The Brief

Three California hospitals that declared bankruptcy earlier this year are hashing out deals that could bring back or save much-needed health care services for their communities.

Defunct Madera Community Hospital in the San Joaquin Valley, cash-strapped Beverly Community Hospital east of Los Angeles and Hazel Hawkins Memorial Hospital in rural San Benito County are trying to clinch lifelines in deals with health chains that have a reputation for revitalizing distressed hospitals.

The proposals are far from the finish line, but they present a glimpse of hope for residents who face longer journeys to emergency rooms and increased risk when local medical centers close. Two of the three — Madera Community and Hazel Hawkins — are the only hospitals in their counties.

“This is really great news. There will be a number of stages, and the first stage is for (partnering chains) to indicate their interest,” said state Sen. Anna Caballero, a Democrat whose district includes Madera and San Benito counties. “Now there’s a lot of work that has to happen in a very quick period of time.”

Madera Community, which shut down at the start of the year, is trying to secure a management agreement with Adventist Health, the seventh largest health system in the state. As proposed, Adventist would take over operations of the closed hospital and its affiliated rural clinics. If all goes according to plan, Madera Community could reopen in six to nine months.

Adventist Health is also a candidate to buy Beverly Community Hospital in the city of Montebello outside of L.A. That hospital has to secure a deal ahead of a key bankruptcy court deadline this week.

Meanwhile, Hazel Hawkins Memorial Hospital in Hollister recently announced a proposed “lease to own” partnership with American Advanced Management, a company that operates six other California hospitals.

The three are among a handful of hospitals that in the past year or so publicly announced their financial troubles. The state responded this spring with a $300 million interest-free loan program that can provide emergency funds to hospitals. The state is expected to distribute the money later this month. The three bankrupt hospitals have already asked for $125 million.

Saving Madera Community Hospital

The proposed partnership in Madera is largely dependent on Madera Community securing an $80 million loan from the state’s Distressed Hospital Loan Program.

Karen Paolinelli, chief executive of Madera Community Hospital, told CalMatters that while she recognizes the requested amount is substantial, her hospital is the only one that is currently closed. “It is very expensive to reopen a hospital,” she said. “We don’t want to just reopen, we want to be sustainable; we don’t want to be back here in a couple of years.”

Madera is also awaiting another $5 million in state funding that was granted in last year’s budget but placed on hold when the hospital closed.

In a letter outlining its terms, Adventist Health said it will require at least $55 million to fund staffing, supplies, maintenance, training and services in the first year, and another $30 million in the second year. Madera Community Hospital would have to pay Adventist a management fee.

In exchange, the health system would provide its management expertise and personnel to support Madera’s reopening. According to the proposal, Adventist would have the option to purchase the hospital after three years.

Outlines of the Madera Community Hospital sign are partly covered by a tarp at the emergency room entrance on Jan. 2, 2023. Madera County Sheriff Tyson Pogue announced a state of emergency for the county when the hospital closed due to bankruptcy.

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Paolinelli said a management agreement is the hospital’s best bet at reopening. It has not found a buyer for a straightforward sale. Paolinelli said she has not discussed with Adventist whether she will stay on as head of the hospital.

Adventist Health has experience reopening closed hospitals. For example, five years ago Adventist reopened and rebranded what was once known as Tulare Regional Medical Center. That hospital is now Adventist Health Tulare.

Obstacles to Beverly hospital’s sale 

Beverly Community, a 202-bed hospital in Montebello east of Los Angeles, filed for bankruptcy in April. It suspended a number of services by June, including maternity, pediatric and outpatient radiology.

The Attorney General’s office last month announced the conditional approval of the hospital’s sale to a Glendale-based chain called American Healthcare Systems. That proposed deal is quickly dissolving.

According to bankruptcy court documents, bondholders raised concerns about American Healthcare Systems’ ability to support the hospital financially. Recent filings show that Beverly Hospital is now exploring an alternative transaction with Adventist Health.

“Given Beverly Hospital’s critically low cash position and as of now uncertainty about state funding (from loan program), the bid from Adventist Health represents Beverly’s greatest chance of continuing to serve the community it has served for the past 75 years,” said Justin Bernbrock, a lawyer for Beverly Hospital.

