The Brief

David Garza sometimes feels as if he doesn’t have health insurance now that he pays so much to treat his Type 2 diabetes.

His monthly premium payment of $435 for family coverage is roughly the same as the insurance at his previous job. But the policy at his current job carries an annual deductible of $4,000, which he must pay out-of-pocket for his family’s care until he reaches that amount each year.

“Now everything is full price,” said the 53-year-old, who works at a warehouse just south of Dallas-Fort Worth. “That’s been a little bit of a struggle.”

To reduce his costs, Garza switched to a lower-cost diabetes medication, and he no longer wears a continuous glucose monitor to check his blood sugar. Since he started his job nearly two years ago, he said, his blood sugar levels have inched upward from an A1c of 7% or less, the target goal, to as high as 14% at his most recent doctor visit in November.

“My A1c is through the roof because I’m not on, technically, the right medication like before,” Garza said. “I’m having to take something that I can afford.”

Plans with high deductibles — the amount that patients must pay for most medical care before insurance starts pitching in — have become increasingly common. In 2024, half of private-industry employees participating in medical care plans were offered this type of insurance, up from 38% in 2015, according to federal data. Such plans are also offered through the Affordable Care Act marketplace.

With ACA marketplace premiums for next year increasing and many of the subsidies to help people pay for them poised to expire at year’s end, more people face tough choices as they weigh monthly premium costs against deductibles. To afford insurance at all, people may opt for a plan with low premium payments but with a high deductible, gambling that they won’t have any medical crises.

But high-deductible plans pose a particular challenge for those with chronic conditions, such as the 38 million Americans who live with Type 1 or Type 2 diabetes. Adults with diabetes who are involuntarily switched to a high-deductible plan, compared with adults on other types of insurance, face an 11% higher risk of being hospitalized with a heart attack, a 15% higher risk of hospitalization for a stroke, and more than double the likelihood that they’ll go blind or develop end-stage kidney disease, according to a study published in 2024.

“All of these complications are preventable,” said Rozalina McCoy, the study’s lead author.

Care vs. cost

The initial rationale behind such high-deductible plans was to encourage people to become wiser health care shoppers, said McCoy, an associate professor of medicine at the University of Maryland School of Medicine in Baltimore. And they can be a good fit, proponents say, for people who don’t use a lot of medical care or who have cash on hand for a health crisis.

But while people with an excruciating earache will seek care, McCoy said, those with unhealthy blood sugar levels might not feel as urgent a need to seek treatment — despite the potential long-term damage — given the acute financial pain.

“You have no symptoms until it’s too late,” she said. “At that point, the damage is irreversible.”

Overall, medical care for people with diabetes costs insurers and patients an average of $12,022 annually to treat the disease, according to an analysis of 2022 data. Type 2 diabetes, the more common form, is diagnosed when the body can no longer process or produce enough insulin to adequately regulate blood sugars. With Type 1, the body can’t produce insulin. Those with the disease may end up on the financial hook not just for insulin and other types of medication but for related equipment.

Mallory Rogers, whose 6-year-old daughter, Adeline, has Type 1, calculates that it costs roughly $1,200 a month for insulin, a pump, and a continuous glucose monitor. That figure doesn’t include the cost of emergency supplies needed in case Adeline’s technology malfunctions. Those include another type of insulin, blood-testing strips, and a nasal spray that’s nearly $600 for a two-pack of vials — supplies that must be replaced once a year or more frequently.

“If she doesn’t have insulin, it would become an emergency situation within two hours,” said Rogers, a technology consultant who lives in Sanford, Florida. Rogers has been saving for the coming year when her daughter moves to the high-deductible health plan offered by Rogers’ employer, which has a $3,300 deductible for family coverage.

To treat her diabetes, Adeline relies on insulin, a pump, and a continuous glucose monitor that together cost about $1,200 a month, not including emergency supplies in case her technology malfunctions.

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Courtesy by Mallory Rogers

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Taxing decisions

Many insurance plans carry increasingly high deductibles. But to be defined as a high-deductible health plan — and thus be eligible to offer a health savings account — a plan’s deductible for 2026 must be at least $1,700 for an individual and $3,400 for a family, according to IRS rules.

