A line of federal immigration agents and protesters stand-off near the Glass House Farms facility outside Camarillo on July 10, 2025. Protesters gathered after federal agents conducted an immigration raid earlier in the day.
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Larry Valenzuela
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CalMatters/CatchLight Local
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Topline:
The presence of thousands of hard-to-identify federal agents is a new fact of life in Southern California this summer as the Trump administration carries out the president’s promised deportations. Images on social media show a constellation of federal agencies supporting immigration sweeps in Southern California. Here's how you can identify them.
About the agents: ICE agents might wear an “ICE” patch on the front or back of their vest, usually in black-and-white, though they also can carry a badge of the same design in gold. The ICE emblem features the U.S. Department of Homeland Security eagle seal. ICE agents might display "police" on their uniform. The ACLU wants ICE to stop using the word “police” on uniforms, contending the agency is impersonating local law enforcement officers
National Guard: National Guard troops had been most visible outside a federal building during protests in downtown Los Angeles, but have also accompanied a few immigration enforcement operations. The National Guard troops in L.A. wear Army uniforms. Soldiers in the state units have patches on their left shoulder that show a raven, a sunburst, or a sunburst on top a diamond, each in black and green color schemes. Troops will also have a full color U.S. flag on the right shoulder.
Border Patrol: Border Patrol agents often wear green uniforms and “Border Patrol” and “U.S. Customs and Border Protection” might be labeled on their badge, vest, shoulder, back, bucket hat or cap, and usually in yellow text over blue. Their marked vehicles tend to be white with a green slash, reading “Border Patrol” on the side.
Read on . . . to learn about sub-groups within these agencies that you might encounter along with efforts in the state to ban the masking of federal agents.
The presence of thousands of hard-to-identify federal agents is a new fact of life in Southern California this summer as the Trump administration carries out the president’s promised deportations.
Many residents may assume these masked agents are officers from Immigration and Customs Enforcement (ICE). But that's not always the case.
Many of them belong to the Border Patrol, the agency that traditionally has policed the nation’s border with Mexico. But the Trump administration sent officers from other agencies to Los Angeles, too, including the FBI and special tactical teams from the Department of Homeland Security not widely seen until now.
Democrats in California’s Legislature have proposed measures to unmask the federal agents.
Senate Bill 627, the “No Secret Police Act," seeks to prohibit all local, state and federal officers from using masks with some exceptions. SB 805, the "No Vigilantes Act," would require that officers clearly display their name or badge number. It’s disputed whether the state can regulate federal officers and law enforcement agencies are lobbying against the proposals.
Federal regulations state that ICE and Border Patrol agents should identify themselves when arresting someone "as soon as it is practical and safe to do so.”
And the public is allowed to ask federal agents to identify themselves.
But David Levine, a professor at UC Law San Francisco said, "they can ask but it doesn't mean they'll get the information.”
The number of sweeps and detentions appeared to slow this week after a federal judge issued a temporary restraining order, finding that agents stopped people based on someone’s race, language, accent, presence at a specific location or job. For ensuing stops, agents must have "reasonable suspicion" that doesn't consider those factors “alone or in combination,” according to the judge’s order.
While ICE is a different agency than Border Patrol, both are part of the Department of Homeland Security and carry out immigration enforcement.
The difference may not always matter much, but misidentifying an agency can confuse the public, as it did with the sighting of federal agents outside Dodger Stadium in June. The agents reportedly had no visible names or badges and attempted to enter the stadium’s parking lots. The Dodgers put out a statement that “ICE agents” had been denied entry to the stadium. ICE denied it was ever there; the Department of Homeland Security then clarified that it had been Customs and Border Protection agents at the venue.
Images on social media show a constellation of federal agencies supporting immigration sweeps in Southern California. Here's how you can identify them.
Border Patrol far from the border
Federal agents descend on MacArthur Park in Los Angeles on July 7, 2025.
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J.W. Hendricks
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CalMatters
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Border Patrol agents often wear green uniforms and “Border Patrol” and “U.S. Customs and Border Protection” might be labeled on their badge, vest, shoulder, back, bucket hat or cap, and usually in yellow text over blue.
Their marked vehicles tend to be white with a green slash, reading “Border Patrol” on the side.
Some might confuse Border Patrol with Customs and Border Protection officers. Those officials wear blue and usually stay stationed at ports of entry.
