the potentially costly mistake.

Instead, five months later, while Sheridan contemplated rebuilding plans, he was shocked to find out from L.A. Times journalists that his property had been the subject of a complicated internal debate within the Army Corps and debris removal workers.

“I feel like I absolutely should have been notified. I’m just reeling in my head right now,” he said. “If they over-excavated, and if they’re not going to do anything about it, what are my recourses? I don’t know.”

In early September, Sheridan called an Army Corps hotline dedicated to handling questions and concerns about the federal cleanup, but didn’t get answers.

A sign expressing community resilience in Altadena on Sept. 10.

A sign announces a future home to be built on a destroyed property in Altadena.

Now Sheridan fears he may have to foot the bill to bring in clean soil and regrade his property before he can rebuild. If a home is seated too low, it won’t be able to properly connect sewer lines and storm drains, which require a high-to-low slope.

Army Corps officials declined to comment on Sheridan’s property, citing privacy concerns.

Many environmentalists and community members had worried the speed of the cleanup might lead to workers cutting corners or substandard workmanship.

Cleanup supervisors routinely observed workers without masks and other safety equipment, according to Army Corps records. In some cases, workers disregarded decontamination protocols by stepping outside of contaminated areas without rinsing their boots.

Jana Karibyna in the backyard of her home after it was destroyed by the Eaton fire.

And according to internal documents attained by The Times, debris crews were regularly confused how to handle contaminated pool water — which researchers have found to contain trace amounts of lead, arsenic and other toxic chemicals. The contractors allegedly sprayed it into building footprints, front lawns, neighboring properties and even in the street, where it could have ended up in drainage systems leading to the oceans.

James Mayfield, owner of Mayfield Environmental Engineering, a private contractor specializing in hazardous materials, cleaned around 200 properties destroyed in the L.A. fires. For pools filled with ash, he suctioned contaminated water with a vacuum truck and sent it to locations that treat wastewater.

Mayfield believes inexperienced workers and the breakneck timeline probably led to some crews ignoring those best practices and redepositing toxic metals onto residential properties and local waterways.

“Proper hazmat disposal is about $10,000,” Mayfield said. “You can imagine, most people didn’t want to do that. They want to cut corners.”

Many wealthier homeowners with robust insurance policies opted out of the federal cleanup and decided to hire private contractors, which, in some cases, may have expedited their cleanup and rebuilding timeline, and provided access to services the government program didn’t provide — such as post-cleanup testing or property-wide soil removal.

A Times analysis of the private cleanups underscores the wealth gap between affluent residents of Pacific Palisades and working-class communities in Altadena: At least 1,392 homes opted out of the cleanup in the Palisades, nearly four times the number in the Eaton fire area, according to the analysis.

Tom James, a lifelong Palisades resident, decided that the Army Corps cleanup came with too many uncertainties. He also didn’t feel comfortable signing the liability waiver that would indemnify the federal government and contractors in the event of mistakes. He chose instead to hire a private crew that he was able to pay with his insurance policy, to clear out fire debris from his historic Victorian home in the heart of the Alphabet Streets, along with his collection of vintage cars and motorcycles in his garage underneath.

Still, James was affected by federal contractors. An Army Corps crew working next door left a large pile of his neighbors’ soil in his backyard. He walked down to the American Legion where Army Corps officials were stationed to let them know. A representative apologized and vowed to remove soil, but James said they never returned.

A time to rebuild

All told, the federal project cleared 9,673 properties — a mix of home sites, commercial properties, parks and schools — according to the Army Corps.

Aerial view of cleared properties and construction crews working on rebuilding a home in Altadena.

That has paved the way for the submission of more than 3,000 applications to rebuild — some 900 of which have already been approved.

In Altadena, some residents ready to rebuild have returned to their empty lots in RVs. The screech of tablesaws and popping of nail guns break up the silence in the fire-hollowed corners of these neighborhoods.

“I had a very simple lot, and they took everything I wanted removed … my neighbor has a real issue to solve now with getting dirt back in.”

— Lamar Bontrager, Altadena resident.

Lamar Bontrager, a real estate agent, has already laid a foundation and begun framing his home on Loma Alta Drive. He credits the Army Corps for the quick start.

“I had a very simple lot, and they took everything I wanted removed,” Bontrager said. Bontrager counts himself lucky. Looking at other lots around town, he said some neighbors will have a big lift. “At some houses, they [federal contractors] dug massive holes — my neighbor has a real issue to solve now with getting dirt back in.”

A fallen tree in front of a construction crew rebuilding an Altadena home that burned down.

While the cleanup was the fastest in history, some survivors feel forgotten. According to federal records, 391 property owners who requested federal help were deemed ineligible by FEMA.