Health savings accounts enable people to squirrel away money that can be rolled over from year to year to be used for eligible medical expenses, including prior to meeting a deductible. Such accounts, available through a plan or employer, can provide tax benefits. The contributions are limited to $4,400 individually and $8,750 for a family in 2026, and employers may contribute toward that total. Rogers’ employer pays $2,000 spread out over the year, and Garza’s contributes $1,200.

Rogers recognizes that she’s fortunate to have accumulated $7,000 so far in her health savings account to prepare for her daughter’s insurance shifting to Rogers’ plan.

“Adding a financial burden to an already very stressful medical condition, it hurts my heart,” she said, reflecting on those who can’t similarly stockpile. “Nobody asks to have diabetes, Type 1 or Type 2.”

The median deductible for employer health insurance plans was $2,750 in 2024, but deductibles can run $5,000 or higher, said George Huntley, CEO of both the Diabetes Leadership Council and Diabetes Patient Advocacy Coalition.

When deductibles are too high, Huntley said, routine maintenance is what patients skimp on: “You don’t take the drug that you’re supposed to take to maintain your blood glucose. You ration your insulin, if that’s your scenario. You take pills every other day.”

Garza knows he should do more to control his blood sugar, but financial realities complicate the equation. His previous health plan covered a newer class of diabetes medication, called a GLP-1 agonist, for $25 a month. He wasn’t charged for his remaining medications, which included blood pressure and cholesterol drugs, or his continuous glucose monitor.

With his new insurance, he pays $125 monthly for insulin and several other medications. He doesn’t see his endocrinologist for checkups more than twice a year.

“He wants to see me every three months,” Garza said. “But I told him it’s not possible at $150 a pop.”

Plus, he typically needs lab testing before each visit, an additional $111.

In 2026, the deductible for a “silver”-level plan on the marketplace will average $5,304 without cost-sharing reductions, according to an analysis from KFF, a health think tank that includes KFF Health News. For a “bronze”-level plan, it will be $7,476. An annual visit and some preventive screenings, such as a mammogram, would be covered free of cost to the patient.

Moreover, people comparing plan options, whether through their employer or the marketplace, should figure out their annual out-of-pocket maximum, which still applies after the deductible is met, Huntley said.

Garza’s family policy requires him to pay 20% until he reaches $10,000, for example.

Given Garza’s high blood sugar levels, his doctor prescribed a fast-acting form of insulin to take as needed with meals, which costs an additional $79 monthly. He planned to fill it in December, when he’s responsible for only 20% of the cost after he has hit his deductible but not yet reached his out-of-pocket maximum.

Garza likes his job despite its health plan, saying he’s never missed a day of work, even recently when he had a stomach bug. As of late 2025, he remained conflicted about whether to sign up for health insurance when his company’s enrollment period rolls around in mid-2026.

He worries that dropping insurance would place his family too much at risk if a major medical crisis struck. Still, he pointed out, he could then use the money he now spends on monthly premiums to directly pay for care to better manage his diabetes.

“I’m just stuck, to be honest with you,” he said.

As Los Angeles homeowners grapple with the expense of rebuilding after last year’s devastating fires, an L.A. City Councilmember is putting forward an idea that could lower some costs.

Councilmember Traci Park, who represents the Pacific Palisades, has introduced a motion to explore waiving part of the city’s portion of the local sales tax for fire victims who purchase rebuilding materials in the city.

The 1% of the local 9.75% sales tax that goes into the city’s general fund would be given back to consumers under the proposal. The waiver could apply to lumber, appliances and other rebuilding goods purchased within the city.

The motion, introduced Friday by Park and seconded by Councilmember John Lee, says: “The City should do everything within its power to alleviate the financial burden for these residents and businesses in order to facilitate their return and stabilize the Pacific Palisades community.”

Would it make much of a difference? 

Economists told LAist the proposal could help many homeowners mitigate the high cost of rebuilding, but likely wouldn’t tip the scales for under-insured, under-resourced property owners.