This month will be key for the hospital. Beverly is losing about $5 million a month and projects to run out of cash by September, court documents show. The hospital applied for $35 million from the Distressed Hospital Loan Program.

On Thursday, the hospital is due to present a deal proposal to a bankruptcy court judge.

Hazel Hawkins takes first step with potential partner

Twenty-five bed Hazel Hawkins Memorial Hospital is San Benito County’s sole hospital. After months of looking for potential partners, management at Hazel Hawkins recently announced that it received a “letter of intent” from Modesto-based American Advanced Management.

The small chain is a private, for-profit company that operates six other hospitals in the state. It’s proposing to lease Hazel Hawkins for five to 10 years before having the option to purchase the hospital.

American Advanced Management has taken over a handful of distressed or closed hospitals in rural parts of the state, according to its website. These include Coalinga Regional Medical Center, Glenn Medical Center and Colusa Medical Center.

Hazel Hawkins is part of a publicly governed health care district, and the deal would need to be approved by the district’s board and by county voters.

Hospital leaders sought a partner that, among other things, “possessed the resources to guarantee a continuum of care delivery for the future needs of our county,” Mary Casillas, interim CEO at Hazel Hawkins, said in a statement.

Hazel Hawkins declared a fiscal crisis late last year, and in May filed for Chapter 9 bankruptcy, but has continued to provide services. Last month, the hospital applied for $10 million from the state’s Distressed Hospital Loan program. If the hospital is approved for this loan, it would be in addition to a separate $3 million loan it received from the state in January.

In its May bankruptcy filings, the hospital said it expected to run out of cash in November 2024. At least one group, the California Nurses Association, has questioned whether the hospital filed for bankruptcy prematurely. The nurses union said it has asked the hospital to explain how it calculates its projections but has not received answers.

According to its financial statements, the hospital reported earnings of just over $2 million in calendar year 2022.

The union represents about 120 nurses at Hazel Hawkins. Filing for bankruptcy, according to the union, has prompted nurses to leave for jobs in other hospitals, leaving staff there shorthanded.

Los Angeles has handily broken its record for most days of coastal flooding in a year. And that’s without including October in the tally and with a wet El Niño winter ahead — a worrying sign for coastal homes and infrastructure.

Researchers can’t yet project how many more days of flooding we’ll have in 2026 — but we’re already well ahead of what the National Oceanic and Atmospheric Administration’s models had forecast up to this point.

NOAA oceanographer Karen Kavanaugh said models had predicted three to six flood days between May 2026 and April 2027. Those models took El Niño and sea level rise into account. She said that there have already been nine flood days in that window and added that the 12 flood days so far in the calendar year are “abnormally high.”

The number of days of coastal flooding observed at NOAA’s tide gauge in San Pedro is the highest recorded since observations started being taken in 1923. The previous record was set at nine in 1983, during another El Niño event.

When might we see more flooding?

Kavanaugh couldn’t say with certainty when flooding might occur, but noted that high-risk times ahead coincide with Thanksgiving and Christmas. Around then, the moon will be at its closest point to the Earth. The stronger gravitational pull from the moon causes what are commonly known as king tides, a nonscientific term for the highest predicted tides of the year.

In addition to these factors, the wide range of events affecting our tides this year, including storms, climate change, El Niño and related Kelvin waves, could very well cause other flooding events or cause the existing ones to become stronger.

Kavanaugh said a combination of factors — specifically Kelvin waves and astronomical high tides — was exactly what was responsible for the flooding seen this week.

“That could happen, perhaps, again in November and December if we have another pulse of a Kelvin wave,” Kavanaugh said.

Flooding inundated coastal communities around Southern California this week, including Orange County's Sunset Beach.

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Robert Gauthier

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How high will the tides be?

Unfortunately, Kavanaugh said, there’s no way to predict the severity of upcoming king tide events at this moment in time.

“But as we move closer to an event, there are good models that the National Weather Service uses to forecast flooding,” she added. “But they need it to be within seven days, sometimes shorter timelines.”

How to prepare for high tide conditions

Kavanaugh recommended keeping an eye on National Weather Service reports for the latest information and predictions. (There are separate pages for Los Angeles and Orange counties.)

