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The Brief

The most important stories for you to know today
  • We break down the process and costs
    NPR spoke to immigration experts and lawyers and reviewed government documents to break down the steps of the U.S. deportation process and its cost.
    NPR spoke to immigration experts and lawyers and reviewed government documents to break down the steps of the U.S. deportation process and its cost.

    Topline:

    Here's how immigration experts and lawyers who reviewed government documents break down the steps and associated costs of the U.S. deportation process.

    Why now: President Trump kicked off his second term vowing to deport a record number of people from the U.S. But deportation is typically a cumbersome process generally involving an arrest, detention, a removal order from a judge and finally a flight out of the U.S. and can take months or years.

    What's next: Trump has taken steps to change how law enforcement officials track, find, detain and remove those in the country without legal status. He's also broadened the categories of people eligible for deportation.

    Keep reading... for details on each step of the process.

    President Trump kicked off his second term vowing to deport a record number of people from the U.S. But deportation — a cumbersome process generally involving an arrest, detention, a removal order from a judge and finally a flight out of the U.S. — can take months or years.

    "Each of those pieces can be extremely difficult and complicated depending on where someone is, who they are, what types of protection claims they might have, what types of resources the U.S. government has," said Kathleen Bush-Joseph, lawyer and policy analyst with the U.S. Immigration Policy Program at the Migration Policy Institute, a nonpartisan think tank.

    Much like his predecessors, Trump has taken steps to change how law enforcement officials track, find, detain and remove those in the country without legal status. He's also broadened the categories of people eligible for deportation.

    "The sands are shifting underneath our feet," said Eric Welsh, partner at Reeves Immigration Law Group in Los Angeles, which represents individuals and businesses on issues related to immigration status and visas.

    NPR spoke to immigration experts and lawyers and reviewed government documents to break down the steps of the U.S. deportation process and its cost. This is meant as a general breakdown of the process and not a rule for each individual's circumstances. 


    Step 1: Identifying who is removable

    In March, Immigration and Customs Enforcement told reporters it had arrested 32,000 people since Trump took office. 

    Those at risk for arrest include people without legal status because they may have entered the country illegally, overstayed a work or student visa, or violated the terms of their green card, including by committing a crime.

    But immigration law experts add that federal law officials do not have to prove someone committed a crime to deport them — as recent examples of revoked student visas show.

    Trump's latest moves include ending programs that granted legal status to migrants from certain countries. The administration said it would not renew Haitians and Venezuelans' Temporary Protected Status, a program that grants citizens of certain countries permission to live and work in the U.S. The White House also said it would end a Biden-era humanitarian program that granted two-year permits to live and work in the U.S. to Cubans, Haitians, Nicaraguans and Venezuelans who had fiscal sponsors in the United States.

    There is pending litigation that has paused plans to end the protections, but if they lapse, once-eligible people who remain in the U.S. would be in the country without legal status and thus eligible for deportation.

    Former President Joe Biden had a focus on border-region enforcement as the number of border encounters increased during his tenure. This second Trump administration has seen a low in border encounters compared to last year and has pivoted its enforcement to the interior of the country.


    Step 2: Arrests

    Those at risk for arrests include people without legal status because they may have entered the country illegally, overstayed a work or student visa, or violated the terms of their green card, including by committing a crime.
    Those at risk for arrests include people without legal status because they may have entered the country illegally, overstayed a work or student visa, or violated the terms of their green card, including by committing a crime.
    (
    Ana Galvañ for NPR
    )

    Since taking office, Trump and Homeland Security Secretary Kristi Noem have tapped law enforcement in other federal agencies to assist with arrests to meet an aggressive quota pushed by Trump's officials.


    In January, ICE officers were assigned a quota of 75 arrests per day for each of the 20 field offices.

    The FBI, U.S. Marshals Service and Drug Enforcement Administration are now assisting in investigations and arrests. But those "at-large arrests" — done directly by federal agents — have constituted a minority of all ICE arrests in most years, according to the Migration Policy Institute; they were just 29% of all arrests in fiscal year 2024. Typically, most arrests come from local law enforcement.

    Often, that involves the Criminal Alien Program, which takes people who are in local jails and prisons and transfers them to ICE custody, and a provision known as 287(g), which allows local police and jails to conduct limited immigration law enforcement.