“It wouldn't hurt if it's very well designed and easy to use,” said Alexander Meeks, a director at the Santa Monica-based Milken Institute. “But I'm not sure if it's really going to tackle the scale of the financial challenge that survivors are facing.”

Meeks noted that the tax waiver wouldn’t lower up-front costs such as environmental testing, architectural design and permitting. And it may not help homeowners sourcing raw materials from outside the city.

Zhiyun Li, a UCLA Anderson School of Management economist, said the waiver could help some homeowners justify the additional cost of rebuilding more fire-safe structures.

“Homeowners must typically pay out of pocket to upgrade to IBHS+ standards, which are more stringent,” Li said. “The tax waiver could encourage upgrading to IBHS+ standards or investing more in mitigation, thereby reducing future risk and improving the likelihood of maintaining insurance coverage.”

What’s next for the proposal? 

The proposed tax relief would not be available to properties that have been sold since the fires started in January 2025.

The motion has been sent to the City Council’s budget and fire recovery committees. If approved by the full council, it would require the city administrative officer, the Office of Finance and the city attorney to report back to the council within 60 days on options for crafting a tax relief plan.

The motion calls for the report to consider factors such as how to minimize the burden of administering the tax relief, what documentation homeowners would have to submit and what it would cost the city to oversee the program.

Senate and House Republican leadership have resurrected a stalled plan to fund the Department of Homeland Security after a record 47-day funding lapse.

House Speaker Mike Johnson, R-La., and Senate Majority Leader John Thune, R-S.D., said in a joint statement on Wednesday that the House will take up a measure passed by the Senate last week to fund most of DHS except Immigration and Customs Enforcement and Border Patrol through the end of September.

Republicans would then attempt to fund ICE and Border Patrol for three years using a party-line budget reconciliation bill that would not require support from Democrats.

"In following this two-track approach, the Republican Congress will fully reopen the Department, make sure all federal workers are paid, and specifically fund immigration enforcement and border security for the next three years so that those law-enforcement activities can continue uninhibited," Thune and Johnson wrote.

The agreement comes nearly a week after House Republicans dismissed an identical plan, refusing to take up the Senate-passed measure and instead passing a 60-day short term funding bill for all of DHS that had little chance of overcoming Democratic opposition in the Senate.

Johnson called the agreement a "joke" and President Donald Trump declined to publicly endorse the deal. Trump had previously resisted any package that did not include his push to overhaul federal elections known as the Save America Act.

"I think any deal they make, I'm pretty much not happy with it," Trump told reporters last week.

Democrats welcomed the agreement as in line with their pledge not to give ICE any more money without reforms after immigration enforcement agents killed two U.S. citizens in Minneapolis. But the deal does not include any of the policy demands Democrats are pressing for, such as a ban on masks for immigration enforcement officers and requiring warrants issued by a judge, not just the agency, to enter homes.

"For days, Republican divisions derailed a bipartisan agreement, making American families pay the price for their dysfunction," Senate Minority Leader Chuck Schumer, D-N.Y., wrote in a statement Wednesday. "Throughout this fight, Senate Democrats never wavered."

Trump seemed to bless the revived plan earlier Wednesday, writing on social media that he wants a party-line bill to fund immigration enforcement on his desk by June 1.

"We are going to work as fast, and as focused, as possible to replenish funding for our Border and ICE Agents, and the Radical Left Democrats won't be able to stop us," Trump wrote.

Despite the shutdown, ICE has been minimally impacted because Republican lawmakers approved $75 billion for ICE through another party-line budget reconciliation bill last year.

Congress is on a two-week recess, but the Senate and House could move to fund all of DHS except ICE and CBP as early as Thursday using a procedure known as unanimous consent that allows the chambers to circumvent formal voting as long as no member objects.

Even during a recess when most members are not in Washington, this could be unpredictable, especially in the House, where many hard-line conservatives oppose a deal that does not fully fund DHS.

"Let's make this simple: caving to Democrats and not paying CBP and ICE is agreeing to defund Law Enforcement and leaving our borders wide open again," Rep. Scott Perry, R-Pa., a member of the ultra-conservative House Freedom Caucus, wrote on X. "If that's the vote, I'm a NO."