Kavanaugh stressed that, given this year's unpredictability so far, people should be as prepared as possible.

“It's an unusual type of phenomenon to plan for for some communities,” she said. “We're used to planning for a big storm, maybe, and flooding from that, but not planning for, ‘Oh, it's gonna be beautiful sunny weather, and also you might have flooding on the roads.’”

Kavanaugh also recommended paying close attention to local emergency officials’ guidance and being mindful not to park cars in low-lying areas that could end up being inundated.

“If [local officials are] asking you to get sandbags or things like that, keep those sandbags because you might need them again in a few weeks,” she said.

The federal government must pull three taxpayer-funded Trump administration ads that appear to have been made for political or propaganda purposes, including one touting the president’s claim that every American will get $5,000 if Republicans keep control of Congress in the upcoming election, a judge ruled Friday.

U.S. District Judge Jennifer L. Rochon in New York sided with a coalition, including the nonpartisan watchdog Common Cause, in ordering the government to take down the advertisements titled “$5,000 to Americans,” “Every Democrat Voted Against No Tax on Tips,” and “Cost of Socialism.” She declined to pull several other ads.

She said the three ads must be taken off official government websites, including social media sites such as YouTube, Instagram and the like. Rochon also ordered the cancellation of any plans for the airing or distribution of the ads through authorized third parties, including by President Donald Trump’s flagship super PAC, MAGA Inc.

Rochon was nominated to the court by then-President Joe Biden, a Democrat, and once served as a law clerk for Trump’s sister, the late Maryanne Trump Barry, a longtime federal appeals court judge.

Responding to the ruling, White House spokesperson Lauren Bis said: “This Biden-appointed activist judge issued a lawless order to stop the administration from sharing patriotic videos.”

Rochon ruled during a hearing in which she considered expanding a temporary restraining order she issued two weeks ago, when she banned a series of ads that glorify Trump and echo his political messaging going into the midterms.

The plaintiffs sought the removal of at least 13 ads, but Rochon only ordered that the three be pulled, at least for now. She noted that the Government Accountability Office has observed that there are instances when the president’s office is entitled to inform the public of its policies, justify its policies and respond to attacks on its policies.

Rochon said the plaintiffs were seeking to restrict the office in ways that were “broad and far reaching” and she found herself concluding that the government will ultimately prevail legally with regard to many of the ads.

The White House has defended the ads as public service announcements akin to what past administrations have made to promote various policies. But the recent ads differ from many past public service announcements because they don’t try to help the public benefit from specific government programs, according to the plaintiffs.

After Rochon issued the order, she noted that she was doing so on a Friday afternoon and that the government would have no excuse to delay taking them down immediately.

A government lawyer acknowledged that he would be able to immediately notify relevant individuals responsible for taking down the ads.

“Everyone is here. Everyone can hear my order. No one is at the theater,” the judge quipped in a reference to excuses offered by government lawyers when her recent order, issued over a weekend, wasn’t immediately obeyed.

Rochon said irreparable harm could result to the plaintiffs if she didn’t ban the ads while the court case proceeds, though she noted that she could reverse herself and restore the ads or ban additional ads after hearing more evidence in the coming weeks.

“This court can neither postpone an election nor turn back the clock,” Rochon said after concluding that the plaintiffs were likely to succeed on their claims regarding the ads and would suffer harm if they were not taken down.

“This temporary restraining order will stop the administration’s wanton disregard for the law while the court hears the full case,” said Bradley Girard, a lawyer with Democracy Forward. “Congress has made clear that partisan ads cannot be funded with taxpayer dollars, and we are proud to work with this coalition to earn today’s result.”

In court papers, the coalition’s lawyers wrote that Congress did not appropriate funds to the president’s office “to run a PR shop to help the President’s allies and attack his perceived ideological opponents.”

Assistant U.S. Attorney Jeffrey Oestericher wrote in response to the plaintiffs that there was nothing wrong with White House staff compiling advertisements to “inform the public about his policies and to rebut attacks on those policies and his Administration.”

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Associated Press writer Michael R. Sisak contributed to this report.

Thousands of military veterans with VA-backed mortgages have been hit with higher interest rates and monthly payments since last year, when the Trump administration shut down a low-interest program designed to help them.