    Immigration detention can come at any point from arrest to a final decision in court. The cost can range and DHS also uses government contracts with private prison operators to expand available space. One recent contract is estimated to generate $180 million in annual revenue for CoreCivic. Alternatives to detention, such as ankle monitors and regular check-ins with ICE, can also be used.

    Immigration lawyers explain that sometimes immigrants may ignore a notice to appear, or miss the notice altogether due to filing glitches. But a failure to appear results in a final order of removal.

    Trump has also sought to skip the court process, relying on programs like "expedited removal," which allows anyone in the country for under two years without legal status to be deported quickly, and the "Alien Enemies Act," which the government has claimed allows it to deport people it deems members of Venezuelan gangs without due process, an assertion under intense legal scrutiny in federal courts.


    Step 3: Immigration court system

    A person is required to appear in court for a judge to decide whether they are removable.
    A person is required to appear in court for a judge to decide whether they are removable.
    (
    Ana Galvañ for NPR
    )

    Immigration law decisions, including whether someone gets a final removal order, fall under the Executive Office for Immigration Review within the Justice Department. That office had more than 4 million pending cases in the last quarter of 2024.


    "People referred to the immigration courts might end up waiting years before they have a hearing determining their case," said Bush-Joseph, from the Migration Policy Institute. "And when someone files for asylum, those cases can actually take even longer because of the complex nature of the claims."

    If a person is found to be removable by a judge, a judge may find them "removable as charged," which is not a final order of removal but kicks off the rest of the process. The person does not lose their status at this point, if they have it.

    "It's just like any other form of litigation. You can say 'I deny that' and the government has to prove that you are removable," said John Conrace, an immigration attorney in Mississippi. "People who get orders of removal, those are often generated because they are afraid to go to their initial hearing."

    If they appear in court, people have the right to ask for time to seek legal representation, though most people don't have lawyers.

    Immigration lawyers say they often look for two numbers to prepare for the next step: if the person has been here for less than one year or more than 10. Less than one year allows a person to potentially claim asylum. More than 10 can stave off final removal if people can prove there is a relative who will suffer extreme hardship if the person is deported, or if they have a U.S. citizen spouse or children. But this is hard to win — and never grants a pathway to legal status.

    Those in the country between one and 10 years can try to withhold removal based on other claims, such as risk of persecution or humanitarian relief.

    The case of Kilmar Armando Abrego Garcia is a good example: the El Salvador immigrant was able to stave off deportation by arguing, in part, that it was more likely than not that he would be persecuted by gangs in El Salvador. The government later said it deported him by mistake, prompting a lawsuit and a judge's order to bring him back.


    Step 4: Removal

    If a person's claims to stave off deportation fail, the judge issues a final order of removal.
    If a person's claims to stave off deportation fail, the judge issues a final order of removal.
    (
    Ana Galvañ for NPR
    )

    If people's claims to stave off deportation fail, the judge issues a final order of removal. That's also appealable. People can also choose to "voluntarily depart," which is not a formal deportation and does not reflect on a person's future immigration record.


    Appeals of removal are filed with the DOJ's Board of Immigration Appeals and could reach circuit courts and then the Supreme Court.

    "That takes a wildly varied amount of time. If you are not detained and you are free, it could be years before the BIA gets to resolving the issue that was appealed," Conrace said, adding that it is not common for cases to make it up to the highest court.

    In fiscal year 2024, immigration courts issued 666,177 initial case decisions, with a plurality being removal orders.

    As of the last quarter of 2024, there were 1.5 million pending asylum cases in immigration court and 1 million with the U.S. Citizenship and Immigration Services.

    "The current pace of work means that it would take a lot more resources, a lot more immigration judges and asylum officers, to be trying to work through these applications at a faster pace than is currently happening," Bush-Joseph said.

    About 1.4 million people have pending deportation orders, according to ICE, but there are challenges to sending many back to their home countries. One reason is that their home countries have not agreed to accept them.

    The Biden administration carried out deportations to 192 countries in the last fiscal year — nearly every country in the world. The Trump administration is aiming to make inroads with others to be "third-party countries" that can take in deportees.

    Estimates on total cost to deport one person vary depending on where someone is apprehended, how long they are in detention and the length of their legal battle. DHS' budget for ICE is $8 billion, the Customs and Border Protection budget is $20 billion and U.S. Citizenship and Immigration Services budget, which is covered by the fees people pay to apply for citizenship and other benefits, is $865 million. Not all this money goes to immigration law enforcement.