FEMA says some of those properties did not experience enough damage for eligibility. The agency deemed others, including many multi-family homes, as commercial properties, and, therefore, also ineligible.

These decisions put some of the largest housing developments affected by the fires in a bind. For example, the Army Corps cleared the Tahitian Terrace mobile home park in Pacific Palisades, across the street from Will Rogers State Beach, but did not clean up the Pacific Palisades Bowl, a 170-unit mobile home park next door.

“There’s hundreds and hundreds of people that are still having sleepless nights.”

— Jon Brown, Pacific Palisades Bowl resident.

Residents were never told why one property qualified and the other did not; those decisions are entirely up to FEMA.

Rusted metal frames and a blanket of pallid ash still sit within a few hundred feet from the ocean. Residents, who have heard little from the landowners about the dilemma, have been stuck in limbo.

“There’s hundreds and hundreds of people that are still having sleepless nights,” said one resident, Jon Brown, co-chair of the Palisades Bowl Community Partnership fighting for residents’ right to return home. “I just drove by the park today and it just makes me sick.”

Brown and others have watched the Corps clear thousands of lots and a handful of owners start rebuilding, while their piles of charred debris remained virtually untouched. They have little certainty they’ll ever be able to return.

Brown, facing steep rent for temporary housing, fears the owners may be looking for a way out — selling the land or changing its use.

“What is going to compel them to rebuild it as a mobile home park if they can’t even be motivated to clean it up?” Brown asked.

Federal disaster officials and contractors are no longer around to answer those questions.

Before the Army Corps and its workers packed up, they held two small ceremonies to commemorate the last homes to be cleaned in each burn scar.

In Altadena, Tami Outterbridge, daughter of renowned artist John Outterbridge, had specifically requested to be last.

Tami Outterbridge is working to preserve the legacy of her father, artist John Outterbridge.

She and her mother, Beverly, lived in two separate homes on their family’s lot in West Altadena. They postponed their cleanup several times, asking her father’s friends and contemporaries to help them scour the ashes for pieces of his artwork and other mementos. They found a pair of her father’s vintage spectacles and fragments of his sculptures, assembled from knickknacks and everyday objects.

When the cleanup crew arrived in mid-August, they came with a team of dog-assisted archaeologists that helped find her grandmother’s ashes — and recover some of John Outterbridge’s collection of flutes from underneath a collapsed wall.

“Those are things that literally are irreplaceable,” Tami Outterbridge said. “As I was reckoning with what it meant to say you’ve lost two homes and all your possessions — that’s when the idea started formulating. I can literally adhere to Dad’s art practice, which was very much about this notion of finding objects that other people saw as discarded — not worthy, trash debris — and turning them into aesthetic marvels.”

Stanley C. Wilson sifts through the ashes that remain of John Outterbridge's family home.

At the Aug. 14 ceremony commemorating Outterbridge’s home as the final Altadena home to be cleaned as part of the federal project, Saraiya, the Altadena recovery director, looked around at a neighborhood that just a few months ago had been chock-full of ash and cinders. It was now a sweeping panorama of mostly empty, mulch-covered lots.

“I’m not a very emotional person, but I felt myself getting choked up,” he said, “because it was really this one clarifying moment that this work is done.”

Saraiya said he understood local officials would need to soon start discussing rebuilding roads, installing underground power lines and planning a more fire-resilient community. “After all of these months, after all of this work and all of this effort — there’s so much more to do.”

Assistant data and graphics editor Vanessa Martinez and senior journalist Lorena Iñiguez Elebee contributed to this report.

Science

Trump administration declares ‘war on sugar’ in overhaul of food guidelines

Published

2 days ago

January 7, 2026

Press Room

Trump administration declares ‘war on sugar’ in overhaul of food guidelines

The Trump administration announced a major overhaul of American nutrition guidelines Wednesday, replacing the old, carbohydrate-heavy food pyramid with one that prioritizes protein, healthy fats and whole grains.

“Our government declares war on added sugar,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a White House press conference announcing the changes. “We are ending the war on saturated fats.”

“If a foreign adversary sought to destroy the health of our children, to cripple our economy, to weaken our national security, there would be no better strategy than to addict us to ultra-processed foods,” Kennedy said.

Improving U.S. eating habits and the availability of nutritious foods is an issue with broad bipartisan support, and has been a long-standing goal of Kennedy’s Make America Healthy Again movement.

During the press conference, he acknowledged both the American Medical Association and the American Assn. of Pediatrics for partnering on the new guidelines — two organizations that earlier this week condemned the administration’s decision to slash the number of diseases that U.S. children are vaccinated against.

“The American Medical Association applauds the administration’s new Dietary Guidelines for spotlighting the highly processed foods, sugar-sweetened beverages, and excess sodium that fuel heart disease, diabetes, obesity, and other chronic illnesses,” AMA president Bobby Mukkamala said in a statement.