Among veterans who had their loans modified after a financial hardship, more than 15,000 saw their monthly payments increase by at least $150, according to an NPR investigation that obtained previously unreported data from the Department of Veterans Affairs.

More than 700 veterans suffered payment increases of $1,000 or more.

Lenders offer loan modifications to enable homeowners to catch up on missed payments. It involves changing the loan terms, and for the vast majority of Americans, it either lowers their payment or keeps it the same, depending on what they can afford. But that's not the case for VA loans, since the VA abruptly ended the program.

NPR found that 63% of veterans who received a loan modification were hit with a payment increase, compared with just 2% for modifications of loans guaranteed by the government-sponsored enterprises Fannie Mae and Freddie Mac, which cover most of the U.S. mortgage market.

"This is the height of insanity," said California Democratic Rep. Mark Takano, the ranking member of the House Veterans' Affairs Committee, after NPR shared its findings.

"These are veterans that are already financially distressed — they were already in trouble," he said.

Veterans like Scott Boyd are literally paying the price.

When Boyd was a teenager, his dad died of cancer. He said he saw the military as a clear path to start helping his family.

"My mom signed paperwork when I was 16," Boyd recalled. "I'm like, 'I'm sending my checks home to take care of my mom.'"

He started out in the infantry and saw combat. Later, Boyd worked in Army intelligence in some dangerous places. When he got out in 2002, he had skills that set him up for a career in tech. In 2021, he bought a house near Columbus, Ohio, using a VA home loan. Like other buyers at the time, he got a nice low-interest rate. "I felt very blessed," he said.

But a few years later, Boyd hit a crisis: He lost his job in a mass layoff, and he said his time in combat came back to haunt him in the form of PTSD. He checked himself into the Dayton VA hospital for treatment but fell behind on his mortgage.

Boyd and thousands of other veterans were pushed into much-higher-cost modified home loans. Hundreds are paying at least $1,000 more a month.

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Most Americans can get help in a situation like this. Mortgage companies don't want to foreclose because both they and the homeowner experience losses. So they have levers they can pull to help people who've fallen behind on payments.

Boyd's lender told him that he didn't have to worry because the VA had a loan forbearance program that would allow him to pause his payments and provide him with an affordable way to catch up after.

"I later found out that wasn't true," he said.

It wasn't true because the Trump administration then shut down a key part of the VA's home loan program. It was called the Veterans Affairs Servicing Purchase (VASP) program. Without it, vets like Boyd were stranded with no option but a much-higher-cost modified home loan at today's higher interest rates.

In Boyd's case, he is now stuck paying $1,181 more — every month.

"This is outrageous," said Boyd. "I remember just thinking to myself, 'This is just so broken.'"

Some in Congress agree.

"The VA home loan program should not be making things worse and more stressful for that veteran, a combat veteran, who's been through hell," said Takano, about Boyd's case in particular.

Rep. Mark Takano, D-Calif., speaks on Capitol Hill in 2025.

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Illinois Republican Rep. Mike Bost, chairman of the House Veterans' Affairs Committee, did not respond to NPR's repeated requests for comment. NPR also reached out to Wisconsin Republican Rep. Derrick Van Orden, a committee member who led the call to wind down the VASP program. He also did not respond to requests for comment.

The VA said in a statement that it helps thousands of veterans "retain homeownership and/or avoid foreclosure through programs like payment forbearance, loan modifications and individualized repayment plans."

The VA was warned this would happen

Before it was shut down, the VASP program was helping tens of thousands of veterans who had fallen behind on their home loan payments by rolling those missed payments into a new mortgage with a low 2.5% interest rate. That made the program a lifeline for vets in today's higher-interest-rate environment.

And Boyd said his mortgage company had been telling him that he too could use VASP when he was able to resume paying his mortgage.

" I would constantly ask them, 'OK, this is getting further and further behind,' and they were like, 'You have this last lever to pull.'"

This was in the spring of 2025, just months into the second Trump administration. Key Republicans on the House Veterans' Affairs Committee vocally opposed VASP, which the Biden administration created after its own VA home loan disaster. Republicans warned that VASP was putting taxpayers on the hook for thousands of loans to vets who had trouble paying.