If a member does object, that could require waiting for another vote when all members are back from recess.

Claudia Grisales contributed reporting.
Copyright 2026 NPR

California clocked its second-worst snowpack on record Wednesday, a potentially troubling signal ahead for fire season.

It’s an alarming end to a winter that saw abnormally dry conditions briefly wiped from California’s drought map in January, for the first time in a quarter-century.

Though precipitation to date has been near average, much of it fell as rain rather than snow. Then March’s record-breaking heat melted most of the snow that remains. The state’s major reservoirs are nevertheless brimming above historic averages and are flirting with capacity, and a smattering of snow, rain and thunderstorms are dousing last month’s heat wave.

But experts now warn that California’s case of the missing snowpack could herald an early fire season in the mountains.

On Wednesday, state engineers conducting the symbolic April 1 snowpack measurement at Phillips Station south of Lake Tahoe found no measurable snow in patches of white dotting the grassy field.

“I want to welcome you call to probably one of the quickest snow surveys we’ve had — maybe one where people could actually use an umbrella,” joked Karla Nemeth, director of the California Department of Water Resources. “We’re getting a lot of questions about are we heading into a hydrologic drought? The answer is, I don’t know.”

State data reports that California’s snowpack is closing out the season at an alarming 18% of average statewide, and an even more abysmal 6% of average in the northern mountains that feed California’s major reservoirs.

Only the extreme drought year of 2015 beat this year’s snowpack for the worst on record, measuring in at just 5% of average on April 1st, when the snow historically is at its deepest.

“I think everyone's anticipating that it will be a long, busy fire season,” said Lenya Quinn-Davidson, director of the UC Division of Agriculture and Natural Resources Fire Network.

“Without a snowpack, and with an early spring, it just means that there’s much more time for something like that to happen.”

‘It’s pretty bizarre up here’ 

In the city of South Lake Tahoe, which survived the massive Caldor Fire in the fall of 2021 without losing any structures, fire chief Jim Drennan said his department is already ramping up prevention efforts.

“It's pretty bizarre up here right now. It really seems like June conditions more than March,” Drennan said. “People are already turning the sprinklers on for their lawns.”

Without more precipitation, an early spring may complicate prescribed burning efforts. But Drennan said fire agencies in the Tahoe basin can start mechanically clearing fuels from forest areas earlier than usual.

“That means we can get more work done,” he said.

It also means homeowners need to start hardening their homes now, said Martin Goldberg, battalion chief and fuels management officer for the Lake Valley Fire Protection District, which protects unincorporated communities in the Lake Tahoe Basin’s south shore.

Goldberg urges residents to scour their yards for burnable materials, create defensible space and reach out to local fire departments with questions. The risks are widespread — from firewood, wooden fences, gas cans, plants, pine needles — even lawn furniture stacked against a house.

“In years past, I wouldn't even think of raking and clearing until May,” Goldberg said. “But my yard's completely cleared of snowpack, and it has been for a couple weeks now.”

‘A haystack fire’

Battalion chief David Acuña, a spokesperson for Cal Fire, said fire season is shaped by more than just one year’s snowpack.

Climate change has been remaking California’s fire seasons into fire years. And California’s recent average to abundant water years have fueled what Acuña called “bumper crops of vegetation and brush.”

“Most of California is like a haystack. And if you’ve ever seen a haystack fire, they burn very intensely because there's layers of fuel,” Acuña said.

Like Quinn-Davidson, Acuña wasn’t ready to make specific predictions about fires to come.

But John Abatzoglou, a professor of climatology at UC Merced, said the temperatures and snowpack conditions this year offer a glimpse of California in the latter decades of this century, as fossil fuel use continues to drive global temperatures higher.

How this year’s fires will play out will depend on when, where and how wind, heat, fuel and ignitions combine. But it foreshadows the consequences of a warmer California for water and fire under climate change.

“This,” Abatzoglou said, “is yet another stress test for the future in the state.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.