People clash with U.S. Border Patrol after a traffic collision with one of their vehicles during an immigration raid in Bell on June 20, 2025.
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Carlin Stiehl
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Los Angeles Times via Getty Images
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You may be wondering why Border Patrol agents are conducting immigration operations deep into Los Angeles neighborhoods, rather than staying closer to the border.
Border Patrol agents can search vehicles without a warrant throughout much of the country. They’re allowed to operate 100 miles from any edge of the country and coastline, reaching roughly two-thirds of the U.S. population, according to a CalMatters investigation and documentary produced in partnership with Evident and Bellingcat.
Since its creation by Congress in 1924, the Border Patrol's role has been to prevent unauthorized entry into the United States. The agency polices trade, narcotics, contraband and combats human trafficking.
Residents confront federal agents and Border Patrol agents as residents scream over their presence in their neighborhood on Atlantic Boulevard in the city of Bell on June 19, 2025.
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Genaro Molina
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Los Angeles Times via Getty Images
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The agency has a SWAT-like unit known as BORTAC, or Border Patrol Tactical Unit, which has also been documented in immigrant hubs such as MacArthur Park, Los Angeles' Toy District, and Bell. Border Patrol sources describe the unit's use for "high-risk" purposes.
In fatigues, the unit wears a "BORTAC" patch on the left shoulder with, at times, black undershirts.
Customs and Border Protection also deployed its tactical Special Response Team in Los Angeles' North Hills late June, executing a federal search warrant at a "human smuggling hub" tied to national security threats, arresting two, according to the agency.
ICE in police vests
ICE agents might wear an “ICE” patch on the front or back of their vest, usually in black-and-white, though they also can carry a badge of the same design in gold. The ICE emblem features the U.S. Department of Homeland Security eagle seal.
ICE agents might display "police" on their uniform. The ACLU wants ICE to stop using the word “police” on uniforms, contending the agency is impersonating local law enforcement officers
After 9/11, the Bush administration created the Department of Homeland Security, and Immigration and Customs Enforcement within it shortly thereafter. ICE is tasked with enforcing trade and immigration laws, including within the interior of the country.
The Cato Institute found that ICE booked over 200,000 people into detention between October 1 and June 14. More than 93% of book-ins had no violent conviction and 65% had no criminal conviction whatsoever.
A group of four U.S. Immigration and Customs Enforcement (ICE) officers, wearing tactical vests and armed with weapons, detain a man in a white shirt with his hands cuffed behind his back next to a car.
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via U.S. Marshals Service Los Angeles
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ICE itself has a few enforcement divisions. That's why some ICE uniforms might read ERO—part of their “Enforcement and Removal Operations” team—or HSI for “Homeland Security Investigations.”
In 2024, ICE launched a rebrand and created the investigations unit to develop cases, and improve public outreach, including with local law enforcement, an HSI official told ABC News.
According to its website, HSI combats a broad array of transnational-related crime, ranging from narcotics smuggling to cybercrime, and from human trafficking to intellectual property theft.
ERO meanwhile manages all aspects of the typical immigration enforcement process: identifying, arresting, GPS monitoring, and deporting unauthorized immigrants. Their site description also says they seek to deport priority undocumented immigrants after they are released from U.S. jails and prisons. They can also assist multi-agency task forces in arresting unauthorized immigrants without any other criminal history who are "deemed a threat to public safety."
A group of Homeland Security Investigations (HSI) agents in tactical gear stand on a residential street during a daytime raid.
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courtesy of Pedro Rios
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ICE also deployed its Special Response Team (SRT), decked in military wear and weaponry, in San Diego late May. It sent a dozen or more of those officers to the Santa Fe Springs Swap Meet near southeast Los Angeles in June, detaining two people for deportation.
Agents from those teams will often feature their logo on the shoulder and will be seen in heavy military-like uniforms. The teams are meant to engage "high risk" situations, according to ICE.
Rare National Guard deployment
National Guard troops in Downtown Los Angeles on June 8, 2025.
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Saul Gonzalez
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KQED
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National Guard troops had been most visible outside a federal building during protests in downtown Los Angeles, but have also accompanied a few immigration enforcement operations. In mid-June, National Guard soldiers accompanied federal agents raiding marijuana farms around Thermal, a desert town near Coachella, where about 70 undocumented immigrants were arrested, according to the Drug Enforcement Administration.