"If the Biden version of VASP was allowed to continue, I fear that the home loan will not exist in the future for my fellow veterans," said Van Orden during a House Veterans' Affairs Committee hearing on March 11, 2025.

Rep. Derrick Van Orden, R-Wis., speaks in Eau Claire, Wis., on Oct. 20. He is currently in a tight race for reelection.

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But at the same hearing, as well as in letters to Congress and press releases, the mortgage industry and housing groups explicitly warned the Trump administration not to kill the program without first creating another viable option for vets. They said if the VA shut down the program before standing up a replacement, vets would be left with far worse options than other American homeowners. With interest rates up around 7%, they warned that the only option left would be a modified loan at the current higher rates, which would result in foreclosures for those who couldn't afford the higher payments. And that's exactly what has been happening.

" I was doing the math in my head as they were telling me, you know?" Boyd said about the loan modification he was presented with. "If I'm going from 2.75 to 6.75 … it seemed ridiculous," he said. Not only would that jump in his interest rate boost his payment by nearly $1,200 every month, but his loan term was extended to 40 years. So he went from about half of his monthly payment going toward principal to now more than 90% of his payment going to cover just the interest.

"This was a foreseeable outcome of abruptly ending a program without a replacement in place," said Matthew Douglas, of the Housing Policy Council. He represents the largest mortgage companies in the U.S. and was among those warning the VA not to kill VASP. Asked about NPR's findings, he said, "It's a mathematical certainty that borrowers are going to have those kind of shocking payment increases." 

Despite the warnings, the Trump administration ended the VASP program on May 1, 2025 — apparently in coordination with House Republicans, who announced the move before the Department of Veterans Affairs did, even though VASP was ended administratively, with no vote from Congress.

"We — along with many of our colleagues — had serious concerns about the impact VASP would have on not only the future of VA's home loan program, but the mortgage lending business as a whole. Today, the Trump administration rightfully put an end to VA's VASP program," Bost and Van Orden said in a joint press release at the time.

In his statement to NPR, VA press secretary Quinn Slaven wrote: "many leading voices in Congress supported the termination of VASP, which put the entire VA home loan program at risk."

The VA's new program slowly rolls out

Boyd lives with his partner and her four children, whom they are raising together.

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At the same time Van Orden was calling for VASP to be scuttled, he had written a bill to replace it with a new VA Partial Claim Program (PCP). Congress quickly passed that bill with broad bipartisan support in the wake of the VA scuttling VASP. It directed the VA to create an option for vets behind on payments, enabling them to move their missed payments to the back of their loan term. That way, vets could keep their original mortgage and not be forced into a higher-cost loan.

But after ending VASP, it took the VA more than 13 months to design and announce the details of the new program, which it did in June of this year. And the industry was then given another 180 days to implement it. Most mortgage companies still do not offer it.

In that gap, thousands of veterans got modified loans with higher interest rates and payments. The VA's new PCP program won't do anything to help those vets — they'll remain stuck in those modified loans.

Congress could help

Boyd holds a challenge coin from the Department of Defense that was given to him during his military service.

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NPR asked the VA about the vets who fell into the gap between the two programs. Slaven, the VA spokesman, said in his statement that the VA home loan program "is based on the premise that while Veterans may need some assistance, they must generally be able to make their mortgage payments."

Industry groups say raising a struggling homeowner's payment makes it more likely for them to redefault and face foreclosure. Foreclosures on VA loans rose to a 10-year high after VASP was killed, according to industry data. Experts warned in a congressional roundtable in September that time is running out for the government to help these vets or a wave of foreclosures is still to come.

Rep. Takano told NPR that the VA, if it chose to, could put these vets back into lower-cost mortgages or that Congress could pass a law to do it.

"We could do something for those veterans who saw a jump in their interest rates," Takano said.

Hanging on to home 

Boyd says he feels defeated after receiving worse loan options from the VA.

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Outside Columbus, Ohio, Scott Boyd is still managing to make those higher mortgage payments.

When he bought the home, he said, it felt like a guarantee of shelter and stability for him, his partner and the four kids they are raising together.

" I made a commitment, saying no matter what, I want to build a home that is big enough. …  I wanted to get them in better schools and things like that," he said.