    "Overall, the U.S. immigration system remains extremely overwhelmed, under-resourced and outdated," Bush-Joseph said. "It's going to take congressional action to really update and reform the system and bring it into the 21st century to meet modern migration challenges."

    That reform, though, has proved a challenge — decades of reform efforts have died in Congress. A promising bipartisan effort came together early last year after months of careful negotiation, but fell apart less than a day after it was made public — as then-candidate Trump pressured Republicans to oppose the deal in order to keep border security alive as an issue in the presidential election.

    Now, the administration is hoping that Congress can provide $175 billion for border security in the budget reconciliation process later this year.

    Copyright 2025 NPR

  • Flies still warm homes after Lineage Fire
    Fly traps hang on trees in front of homes with metal fences.
    Fly traps hang outside homes on Los Palos Street near the Lineage warehouse.

    Topline:

    County inspection reports show that flies are still breeding at the Lineage warehouse amid unsanitary conditions created by organic waste, sludge and food.

    How to access fly traps: Residents can request fly traps through Lineage’s online community contact form on its website.

    A neighbor's story: Two months after the Lineage warehouse fire, Nataly Degante was finally able to control the fly infestation plaguing her East Los Angeles home. A mix of mosquito zappers, sprays, a fly swatter and net that she purchased helped her combat the throngs of flies flocking into neighborhoods after the fire left 85 million pounds of rotting food inside the warehouse. At one point, there were so many flies that she couldn’t even cook. “They would get into the food,” said Negante, who lives about a mile and a half away from Lineage.

    Read on... for more on how to get free fly traps.

    This story first appeared on The LA Local.

    Two months after the Lineage warehouse fire, Nataly Degante was finally able to control the fly infestation plaguing her East Los Angeles home.

    A mix of mosquito zappers, sprays, a fly swatter and net that she purchased helped her combat the throngs of flies flocking into neighborhoods after the fire left 85 million pounds of rotting food inside the warehouse. 

    At one point, there were so many flies that she couldn’t even cook. “They would get into the food,” said Negante, who lives about a mile and a half away from Lineage.

    “It’s overwhelming because I have two children that I need to feed. It was very, very frustrating coming home and having to deal with, ‘How do I kill all these moscas?’” Degante said. 

    She’s not alone.

    Residents at recent public meetings have said they continue to cope with flies in their neighborhoods. One resident at a Tuesday gathering at Resurrection Church said she has seen an influx of flies in recent days.  

    A fly trap is hung from a pole with a sign next to a street.
    A fly trap is hung from a pole across the street from the Lineage warehouse where workers continue to clear it out.
    (
    Steve Saldivar
    /
    The LA Local
    )

    County inspection reports show that flies are still breeding at the Lineage warehouse amid unsanitary conditions created by organic waste, sludge and food. An Aug. 26 inspection report— conducted by the Los Angeles County Department of Public Health — details how Lineage has failed to eliminate fly breeding sources and take necessary measures to prevent flies originating from the property from migrating to neighboring areas. 

    The health department said it has conducted daily inspections since July 15 to verify whether Lineage has corrected those violations. The company hasn’t, and since then, more than 30 citations totaling about $60,000 have been issued, according to inspection reports and citations on the department’s website

    The latest inspection report on Aug. 26 notes that hundreds of live flies were seen in several locations, including on organic waste and walls throughout the loading dock adjacent to Freezer 1, as well as on the ground floor within the freezer. 

    Live flies were also spotted “on the exterior premises of the facility,” as well as dead flies along Union Pacific Avenue.

    Flies cover a shovel and a concrete floor next to a building.
    An environmental health specialist with the Los Angeles County Department of Public Health observed more than 75 live flies on a shovel handle and over 50 dead flies on the ground floor in the Freezer 1 loading dock on Aug. 18 at Lineage.
    (
    Courtesy of Los Angeles County Department of Public Health
    )

    A Lineage spokesperson said the company has expanded pest-control efforts with support from Orkin, a company that provides pest and rodent control services, to help reduce fly and rodent activity around the site. This includes daily fly-control treatments and inspections of the property perimeter, as well as rodent-control devices that have been installed around Lineage. 

    Lineage highlighted the installation of up to 248 exterior fly-control devices, including bait stations and fly traps to help reduce fly populations. 

    The Lineage spokesperson said the company continues to distribute fly traps to residents, adding that a total of 1,989 fly traps have been provided since the fire. 