On July 7, about 90 California National Guard soldiers swept through the Los Angeles immigrant hub of MacArthur Park, a defense official said, to protect immigration agents from potentially hostile crowds, according to the Associated Press. They also were on site in Carpinteria last week.
The National Guard troops in L.A. wear Army uniforms. Soldiers in the state units have patches on their left shoulder that show a raven, a sunburst, or a sunburst on top a diamond, each in black and green color schemes. Troops will also have a full color U.S. flag on the right shoulder. The patch under that, if any, can vary and may be based on a soldier's past deployments.
Part of the U.S. military, the National Guard is able to serve both domestically and globally for state and federal duties, assisting with natural disasters, border security, civil unrest, overseas combat, counter-drug efforts and more. Soldiers largely stay in their home state and can be called on by the state governor or president.
Gov. Gavin Newsom opposed President Trump's decision to send the troops to Los Angeles, and the assignment marked the first time that a president has deployed the National Guard over the objections of a governor since the Civil Rights era.
More federal law enforcement officers
In January, a Homeland Security memo called for Justice Department agents to carry out immigration enforcement, according to ABC News. Deputized bureaus include the Drug Enforcement Administration (DEA), the Bureau of Alcohol Tobacco and Firearms (ATF), the U.S. Marshals Service, the Federal Bureau of Prisons receiving the "same authority already granted to the FBI."
Officers’ affiliations can be seen on their vests, jackets, or at times, their shoulder patches.
Agents wearing FBI fatigues were most visible in the worksite sweep at Ambiance Apparel in LA’s Fashion District, arguably the first major operation of the current wave of raids.
On June 10, FBI Los Angeles' X account touted its collaboration with an ICE operation in Ventura County. They have also participated in other immigration raids across the country.
A spokesperson with the Justice Department declined to comment on how it deployed agents from various agencies. In early June, the FBI told KTLA that it is participating in immigration enforcement in Los Angeles and nationwide "as directed by the Attorney General," supporting with SWAT, intelligence and more.
The ATF was also seen at the Ambiance Apparel raid. The DEA was there, too, and has since collaborated with ICE in the region.
On X, U.S. Marshals touted themselves as "on the front lines of immigration enforcement" in Los Angeles while showing officers interviewing a man on a bike. Marshals were also on site at a Ventura County marijuana farm raid where more than 200 people were arrested.
Can California unmask federal agents?
A federal agent sits in a vehicle while surrounded by an angry crowd after an immigrant raid on Atlantic Boulevard In the city of Bell on June 19, 2025.
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Genaro Molina
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Los Angeles Times via Getty Images
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The use of masked agents without clearly identifying uniforms has confused the public, including local police receiving reports of kidnappings.
California Attorney General Rob Bonta warned in March that reports of ICE impersonations were growing. Alleged federal agent impersonations have occurred in Huntington Park, Wisconsin, Philadelphia and elsewhere.
“We don't even know who these people are. It's so dangerous, it's so horrific, and it's time to put standards in place," said Sen. Scott Wiener, a San Francisco Democrat who is backing two proposals that would compel law enforcement officers to go without masks and display identification.
The Trump administration maintains that the masks are necessary to protect officers’ identities as they carry out investigations.
"So, I’m sorry if people are offended by them wearing masks but I’m not going to let my officers and agents go out there and put their lives on the line and their family on the line because people don’t like what immigration enforcement is," said acting ICE Director Todd Lyons in a press conference early June.
And some law enforcement experts say the federal government has that authority.
"Certain legislators are giving a false sense of hope that California can legislate laws to control the practices of federal agents," said Ed Obayashi, a longtime sheriff’s deputy in California and policy adviser to the Modoc County Sheriff’s Office.
"They cannot do that—bottom line. Plain and simple. Federal law is supreme."
Acknowledging potential legal disputes, Wiener said he’s willing to test the "time-sensitive" bills in the courts. "Federal employees can't just come in and ignore all California laws," he said. "There are laws that they have to follow."
Cato Hernández
covers important issues that affect the everyday lives of Southern Californians.
Published December 4, 2025 12:34 PM
Seagulls gather near a fishing boat in Northern California.