Science

Contributor: With high deductibles, even the insured are functionally uninsured

Published

3 days ago

January 6, 2026

Press Room

Contributor: With high deductibles, even the insured are functionally uninsured

I recently saw a patient complaining of shortness of breath and a persistent cough. Worried he was developing pneumonia, I ordered a chest X-ray — a standard diagnostic tool. He refused. He hadn’t met his $3,000 deductible yet, and so his insurance would have required him to pay much or all of the cost for that scan. He assured me he would call if he got worse.

For him, the X-ray wasn’t a medical necessity, but it would have been a financial shock he couldn’t absorb. He chose to gamble on a cough, and five days later, he lost — ending up in the ICU with bilateral pneumonia. He survived, but the cost of his “savings” was a nearly fatal hospital stay and a bill that will quite likely bankrupt him. He is lucky he won’t be one of the 55,000 Americans to die from pneumonia each year.

As a physician associate in primary care, I serve as a frontline witness to this failure of the American approach to insurance. Medical professionals are taught that the barrier to health is biology: bacteria, viruses, genetics. But increasingly, the barrier is a policy framework that pressures insured Americans to gamble with their lives. High-deductible health plans seem affordable because their monthly premiums are lower than other plans’, but they create perverse incentives by discouraging patients from seeking and accepting diagnostics and treatments — sometimes turning minor, treatable issues into expensive, life-threatening emergencies. My patient’s gamble with his lungs is a microcosm of the much larger gamble we are taking with the American public.

The economic theory underpinning these high deductibles is known as “skin in the game.” The idea is that if patients are responsible for the first few thousand dollars of their care, they will become savvy consumers, shopping around for the best value and driving down healthcare costs.

But this logic collapses in the exam room. Healthcare is not a consumer good like a television or a used car. My patient was not in a position to “shop around” for a cheaper X-ray, nor was he qualified to determine if his cough was benign or deadly. The “skin in the game” theory assumes a level of medical literacy and market transparency that simply doesn’t exist in a moment of crisis. You can compare the specs of two SUVs; you cannot “shop around” for a life-saving diagnostic while gasping for air.

A 2025 poll from the Kaiser Family Foundation points to this reality, finding that up to 38% of insured American adults say they skipped or postponed necessary healthcare or medications in the past 12 months because of cost. In the same poll, 42% of those who skipped care admitted their health problem worsened as a result.

This self-inflicted public health crisis is set to deteriorate further. The Congressional Budget Office estimates roughly 15 million people will lose health coverage and become uninsured by 2034 because of Medicaid and Affordable Care Act marketplace cuts. That is without mentioning the millions more who will see their monthly premiums more than double if premium tax credits are allowed to expire. If that happens, not only will millions become uninsured but also millions more will downgrade to “bronze” plans with huge deductibles just to keep their premiums affordable. We are about to flood the system with “insured but functionally uninsured” patients.

I see the human cost of this “functional uninsurance” every week. These are patients who technically have coverage but are terrified to use it because their deductibles are so large they may exceed the individuals’ available cash or credit — or even their net worth. This creates a dangerous paradox: Americans are paying hundreds of dollars a month for a card in their wallet they cannot afford to use. They skip the annual physical, ignore the suspicious mole and ration their insulin — all while technically insured. By the time they arrive at my clinic, their disease has often progressed to a catastrophic event, from what could have been a cheap fix.

Federal spending on healthcare should not be considered charity; it is an investment in our collective future. We cannot expect our children to reach their full potential or our workforce to remain productive if basic healthcare needs are treated as a luxury. Inaction by Congress and the current administration to solve this crisis is legislative malpractice.

In medicine, we are trained to treat the underlying disease, not just the symptoms. The skipped visits and ignored prescriptions are merely symptoms; the disease is a policy framework that views healthcare as a commodity rather than a fundamental necessity. If we allow these cuts to proceed, we are ensuring that the American workforce becomes sicker, our hospitals more overwhelmed and our economy less resilient. We are walking willingly into a public health crisis that is entirely preventable.

Joseph Pollino is a primary care physician associate in Nevada.