    But they’re not available to everyone, only to those in areas designated by Lineage (see areas below). 

    Degante finds it appalling that she and her neighbors have to foot the bill for these kinds of expenses. She estimates spending nearly $100 on products to combat the fly problem in her house. 

    “I’m a single parent, and my community, they’re working-class people. We don’t have additional income to spend on a mistake from [Lineage]. We’re being overlooked,” she said. 

    How to access fly traps

    Residents can request fly traps through Lineage’s online community contact form on its website. 

    The form notes that Lineage support is only available for households located between Los Palos Street and South Herbert Avenue and between the I-5 and Union Pacific Avenue. 

    Lineage Logistics can be reached by emailing boyleheights@onelineage.com or by calling (866) 317-1115.

    Fly traps are also available to residents at the Boyle Heights City Hall Community Resource Center that is open from 11:30 a.m. to 3 p.m. Monday, Wednesday and Friday at 2130 1st St.

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  • Bringing the family menu back home
    Three round white curry pots sit in individual metal warmers with small lit flames underneath, on a dark wood table. The left pot holds a reddish-brown chili curry, the back pot a lighter orange curry, and the front-right pot a green curry with visible chicken and Thai basil. Fresh herbs, bean sprouts, and a plate of white rice noodles in a blue-and-white dish sit in the foreground.
    The trio of curries at Chao Krung's Kanom Jeen Curry Night, alongside fresh herbs, bean sprouts, and rice noodles.

    Topline: Chao Krung, L.A.'s oldest existing Thai restaurant, is marking a new chapter with Kanom Jeen Curry Night, a Wednesday-only concept from second-generation owners Katy Noochlaor and Amanda Maneesilasan. The menu features a trio of house-made curries — including a family recipe passed down from their grandmother — served over rice noodles alongside grilled skewers, at the same Fairfax Avenue location the family has run since the 1970s.

    Why now: What reads as a single new menu item is really the latest step in a decades-long reclamation. Chao Krung's founders opened the restaurant in 1969 and had to disguise it with Chinese dishes like chow mein just to get customers in the door. Katy and Amanda took over in 2017 to undo that compromise, and this spring bought the Fairfax building outright — finally giving them room to build something new.

    Why it matters: Kanom Jeen Curry Night, alongside the family's growing footprint with Tuk Tuk Thai and Ban Ban Burger, is less a rebrand than a family finally serving the food on its own terms.

    In Los Angeles, Thai food is something many of us take for granted — as central to how Angelenos eat as tacos or sushi. But in 1969, when one of the first Thai restaurants, Chao Krung, opened its doors, the cuisine was so unfamiliar that its owners had to offer Chinese dishes to put customers at ease.

    "My mom had a chalkboard — barbecue chicken, wonton soup, chow mein," recalled Amanda Maneesilasan of her mother, Supa Kuntee. "She'd start seeing people coming in, and then slowly introduce them to something Thai."

    The restaurant mostly served L.A.'s scattered Thai community — years before Thai Town existed.

    Boon and Supa Kuntee, along with Supa's sister, Nillaung, opened Chao Krung’s first location, a small storefront on Western Avenue, not long after the couple arrived in California in pursuit of a better education and a better life.

    The family later closed that location for a second spot on Hollywood Boulevard, a narrow, single storefront where the same struggle to explain Thai food to Angelenos continued — and the same Chinese menu holdovers stuck around to keep customers coming in.

    It wasn't until the family opened its third and current location on Fairfax Avenue in 1972 that Chao Krung began to take the shape it's known as today.

    As Thai food became more popular and moved into the mainstream in the '70s and '80s, its clientele grew, boosted by staffers at nearby CBS Television City. You can see family photos in the space spanning the past few decades, in between statues of the Thai Buddha and colorful tapestries, showcasing Los Angeles' restaurant history.

    Two  women both with medium dark skin stand behind a bar, smiling broadly at the camera. The woman on the left has long dark hair and wears a black top under navy denim overalls with leather strap details. The woman on the right has long dark hair and wears a light gray jacket over a purple top. Beer taps, wine glasses, and a mural depicting a Thai temple scene are visible in the background.
    Sisters Amanda Maneesilasan (left) and Katy Noochlaor (right), second-generation owners of Chao Krung, behind the bar.
    (
    Courtesy Chao Krung Thai
    )

    Second generation

    As children, Maneesilasan and her sister, Katy Noochlaor, grew up in the restaurant — doing homework between tables, playing behind the building — wherever the family was, they were there, too.