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Brian van der Brug
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Los Angeles Times via Getty Images
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Topline:
L.A. County health officials are asking residents to take precautions after a handful of wild birds tested positive for avian influenza, also known as H5 bird flu. It comes about a year after an outbreak hit the state.
Where were the birds? The health department says the five birds, mostly gulls, were found across L.A. County in November. A majority were along the coast in Manhattan Beach, Malibu, San Pedro and Palos Verdes. Another was found in Van Nuys.
Why it matters: While risk to the public is low, bird flu can cause problems in the agriculture industry. Multiple outbreaks in poultry and dairy farms affected workers’ health and led to a statewide emergency in 2024. Pets can also catch it — cats in particular have gotten very sick.
How it spreads: California hasn’t reported any person-to-person spread, but last year, there were over three dozen human cases in 2024. Humans typically catch bird flu when they’re in close contact with an infected animal, while animals have been shown to get it by consuming infected raw meat or unpasteurized milk.
What you should do: The health department says you and your pets should keep away from birds and avoid direct contact, including from surfaces where bird droppings could be. They’re asking the public to not feed the wild animals and report sick and dead birds to your local animal control service, which can be found by calling 211.
Volunteers in Altadena refuse to let lights go out
Josie Huang
is a reporter and Weekend Edition host.
Published December 4, 2025 12:10 PM
Scott Wardlaw, president of the Altadena Christmas Tree Lane Association, pulls on a string of lights during a 2024 light installation.
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Genaro Molina
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Los Angeles Times via Getty Images
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Topline:
Altadena’s century-old Christmas Tree Lane returns Saturday for its first lighting since the Eaton Fire and a ceremony that will acknowledge the community’s loss. Organizers say the display will shine brighter thanks to the addition of thousands more bulbs.
Background: Celebrated as the country’s largest and oldest outdoor lighting display dating back to 1920, the spectacle is created entirely by volunteers painstakingly stringing up lights with ropes and pulleys over the course of several months.
Read on ... for details of the lighting ceremony and the history of the tradition.
Over its 105-year history, Altadena’s Christmas Tree Lane has fallen dark only in extraordinary times — as World War II raged and during a national energy crisis in the 1970s.
This year, as Altadena weathers its greatest test post-Eaton Fire, the thought of keeping the storied lane unlit was considered.
But only briefly.
“We did talk about whether it would be depressing because of what was lost,” said Scott Wardlaw, president of the Christmas Tree Lane Association. “But people were urging us to do it again and saying ‘Please put the event on and put those lights up.’”
Starting Saturday, more than 20,000 lights will roar back on the deodars towering over a nearly mile-long stretch of Santa Rosa Avenue, right on the edge of the burn scar.
Visitors from around Southern California drive under a canopy of lights on Christmas Tree Lane, a 105-year-old tradition in Altadena.
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Frazer Harrison
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Getty Images
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Some of the holiday lights and tree branches were damaged in the windstorm that fanned January’s fire. Homes at the northern end of the lane were scorched.
But miraculously, not one of the 153 deodars, some as high as 130 feet, were lost.
“This will be a symbol of Altadena's rebirth, and us coming together again as a community,” Wardlaw said.
A homecoming
Celebrated as the country’s largest and oldest outdoor lighting display dating back to 1920, the spectacle is created entirely by volunteers painstakingly stringing up lights with ropes and pulleys over the course of several months.
Every year, thousands of visitors from all over Southern California travel to Altadena from December into early January to drive under the canopy of lights.
“It's just the simplest thing ever — just lights in a tree,” said Mikayla Arevalo, who coordinates volunteers for the association. “I feel like that's what made us so special. We're not bright. We're not flashy.”
Volunteers and members of the Christmas Tree Lane Association string lights on the ground before hanging them in the deodar trees along Santa Rosa Avenue in Altadena.
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Dañiel Martinez
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LAist
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This being the lane’s first lighting after the Eaton Fire, organizers expect turnout at Saturday’s kickoff event at 6 p.m. will be larger than usual.
“We wanted to use this celebration as a moment for community members to come back to Altadena to see their neighbors and their friends, as many people are in different areas now and no longer together,” Arevalo said.
The ceremony will include new elements, including a moment of silence for the 19 Altadenans who died in the fire.
