The Brief

Thousands of volunteers will spread out across Los Angeles this week to take an official tally of the region’s unhoused population — an effort that carries new urgency after the recent wildfires.

The point-in-time Homeless Count, led by the Los Angeles Homeless Services Authority, was originally scheduled for last month but was delayed due to the wildfires that tore through Los Angeles County. The annual event is a crucial metric for understanding the scope of L.A.'s homelessness crisis and the effectiveness of local policies.

But the fires this year have made the effort more complicated by displacing thousands of residents, polluting the region with toxic smoke and ash, and potentially upending the normal routines of homeless Angelenos.

Homeless service providers and advocates also say they fear the focus on wildfire recovery is already diverting public attention and resources away from homelessness. They say the data gathered in this year’s count is key to keeping the issue on the public’s radar.

“Not only do we get a snapshot of what's happening here in L. A. County — of what's working and what's not working – we also get to compare that against other parts of the country,” said Rowan Vansleve, president of Hope the Mission in the San Fernando Valley.

“And that is so important right now.”

Delayed count

The count had been scheduled for late January but was postponed over concerns that evacuations of both housed and unhoused residents and disruptions to homeless services providers would compromise the accuracy of the data gathered.

The Los Angeles Homeless Services Authority, known as LAHSA, was also worried about sending volunteers into burn areas where their health or safety could be jeopardized.

Because of the risks, LAHSA is expected to deploy teams of its own outreach workers, instead of volunteers, to count unhoused people within census tracts that sustained fire damage. Those teams will work with first responders to access the areas safely, officials said.

Despite the challenges, the agency says its volunteer recruitment efforts are on pace with last year’s numbers. As of Friday, more than 4,000 volunteers had registered. Last year, about 6,000 volunteers participated, LAHSA said.

The agency has requested nearly 8,000 volunteers for this year, but the agency said only about 2,600 are required in order to conduct an accurate count.

The annual point-in-time count of the unhoused population is required by the federal Department of Housing and Urban Development. Government agencies, including LAHSA, use the data to decide how to allocate funding and resources.

“This is an opportunity for us to unite and participate in a project that will help people living on our streets,” said LAHSA spokesperson Chris Yee. “The Homeless Count helps us gain a clearer picture of homelessness in our community.”

LAHSA typically publishes the results of the count in late spring or early summer, but the agency hasn’t said how the postponement will affect this year’s release.

Volunteers arrive for the Greater Los Angeles Homeless Count in 2022. LAHSA has made updates to the volunteering process this year to try to make it easier.

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The numbers 

In 2024, LAHSA estimated there were 45,252 unhoused people in the city of L.A. at the time of the January point-in-time count and 75,312 across the county.

In both cases, the numbers were a slight reduction from 2023. They measured a 2% decrease in the city of L.A. and a 0.27% decrease countywide, which is within the count's margin of error.

Still, it was the first time in several years without a spike in the region’s unhoused population. Nationally, the homeless population rose 18% over that same period.

The 2024 Homeless Count also showed a 10% decrease specifically in unsheltered homelessness, as more people moved into shelters and hotels. It’s unclear what those unsheltered numbers will look like this year, or how the wildfires might have shifted the balance.

“Are we gonna see more people unsheltered or, probably more likely, will the shelter numbers be up because people are displaced?” said Ben Henwood, director of USC’s Homelessness Policy Research Institute. “And then how will we know if it’s the disaster that impacted the numbers or something else?”

Deepening the crisis

The wildfires that ignited in early January destroyed nearly 12,000 homes in the Pacific Palisades, Altadena and Pasadena and caused more than $100 billion in losses.

They also spurred increases in rent prices, including instances of illegal rent gouging.

Most of the thousands of families who lost their homes in the fires are not expected to show up in next week’s homeless count, which tallies people living outside in tents and vehicles, as well as in homeless shelters. The count doesn’t include people living doubled-up with other families or staying in Airbnbs.

“Most people who are homeless were last housed with someone else. They weren't even renters, they were lodgers in someone else's property,” said Gary Blasi, a law professor at UCLA.

The loss of thousands of single-family homes in Pacific Palisades and Altadena doesn’t necessarily mean a shorter supply of housing available to extremely low-income Angelenos, experts say.

But rising housing demand from wildfire victims will worsen L.A.'s existing housing shortage, likely forcing more low-income Angelenos into homelessness in the long-term.

“We've been trying to build ourselves out of this mess for a while,” said Sarah Hunter, director of the RAND Center on Housing and Homelessness. “Now there's just going to be more strain on the system.”

How the wildfires will affect this year's Greater L.A. Homeless Count is a big unknown.

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Shifting priorities

Wildfire recovery is expected to remain a top priority for public officials, which could mean less spending on homeless services — especially as the city of L.A. is facing a budget crisis fueled by increased legal payouts and labor costs.

L.A. Mayor Karen Bass has said she aims to end street homelessness by next year, and homelessness has been at the top of the city’s agenda since she took office.

But UCLA's Blasi said that’s likely to change amid rebuilding efforts after the fires.

“The finite attention span of the government is going to be much more focused on this new problem,” he said, “And that's going to take that attention away from the homeless crisis, even as it exacerbates the homeless crisis.”

Many homeless services providers are nervous about decreases in public dollars and charitable donations forcing them to cut back services.

“Attention has shifted, so we're not seeing the number of volunteers,” said Vansleve. “Nor are we seeing the same amount of giving. That is all going to affect the services we provide.”

Providers also worry that rising housing demand after the fires could force certain housing units for the homeless to close.

“I'm concerned that some of the sites that we work with to house folks may be too expensive to actually bring folks indoors,” said Ryan Smith, CEO of homeless services provider the St. Joseph Center in West L.A.

Volunteering for the count

During last year’s count, some volunteers reported confusion about a cumbersome volunteer registration system, confusing training materials, delays checking in at deployment sites and technical issues with the phone app used to coordinate the count.

In response to those concerns, LAHSA officials say they’ve updated processes this year to improve the volunteer experience.

Volunteers will now use a single website to register and access training, according to LAHSA. The agency said it streamlined the check-in process for volunteers to reduce waiting times, and the Homeless Count app has been updated to provide better navigation and tracking features to keep volunteers in their assigned census tracts.

This year’s count will take place over three days this week, beginning at 8 p.m. each evening.

• Tuesday, Feb. 18: Volunteers will tally the unhoused residents in much of the L.A. metro area, the San Fernando Valley, and the Santa Clarita Valley.
• Wednesday, Feb. 19: Volunteers will spread out throughout East Los Angeles and the San Gabriel Valley.
• Thursday, Feb. 20: The count will conclude with a focus on West L.A., South L.A., the Antelope Valley and the South Bay. 

People interested in volunteering can register and learn more at: theycountwillyou.org.

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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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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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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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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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.

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.
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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.

People increasingly can't afford health insurance. 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.

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.

Then, on Dec. 4, 2024, UnitedHealthcare CEO Brian Thompson was shot on a Manhattan street on his way to an investor event. The shocking act of violence sparked a widespread consumer outcry over U.S. health care costs and denied claims, and plunged UnitedHealth Group into a public relations disaster.

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."

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