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Ideas expressed in the piece

High-deductible health plans create a barrier to necessary medical care, with patients avoiding diagnostics and treatments due to out-of-pocket cost concerns^[1]. Research shows that 38% of insured American adults skipped or postponed necessary healthcare or medications in the past 12 months because of cost, with 42% reporting their health worsened as a result^[1].
The economic theory of “skin in the game”—which assumes patients will shop around for better healthcare values if they have financial responsibility—fails in medical practice because patients lack the medical literacy to make informed decisions in moments of crisis and cannot realistically compare pricing for emergency or diagnostic services^[1].
Rising deductibles are pushing enrollees toward bronze plans with deductibles averaging $7,476 in 2026, up from the average silver plan deductible of $5,304^[1]^[4]. In California’s Covered California program, bronze plan enrollment has surged to more than one-third of new enrollees in 2026, compared to typically one in five^[1].
Expiring federal premium tax credits will more than double out-of-pocket premiums for ACA marketplace enrollees in 2026, creating an expected 75% increase in average out-of-pocket premium payments^[5]. This will force millions to either drop coverage or downgrade to bronze plans with massive deductibles, creating a population of “insured but functionally uninsured” people^[1].
High-deductible plans pose particular dangers for patients with chronic conditions, with studies showing adults with diabetes involuntarily switched to high-deductible plans face 11% higher risk of hospitalization for heart attacks, 15% higher risk for strokes, and more than double the likelihood of blindness or end-stage kidney disease^[4].

Different views on the topic

Expanding access to health savings accounts paired with bronze and catastrophic plans offers tax advantages that allow higher-income individuals to set aside tax-deductible contributions for qualified medical expenses, potentially offsetting higher out-of-pocket costs through strategic planning^[3].
Employers and insurers emphasize that offering multiple plan options with varying deductibles and premiums enables employees to select plans matching their individual needs and healthcare usage patterns, allowing those who rarely use healthcare to save money through lower premiums^[2]. Large employers increasingly offer three or more medical plan choices, with the expectation that employees choosing the right plan can unlock savings^[2].
The expansion of catastrophic plans with streamlined enrollment processes and automatic display on HealthCare.gov is intended to make affordable coverage more accessible for certain income groups, particularly those above 400% of federal poverty level who lose subsidies^[3].
Rising healthcare costs, including specialty drugs and new high-cost cell and gene therapies, are significant drivers requiring premium increases regardless of plan design^[5]. Some insurers are managing affordability by discontinuing costly coverage—such as GLP-1 weight-loss medications—to reduce premium rate increases for broader plan members^[5].

Science

Trump administration slashes number of diseases U.S. children will be regularly vaccinated against

Published

3 days ago

January 6, 2026

Press Room

Trump administration slashes number of diseases U.S. children will be regularly vaccinated against

The U.S. Department of Health and Human Services announced sweeping changes to the pediatric vaccine schedule on Monday, sharply cutting the number of diseases U.S. children will be regularly immunized against.

Under the new guidelines, the U.S. still recommends that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella, better known as chickenpox.

Vaccines for all other diseases will now fall into one of two categories: recommended only for specific high-risk groups, or available through “shared clinical decision-making” — the administration’s preferred term for “optional.”

These include immunizations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All these shots were previously recommended for all children.

Insurance companies will still be required to fully cover all childhood vaccines on the CDC schedule, including those now designated as optional, according to the Department of Health and Human Services.

Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule “protects children, respects families, and rebuilds trust in public health.”

But pediatricians and public health officials widely condemned the shift, saying that it would lead to more uncertainty for patients and a resurgence of diseases that had been under control.

“The decision to weaken the childhood immunization schedule is misguided and dangerous,” said Dr. René Bravo, a pediatrician and president of the California Medical Assn. “Today’s decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under strain.”

The American Academy of Pediatrics condemned the changes as “dangerous and unnecessary,” and said that it will continue to publish its own schedule of recommended immunizations. In September, California, Oregon, Washington and Hawaii announced that those four states would follow an independent immunization schedule based on recommendations from the AAP and other medical groups.

The federal changes have been anticipated since December, when President Trump signed a presidential memorandum directing the health department to update the pediatric vaccine schedule “to align with such scientific evidence and best practices from peer, developed countries.”

The new U.S. vaccination guidelines are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.

As doctors and public health experts have pointed out, Denmark also has a robust system of government-funded universal healthcare, a smaller and more homogenous population, and a different disease burden.

“The vaccines that are recommended in any particular country reflect the diseases that are prevalent in that country,” said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. “Just because one country has a vaccine schedule that is perfectly reasonable for that country, it may not be at all reasonable” elsewhere.

Almost every pregnant woman in Denmark is screened for hepatitis B, for example. In the U.S., less than 85% of pregnant women are screened for the disease.

Instead, the U.S. has relied on universal vaccination to protect children whose mothers don’t receive adequate care during pregnancy. Hepatitis B has been nearly eliminated in the U.S. since the vaccine was introduced in 1991. Last month, a panel of Kennedy appointees voted to drop the CDC’s decades-old recommendation that all newborns be vaccinated against the disease at birth.

“Viruses and bacteria that were under control are being set free on our most vulnerable,” said Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health. “It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won’t work and can’t end well.”