And Altadenans whose families have long volunteered on Christmas Tree Lane will take part in the switch-on of the lights alongside L.A. County Supervisor Kathryn Barger, who represents Altadena in the 5th District.
Brighter than ever
When the lights come back on Saturday, return visitors may notice the display glowing brighter than ever before. A donation of an undisclosed amount from the Walt Disney Co., which has employees from Altadena, was used to pay for thousands of extra lights.
Each tree now carries five to six long strings of clear, red, blue, green and yellow lights, up from four or five.
Many of the residences along Christmas Tree Lane get in on the holiday cheer with their own decorations.
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Araya Doheny
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Getty Images
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Immediately after the fire, there were questions whether it’d be safe for volunteers to string lights on the trees amid the ash and debris.
But the tree lighting association said it got the all-clear from the county, which also gave volunteers more than 400 protective suits as they embarked on another round of installations in mid-September.
Leaders worried that they wouldn’t get the same number of volunteers as they did in past years because much of the town had been forced out by the fire. But they saw close to 200 volunteers who showed up on weekends over several months to get the job finished before the 10 weekends it typically takes.
A tradition that endures
That kind of community resilience fits a tradition that has anchored Altadena for more than a century.
Christmas Tree Lane owes its beginnings to the Woodbury family, early Altadena settlers, according to a documentary about the tradition created by the association, Altadena Historical Society and the Altadena Libraries.
After returning from Italy, younger brother John Woodbury became enamored with the deodar cedar and ordered seeds from the U.S. Department of Agriculture to plant along the family’s access road — now Santa Rosa Avenue.
By the early 1900s, the trees had matured into a green corridor, drawing visitors who strolled and drove beneath the shade.
The idea to illuminate those cedars came in 1920, when the newly formed Pasadena Kiwanis Club adopted it as one of its first civic projects.
Within a matter of years a regional sensation was gaining national attention. In 1937, a live radio broadcast of the lighting was broadcast to listeners across the country.
A sign points visitors Christmas Tree Lane, which is listed on the U.S. National Register of Historic Places and is designated as a California Historical Landmark.
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Araya Doheny
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Getty Images
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The lane’s evolution continued in 1956 as volunteers formalized into the Christmas Tree Lane Association, which worked year-round maintaining the lights, caring for the trees, and raising money for repairs.
The lane’s long history shows that interruptions have been the exception.
During World War II, the lane went unlit as part of mandated blackouts ordered by the government to prevent enemy ships and planes from locating targets.
In 1973, the lane fell dark again amid a national energy crisis that saw President Richard Nixon discouraging the use of ornamental outdoor lighting.
But during another difficult juncture for the country during the height of the pandemic in 2021, the light display returned thanks to committed volunteers self-distancing as they decorated the trees.
Now after the Eaton Fire, the display is back because some of those same volunteers refuse to let the lights go out.
“The thing that's impressive to me, that symbolizes Christmas Tree Lane — it's the people,” Wardlaw said.
For more than three decades, it has been routine to give all newborns in the U.S. the hepatitis B vaccine. That could soon change.
Why now: An advisory committee to the Centers for Disease Control and Prevention is expected to vote Thursday on whether to rescind that universal recommendation.
Why it matters: Delaying the birth dose by just two months could result in at least 1,400 additional preventable cases of hepatitis B for each year the revised recommendation is in place, according to a new analysis. Delaying the vaccine until age 12, as President Trump suggested this year, could result in at least 2,700 preventable infections each year, the analysis found.
Read on... for what parents should know about the virus and vaccine.
For more than three decades, it has been routine to give all newborns in the U.S. the hepatitis B vaccine. That could soon change.
An advisory committee to the Centers for Disease Control and Prevention is expected to vote Thursday on whether to rescind that universal recommendation.
If that happens, pediatricians say, the health consequences could be dire.
"It would be extremely dangerous," Dr. Andrew Pavia told NPR this year. He's a professor of pediatrics and medicine with the University of Utah and a pediatric and adult infectious disease specialist.
The hepatitis B virus attacks the liver. The disease has no cure, and chronic infection can lead to serious outcomes such as liver cancer, cirrhosis and death. And the risks of these outcomes are much higher for people who get infected as infants.
"About 25% of children who develop chronic hepatitis B will die of their infection," says Pavia, who is also a spokesperson for the Infectious Diseases Society of America.