    Which is why it made sense in 2017 for them to step into their parents’ shoes. "We knew we would take over the restaurant," Noochlaor said. "We live and breathe that restaurant."

    The menu still had vestiges of the original compromise their parents had to make to survive. The sisters, however, were determined to restore it to its true Thai roots.

    For Maneesilasan, learning to make green curry from her grandmother was a turning point, almost a lightbulb moment, in her understanding of the cuisine.

    Weekly curry nights

    As part of the reclamation effort, the sisters have unveiled a new weekly Kanom Jeen Curry Night, Wednesdays only, which features a trio of curries and grilled skewers.

    When I visited, small ceramic vats of curry crowded the table, alongside plates of rice noodles — steam still rising, their funky aroma enough to make a famished stomach growl.

    The curries consist of Gang Kieaow Waan Gai, the green curry recipe they learned from their grandmother, made with chicken, a coconut curry base, fresh herbs, Thai eggplant and Thai chili.

    Mae's Nam Ya Trout is made with tender bits of trout in a Southern Thai coconut curry, built on house-ground red curry paste, and is the most labor-intensive of the three, taking about five hours to complete. The Nam Prik is a roasted chili curry with smoky herbs and nutty undertones from peanuts. The layered flavors are savory, but when mixed with rice noodles, fresh vegetables, and dried chilies, they take on a new dimension — silky smooth at first, then leaving your lips burning the next.

    An overhead shot of a dark wood table with several dark ceramic plates. On the left, charred meat skewers rest on a banana leaf next to sliced cucumber, red onion, and a red dipping sauce. On the right, two more skewers sit beside a small metal cup of amber sauce. A gold plate at the top holds piles of pickled mustard greens, sliced green beans, shredded cabbage, bean sprouts, and fresh herbs. The edge of a noodle-filled curry bowl is visible in the top right corner.
    A selection of Ping Ping skewers at Chao Krung, including roasted eggplant, lemongrass chicken, beef satay, and shrimp, alongside Isaan-style pork sausage.
    (
    Sydney Yorkshire
    /
    Courtesy Chao Krung
    )

    "Curry is so important in Thai culture, it's part of our tradition," Maneesilasan said. On the trout curry specifically: "I can guarantee you can't find this anywhere else."

    The skewers range from house-made Isaan-style sausage to a surprisingly spicy eggplant, glazed with roasted chili, garlic, and makrut lime leaf — a welcome kick from a vegetable so often relegated to the sidelines.

    In addition to taking over the family restaurant, the sisters have also built their own ventures over the years — Tuk Tuk Thai, a street-food-driven spot now on Sawtelle, and Ban Ban Burger, a Thai-inflected smashburger concept located next door.

    This fall, a second Ban Ban Burger location opens next door to Chao Krung on Fairfax, with the wall between the two restaurants coming down to make way for an archway connecting them. It's a literal and symbolic union of the family's two generational concepts under one roof.

  • It's been a record long wait for LA fire survivors
    The Eaton Fire burned such a large area in Altadena, Calif. that it reached areas that weren't considered at risk. Now, Los Angeles will be requiring some of those homeowners to rebuild with fire-resistant building materials.
    The Eaton Fire burned much of Altadena in L.A. County.

    Topline:

    It’s been nearly 600 days since the L.A. fires became one of the most destructive in U.S. history, yet the federal government has still not appropriated more than $15 billion in long-term recovery funds to help survivors get back home.

    Why it matters: Fire survivors are facing huge gaps to rebuild and are running out of temporary housing insurance. Experts say such federal funds are key to addressing those issues.

    Keep reading... for more on what's become a record-long wait for support.

    It’s been nearly 600 days since the L.A. fires became one of the most destructive in U.S. history, yet the federal government has still not appropriated more than $15 billion in long-term recovery funds to help survivors get back home. That’s longer than the previous record of 500 days survivors of the Maui fires had to wait, according to After the Fire USA.

    “ It's really like nothing we've ever seen before,” said Jennifer Gray Thompson, the nonprofit’s founder and CEO.

    Deep partisan divides and repeated government shutdowns under the Trump administration have been major causes for the delays, officials say.

    “Disaster relief should not be a political bargaining chip — but that’s exactly how the Trump administration has made it out to be,” Sen. Alex Padilla said in a statement.

