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The COVID-19 pandemic took a brutal toll on Danielle Miele’s family, but after two exorbitant ambulance bills she’s afraid to call 911.

Her teenage son attempted suicide in 2022, Miele said. His mental health deteriorated during the pandemic, and he needed an ambulance transfer from the Roseville emergency room where Miele took him to a treatment center in San Mateo. The ambulance company hit Miele with a $9,000 out-of-network charge, which was sent to collections “almost immediately,” she said.

The virus also left Miele with seizures that mimic the symptoms of a heart attack, she said. Miele called 911 the first time a seizure happened. The 15-minute ride to the hospital cost $4,000 without help from insurance.

“The last time I had one of my seizures I basically said, ‘I’m going to die here at home…I’m not getting another ambulance,’” Miele said. “I’d maybe rather die at home than have more medical debt.”

A new California law taking effect Jan. 1 targets the kind of “surprise” ambulance bills that put Miele’s family in debt even though they had medical insurance. These bills take the form of out-of-network charges for commercially insured patients who have no control over which ambulance company responds to a call for help.

Under the new law, patients will only have to pay the equivalent of what they would have paid for an in-network service. Health insurance and ambulance companies will have to settle the bill directly even if they don’t have an existing contract.

Supporters of the new law argue it will make a big difference for thousands of families like Miele’s. The second time that Miele’s son needed an emergency psychiatric hold, the ambulance company that arrived was part of the family’s insurance network. Their co-pay: $83.

Ambulance companies did not oppose the legislation, which includes assurances that health insurance plans reimburse them for services.

Californians hit with millions in surprise bills

The California Association of Health Plans, which represents insurers, opposed the bill before it became law because of its potential to increase premiums by $67.3 million statewide. In contrast, people with commercial health insurance stand to save approximately $44.5 million in direct charges for ambulance rides, according to a legislative analysis.

Katie Van Deynze, a legislative advocate for Health Access California, said the law closes a longstanding gap in California’s consumer protections against surprise medical billing for those with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new legislation.

“It’s the last remaining gap, but it’s a really big one,” Van Deynze said. “You could be insured but it doesn’t matter.”

Approximately 14 million Californians with state-regulated commercial health plans will benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, 73% of all ground ambulance transports in California resulted in an out-of-network charge in 2018 among people with large employer insurance. California also has the highest median surprise ambulance bill in the nation at $1,209, according to a study published last year by the U.S. Public Interest Research Group.

In a statement at the time of the law’s passage, Assemblymember Tasha Boerner, the Democrat from Carlsbad who authored the measure, said people have no control over which ambulance company picks them up in a time of crisis.

“The last thing anyone should be thinking about when they call 911 is whether they can afford the ambulance ride,” Boerner said in her statement.

The law also protects uninsured people from receiving an expensive ambulance bill by limiting their out-of-pocket cost to the Medi-Cal or Medicare rate, whichever is greater. Medi-Cal is the state’s health insurance program for very low-income residents and already protects its enrollees from these types of bills.

About 6 million Californians enrolled in federally regulated health plans won’t be shielded by the law, but a national committee is working on a solution to the U.S. No Surprises Act, which protects Americans from many kinds of surprise bills, including air-ambulance transports, but doesn’t cover ground ambulance rides. Generally, those are Californians who work for large multi-state or multinational private companies with self-funded health plans. Californians can ask their employer what kind of health plan they offer.

$4,400 bill for newborn's ambulance trip

Lainey Arebalo and her family are thankful that future emergencies will be covered in California. Her health insurance company doesn’t contract with any ambulance companies in San Luis Obispo County where they live, leaving them with no choice but to pay out of pocket.

In September, minutes after Arebalo gave birth to her son Brady, doctors made the decision to transfer him to a larger hospital about 20 miles away. Brady wasn’t breathing properly and needed to be admitted to a neonatal intensive care unit. The ambulance came and whisked him away.

Over the next month letters started arriving from the ambulance company: Arebalo owed $4,400 for the transfer, she said.

“Here I am, you know, less than two months after giving birth being told I would be sent to collections,” Arebalo said.

Brady Arebalo playing in his grandparents living room in Templeton on Dec. 19, 2023.

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Larry Valenzuela

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CalMatters/CatchLight Local

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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.