Delaying the birth dose by just two months could result in at least 1,400 additional preventable cases of hepatitis B for each year the revised recommendation is in place, according to a new analysis. Delaying the vaccine until age 12, as President Trump suggested this year, could result in at least 2,700 preventable infections each year, the analysis found. The study was released prior to peer review, ahead of this week's meeting of the Advisory Committee on Immunization Practices.
Before the U.S. began universally vaccinating newborns in 1991, some 18,000 children a year would become infected before age 10. About half were infected through mother-to-child transmission, Pavia says. Giving newborns the shot right after birth prevents the virus from taking hold.
The other half of kids got infected from somewhere else. Trump said hepatitis B is sexually transmitted — which is one means of transmission — so there's no reason to give the vaccine to a baby. But Pavia says the risks for kids are everywhere.
"There have been cases of infections in day care. There have been cases of infection on sports teams. There have been documented infections from shared toothbrushes and from shared razors," he says.
The virus is found in blood, saliva, semen and other bodily fluids, even tears, and it can live on surfaces for up to seven days. A child with a wound who comes into contact with that surface — even days later — could become infected, says Anita Patel, a pediatrician and pediatric critical care physician in Washington, D.C.
According to the Centers for Disease Control and Prevention, about half of people infected with hepatitis B don't know they have the virus, but Patel says they can still pass on the virus unwittingly.
"If you have a cut, that blood could potentially get on the infant," Patel says. "And if that infant has any sort of break in their skin — as infants, frankly, frequently do — they can then get hepatitis B," says Patel.
Dr. Su Wang says she suspects she got infected with hepatitis B as an infant through her grandparents. She says they likely got exposed through their jobs as medical workers in Taiwan. Taiwan used to have very high rates of hepatitis B infection among adults before it began a successful national vaccination program in the 1980s.
"When I was born, they came over to help, like a lot of grandparents do, and they lived with us," Wang says. "They became primary caregivers for the first month of life. And so very likely that's how I got hep B."
Wang is now an internist and researcher specializing in hepatitis at Cooperman Barnabas Medical Center in New Jersey.
She says it's very important to give the shot at birth. Since vaccination of newborns became routine in the U.S., case rates have plummeted 99% among people age 19 and younger.
"When we started doing this as universal for all kids, you saw this blanket protection that protected an entire generation of kids," Wang says.
Copyright 2025 NPR
One year after UnitedHealthcare's CEO was shot and killed, the crisis in U.S. health care has gotten even worse — in ways both obvious and hidden.
Insurance costs are rising: The costs of both Obamacare and employer-sponsored insurance plans are set to skyrocket next year, in a country where health care is already the most expensive in the developed world. The end result is that nearly half of U.S. adults expect they won't be able to afford necessary health care next year, according to a Gallup poll published last month.
Insurers are also struggling financially: Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem. UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It's one of the largest companies in the world, and it's involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill. Shares in UnitedHealth Group have plunged 44% from a year earlier.
Read on . . . to see how healthcare costs are affecting Wall St.
Yet even as costs surge, the companies and the investors who profit from this business are also struggling financially. Shares in UnitedHealth Group, the giant conglomerate that owns UnitedHealthcare and that plays a key role in the larger stock market, have plunged 44% from a year earlier. (It was even worse before a rally in UnitedHealth shares on Wednesday.)
"UnitedHealth's reputation in the investment community, before December 4 last year, was [as] a safe place to put your money. And that basically got all blown up," says Julie Utterback, a senior equity analyst who covers health care companies for Morningstar.
But that was only the start of the business woes for the company and its entire industry — which are facing regulatory scrutiny, tightening margins, and investor skepticism.Many of UnitedHealth's top competitors have also seen their shares suffer in the past year, at a time when the stock market in general has been hitting tech-driven record highs. The S&P 500's healthcare index has lagged the larger market. And some Wall Street analysts are bracing for another rocky year in the business of health care.
"Near term, there's a lot more volatility to come," says Michael Ha, a senior equity research analyst who covers health care companies for investment bank Baird.
Dec. 4 started to reveal the depth of U.S. health care problems
This wide-ranging crisis for both consumers and businesses underlines the brokenness of the U.S. health care system: When neither the people it's supposed to serve nor the people making money from it are happy, does it work at all?