    The state has also lagged, with $2.5 billion in recovery funds only just starting to be released, according to reporting by NBC4.

    Meanwhile, L.A fire survivors are facing massive financial gaps to rebuild, on average between $200,000 and $500,000, even with insurance. And as temporary housing insurance dissipates, many are now being forced to decide whether they can afford to rebuild at all.

    “ The community is struggling and is fighting to come back — and determined to come back — but we are really lacking the state and federal support that is necessary to help get us there,” said Sam James, a sixth-generation Altadenan whose family lost multiple generational homes in the Eaton Fire.

    James founded the Altadena Recovery Team, now called A Resilient Tomorrow, to support fellow survivors in lieu of reliable government and insurance-funded safety nets. Multiple local creative financing efforts are also cropping up more quickly feed that gap.

    “The delay is just really hard to rationalize given how much need there truly is on the ground,” she said.

    In recent months, delegations of local officials as well as Eaton and Palisades fire survivors have traveled to Washington, D.C. to speak with lawmakers about the much-needed federal funds, which experts say can often be used to fill such gaps in finances.

    In June, the White House requested more than $85 billion in supplemental funds, primarily to support the war on Iran. The next month, L.A. Mayor Karen Bass and L.A. County Supervisor Kathryn Barger sent letters to the Senate Committee on Appropriations urging disaster needs be included in such requests.

    “It's on D.C. to begin to move the narrative from an ask to a make it happen,” Barger told LAist.

    Four U.S. senators from states affected by recent disasters — including two Republicans from Utah and North Carolina, as well as California senators Padilla and Adam Schiff — sent a letter in July expressing their concern that no disaster funds were included in the White House’s supplemental appropriations request.

    The senators called the omission an effort by the Trump administration to punish Los Angeles and the state of California.

    Gov. Gavin Newsom has requested more than $10 billion for what’s called “Community Development Block Grant Disaster Recovery,” which can help survivors finance their rebuilds, as well as help local governments rebuild infrastructure, such as water systems, community centers, roads and more.

    “It's the largest bucket of money any community receives in order to recover after a disaster,” said Thompson, from After the Fire USA. “It can really help fill the gaps that people need to get home.”

    On average, the wait for such funds — from appropriation to allocation — is two years, Thompson said. Yet it’s been nearly two years since the L.A. fires, and the funds have yet to be appropriated at all.

  • Lawmakers propose bills to lower costs for GLP-1s
    Three weight loss injection pens are laid on a table under partial shade.
    A photo illustration of a group of weight loss injection pen medications.

    Topline:

    Senate Bill 1089, which would expand access to the class of drugs known as GLP-1s, is clearing its final hurdles this legislative session.

    Why it matters: The bill would direct the state to seek to partner with a drug manufacturer to increase competition and lower prices for GLP-1s under its CalRx program, a state program created to distribute popular, expensive drugs at a fraction of the cost.

    The backstory: It is unclear how long that could take, but it’d likely be a yearslong endeavor. It took the state three years to bring its $55 insulin into the market under CalRx. Today the state program also distributes albuterol inhalers and naloxone.

    Read on... for more on the proposal.

    Laura Richardson pays $450 a month out of pocket for a drug that could keep her off insulin for the rest of her life. She's a California state senator — and even she can't get her own insurance to cover it.

    Richardson started using a GLP-1 a year ago after learning she was pre-diabetic. Her state health plan does not cover it.

    “If something is available to help you to be more healthy, to avoid comorbidities … why would we want to wait till a person became diabetic to help them?” she told lawmakers in a June hearing.

    Her experience is not unusual. For many Californians, popular weight loss drugs such as Ozempic and Wegovy continue to be elusive despite their clinical promise. While prices are dropping, these drugs continue to be unaffordable for many; most insurers don’t cover them; and state programs, wary of costs, have rolled back access.

    Senate Bill 1089, which would expand access to the class of drugs known as GLP-1s, is clearing its final hurdles this legislative session. The bill would direct the state to seek to partner with a drug manufacturer to increase competition and lower prices for GLP-1s under its CalRx program, a state program created to distribute popular, expensive drugs at a fraction of the cost.

    It is unclear how long that could take, but it’d likely be a yearslong endeavor. It took the state three years to bring its $55 insulin into the market under CalRx. Today the state program also distributes albuterol inhalers and naloxone.