He was even able to help when his father-in-law became ill recently; they moved him into the finished basement, where he got home hospice care.

So when he was presented with the terms of that loan modification, he had not only kids in the house but his dying father-in-law too. He'd just gotten back on his feet financially and was being told his options were the loan modification or foreclosure.

"My job was still new, and that still felt shaky. … My PTSD was shaky. … It seemed like the right thing to do was just to take the modification," he said.

Two weeks after Boyd signed the loan modification, the VA launched the new Partial Claim Program that would have allowed him to keep his original loan terms with the same monthly payment and low 2.75% interest rate. It took two more months before the first mortgage company offered vets access to the PCP, and most of the industry is still working to stand up the program before the deadline that the VA gave it of Nov. 28.

Boyd said that he doesn't often talk about his service and that he doesn't feel entitled to be treated better than any other American. But he did not expect the VA to give him worse options than those of people who never served.

" I really felt hurt more than anything. I wasn't angry. I was just like, I felt so defeated," Boyd said.

"Everything that I've done for this country and the things that I've been through, the things that I've seen, the things I've had to deal with … it's come down to, 'Yeah, I'm sorry — it's not in our systems yet. … There's nothing we can do about it.'"
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Very early on Wednesday morning, Dover, N.J., Councilwoman Sandra Wittner started getting messages about immigration agents. A dozen or more were gathering outside a Walgreens, according to the messages she was getting. Throughout the day, neighbors in north New Jersey saw a spike in Immigration and Customs Enforcement activity.

And New Jersey is not alone. In the weeks ahead of the midterms, various cities and states across the country are reporting a notable rise in ICE activity, according to reports gathered by NPR and its member stations.

"The tactics that the administration has been deploying in communities really appear to be designed to try to intimidate voters," says Wendy Weiser of the Brennan Center for Justice at NYU Law School. Despite that, early turnout is surging.

"There was definitely a lot of apprehension and fear," Wittner recalls. "We just really weren't sure if something huge was about to happen. People were not feeling very comfortable or safe."

Wittner is not sure who was detained or where, which is unsurprising: these days it's difficult to report on ICE crackdowns as they happen, because the Department of Homeland Security no longer publicly shares timely information on its operations.

NPR wrote to the agency to ask if there has been a recent surge. It responded: "ICE agents uphold our nation's immigration laws in all 50 states, seven days a week, 24 hours a day."

And yet NPR and its member stations have received tips from rural Illinois, Oregon, Detroit and California about surges in ICE enforcement throughout October.

An official within New York Mayor Zohran Mamdani's office who was not authorized to speak publicly confirmed that they have noted a surge in ICE activity in the city.

"We're certainly witnessing an uptick in activity, and have been since the summer," says a member of a volunteer group of neighbors in New York. She asked that NPR not use her name, as she is worried about retaliation. Her group goes to the scene where an ICE operation is happening, documents it, reminds those being detained of their rights, and alerts neighbors.

"In the past few weeks we've seen numerous large operations, or what we call cluster raids, multiple agents going to one spot and then the next," she said.

On the other side of the country, Oregon Public Broadcasting reporter Troy Brynelson has reported on a similar trend. "What we were seeing in early October and what we've seen continue, at least anecdotally throughout this month, is that ICE activity has really picked up in Portland." Brynelson says it seems to be concentrated in commercial areas. "I'd say it's a noticeable uptick compared to what we've seen over the summer."

Juan Proaño of the League of United Latin American Citizens (LULAC), a civil rights organization, says he's concerned because this is happening so close to the midterm elections. "It's not about ICE at the actual polling station, it's ICE at the perimeter of the polling station," he says.

"Mass enforcement actions could be away from the polls, but with social media and the news, it could be enough to dissuade somebody from actually going out to vote."

Weiser of the Brennan Center says there's no indication the raids are affecting turnout. On the contrary, she says there has been a surge in early voting in minority communities across the country. "The good news is: it isn't working. Americans are tuning this out and we are not seeing a significant impact on participation. And we are actually seeing huge surges in participation in communities of color, and in Latino communities, and in all the communities that have been targeted by ICE and DHS."

Even so, she says that intimidation at the polls is illegal, and should be reported.
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