"We're really at an inflection point," says Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation and the author of a book about the insurance industry.
"Every segment of the health insurance business right now is stressed," she adds.
These stresses became brutally visible a year ago — and persist today. Luigi Mangione, the 27-year-old suspect in Thompson's killing, was in court this week for hearings ahead of his trial.
But the crisis in U.S. health care is much bigger than his case. Here are three main ways it's playing out this year, from Main Street to Wall Street.
Prices are going up — and people are getting ready to go without medical care
No matter how you get your health insurance, it will likely cost more next year.
For the roughly 24 million people who get their insurance through the government's health care exchanges, Affordable Care Act subsidies are set to expire at the end of the year — sending premiums soaring. Another 154 million people are insured through their employers — and premiums for those plans are also set to skyrocket.
Costs are increasing for several reasons: Drug companies have developed more effective cancer treatments and weight-loss drugs, which they can charge more for. More people are going back to the doctor after the pandemic kept them away, which is creating more demand and allowing providers and hospitals to increase prices. And some hospitals, doctors' offices, insurance companies and other businesses within the health care system have merged or consolidated, often allowing the remaining businesses to raise prices for their services.
The end result is that nearly half of U.S. adults expect they won't be able to afford necessary health care next year, according to a Gallup poll published last month.
Jennifer Blazis and her family are among them.
"It just always blows me away, how much I have to consider cost when something happens with the kids," the 44-year-old nonprofit worker and mother of four told NPR this fall in an interview for its Cost of Living series.
Blazis and her family live in Colorado Springs and get their insurance through her husband's small property-management business. She says she's postponing leg surgery that would address a condition that's causing her pain, but which her doctors say is not yet urgent.
"We wait to go to the doctor because we know if we do, we're going to get hit with just a massive bill," Blazis says. "And this is with … a really good health insurance plan that our [family] company pays a ton of money for."
Yet even the biggest businesses selling these services are struggling
Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem.
UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It's one of the largest companies in the world, and it's involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill.
It's also one of the most influential stocks on Wall Street. UnitedHealth Group is one of 30 companies that makes up the blue-chip Dow Jones Industrial Average — so what happens with its shares helps determine what happens with the overall stock market.
The company has had a miserable year on both fronts. The reasons come down to profits, more than PR: UnitedHealth and its competitors have been facing rising costs in the Medicare Advantage businesses that allow private insurers to collect government payments for managing the care of seniors.
These programs were once widely seen as moneymakers for big health insurers, but now they've gotten UnitedHealth embroiled in financial and regulatory trouble, including a Department of Justice investigation into its Medicare business. The company abruptly replaced its CEO in May, a few months before it acknowledged that it was facing the government probe.
Now UnitedHealth is trying to get rid of about 1 million Medicare Advantage patients — and otherwise move on from the past year's many problems.
"We want to show that we can get back to the swagger the company once had," Wayne DeVeydt, UnitedHealth's chief financial officer, told investors last month.
One prominent investor is betting it can: In August, Warren Buffett's Berkshire Hathaway disclosed that it had bought more than 5 million shares in UnitedHealth Group. The news helped lift the stock from its depths — but it still has a long way to go for both its share price and its profits to recover from this year's slump.
Chief Executive Stephen Hemsley acknowledged as much in October, promising investors "higher and sustainable, double-digit growth beginning in 2027 and advancing from there."
Spokespeople for UnitedHealth declined to comment for this story.
Wall Street used to think health care was safe. It's waiting for a turnaround
Health care spending accounts for about a fifth of the U.S. economy, making the for-profit companies that earn this money some of the most powerful in the world.
That's helped their appeal to investors, who traditionally tend to consider health care stocks "defensive," or safe, investments. That appeal sometimes overrides the industry's current financial challenges: In the past month, as Wall Street had its now-quarterly panic over the artificial intelligence bubble, health care stocks actually outperformed the broader market for a few weeks.
Still, health care is massively lagging the market in the long term.
Morningstar's Utterback is optimistic that the industry can eventually turn around its deeper financial, regulatory and reputational problems. She even calls most health care stocks "undervalued" currently — but she warns that investors will have to have a lot of patience if they want to see bets on the sector pay off.
"My explicit forecast period is 10 years. It's not three," she says. "There's a murky outlook here for the next couple years, at least."