    Richardson, an Inglewood Democrat, authored the bill, which is a watered-down version of its original, more ambitious form. Previously, the bill also sought to require that CalPERS, the health plan that insures 1.3 million public employees and retirees, cover GLP-1 drugs.

    CalPERS opposed the bill and argued that the drug’s high cost would increase premiums by $28 per member per month.

    Richardson added that she had discussed including GLP-1s in the CalRx program with the governor, and “he was very positively open to that.” State health officials have said that GLP-1s are among the drugs they are considering for the program.

    A boom in GLP-1 spending

    The bill follows California’s recent elimination of GLP-1 coverage for the treatment of obesity in its Medicaid program, known as Medi-Cal. The state cited growing pharmacy costs and budget pressures for cutting the benefit. The state still pays for certain GLP-1s when prescribed specifically for diabetes treatment.

    GLP-1s have helped many people to better manage their obesity and chronic healthcare conditions. Obesity is a well-known contributor to conditions such as diabetes and cardiovascular disease.

    State data show that the number of GLP-1 prescriptions solely for weight loss jumped from 20,000 to 700,000 between 2018 and 2023 across both Medi-Cal and commercial plans. In 2023, California spent $416.8 million on GLP-1 prescriptions for weight loss in the Medi-Cal program and commercial payers spent $405.2 million, according to state data.

    An analysis by the Legislative Analyst’s Office found that during this time, California’s pharmacy spending nearly doubled, and tied that growth to drugs that treat diabetes, obesity, and inflammatory diseases.

    California is not the only state feeling the burden of these drugs' popularity and cost: New Hampshire, Pennsylvania, Massachusetts and South Carolina also recently eliminated Medicaid coverage for GLP-1s when used solely for weight loss.

    Today 12 states cover GLP-1s for obesity treatment under their Medicaid programs, although Rhode Island will cease coverage in October.

    Similarly, coverage of GLP-1s under private insurance varies widely; there’s no clear standard. Health plans have also pointed to costs , noting they are currently a key contributor to premium increases.

    Alison Sexton Ward, an economist and research scientist at the University of Southern California, said that data show huge benefits for peoples’ health. Modeling projects long-term savings in healthcare spending as well as a narrowing of health disparities, but she noted it’s a tricky investment for insurers to make. There are significant upfront costs before plans may start to see savings because of the reduction of obesity-related health problems, and insurers may not capture those savings when people tend to switch health plans every few years, she explained.

    “The thing about treating obesity is just because you lose weight today doesn't mean that your healthcare costs go down tomorrow,” Ward said. “There's been this unique pressure on these drugs that they pay for themselves.”

    One pilot that researchers and providers are looking at is the new federal Medicare GLP-1 Bridge Program, a temporary project that seeks to bring down the cost of Zepbound, Wegovy and Foundayo to about $50 a month.

    Patients seeking cheaper options 

    Dr. Wayne Ho, an obesity specialist and researcher in Los Angeles, sees the consequences of patchwork access to the drugs in his patients. Patients who can pay cash or whose insurance covers the drugs tend to be able to better manage their health conditions. Those without access try other, less effective therapies.

    “It's really disheartening to see because we have these wonderful innovative treatments that really are life altering,” he said.

    The cost is also driving some of his patients to seek cheaper, compounded versions of the drug, which some doctors warn against because they lack FDA approval.

    Compounding typically involves custom-making a drug for a specific need — removing an allergen, for example. Increasingly, compound pharmacies and telehealth platforms are offering versions of GLP-1s that swap out an ingredient or two. Ho says these compounded drugs carry higher risk because they bypass the FDA’s rigorous vetting and approval process.

    Nationally, calls to poison centers related to weight loss drugs increased by 1,500% between 2019 and 2025, according to data from America’s Poison Centers. Studies and reports have shown that compounded GLP-1s are more likely to cause adverse effects and have a higher risk of preparation errors. A Binghamton University study found that the odds of hospitalization were higher for compounded products. The FDA also warns of the prevalence of counterfeit products.

    Ho calls GLP-1s one of the best tools he has as a provider. He remains hopeful that affordable access to the FDA-approved weight loss drugs is on the horizon. Continued efforts by state lawmakers to expand access are a critical step, he said.

    “I think there's more and more pressure to cover these medications as more and more scientific data come out to show how it affects the body in a very positive manner,” he said.

    Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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