The Brief

California’s port traffic is beginning to look worse now, under the effects of President Donald Trump’s fickle tariff policy, than it did at the height of the COVID-19 pandemic.

“The vessel calls, or cancellations, that we’re seeing today (are) starting to exceed the number that we saw in COVID-19,” Mario Cordero, chief executive of the Port of Long Beach, said in an interview with CalMatters in early May.

At Port of Los Angeles, Executive Director Gene Seroka said during a media briefing last week that the port expected 80 ships to arrive in May, but 17 have been canceled. By comparison, last year through May there were a total of 12 cancellations. There are 10 cancellations for June already, he added.

Farther north, the Port of Oakland saw a 15% month-over-month drop in container activity in April, spokesperson Matt Davis said. It was the first significant decline this year, as tariffs went into effect.

The challenges presented by Trump’s tariffs are “not like COVID,” said Martha Miller, executive director of the California Association of Port Authorities, at a business roundtable last week. The unpredictability of Trump’s edicts means there won’t be a surge of cargo, she said; many businesses are waiting to act, including to order goods for import.

Data for the state’s three biggest ports confirm that jobs are dwindling for longshore workers up and down the state. The numbers of gangs — teams of varied sizes that work to handle cargo — at each of the ports have declined in the past few weeks, and have dropped year over year. Besides the numbers of containers at the ports, gang numbers are another indicator of the amount of work available.

Gary Herrera is president of the International Longshore Workers Union Local 13, which represents port workers in both Long Beach and Los Angeles.

During a media briefing with Long Beach officials, Herrera said that part-time workers are not getting any hours right now. He told CalMatters that full-time workers — who get first dibs on jobs — may not be getting 40 hours a week, either. Herrera was also speaking on behalf of a couple of other locals; altogether they represent about 9,000 full-time and 6,000 part-time port workers.

As the tariff drama drags on, the impact will be felt by other workers along the supply chain, from truck drivers to the staff at warehouses to rail workers and those who work in retail. If and when people don’t have enough work or lose their jobs, their communities and local economies will suffer, port officials and workers say.

“We live and we work in our community,” Herrera said during a recent media briefing with Long Beach officials. “We spend in our community.”

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Luisa Gratz is the president of International Longshore Workers Union Local 26, which represents most of the security on the docks in Los Angeles and Long Beach. The port security workers — who drive other longshore workers from parking lots to the ships, among other things — told CalMatters that her constituents are also struggling.

“When there’s no work for longshoremen, there’s very little work for us except gate monitoring,” she said. “It’s heartbreaking. It’s putting people out of work.”

Truckers are also feeling the squeeze from the tariffs.

Eric Tate is secretary-treasurer of Teamsters Local 848, which represents about 8,000 truck drivers in Southern California. He said truckers, especially part-timers who aren’t guaranteed any hours, are seeing less work, though he did say truckers saw a bit of a pickup in work after Trump temporarily reduced tariffs on China.

“We’re trying to gear up and quickly move stuff around,” he said in an interview with CalMatters. “We’re trying to save Christmas.”

Ship-to-shore cranes loading cargo at the Port of Long Beach on April 10, 2025.

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He said the continued uncertainty means many truck drivers are barely working 40 hours a week. Some shipper drivers, who transport cargo off ships to ease congestion on ports, may be working one to two days a week, Tate said. “When there’s no ship, there’s no congestion,” he added.

But in the Bay Area, the Port of Oakland is seeing a possible pickup in activity in June — as of last week, the planned canceled ships for that month have been reduced from 12 to five, port spokesperson Davis said.

The decline in cargo traffic at the ports could change depending on how different industries and businesses respond to an agreement the Trump administration reached with China on May 12, which lowers the tax on imports from China from 145% to 30% for 90 days.

The volatility is a problem

Besides a decline in imports from places such as China, the ports are handling fewer exports from the state’s agricultural industry, thanks to retaliatory tariffs on U.S. goods. Stephanie Magnien Rockwell, chief of staff at the Port of Los Angeles, said in mid-May that California farmers are taking a hit.

“One of our greatest exports are soybeans to China,” she said at a hearing held by State Treasurer Fiona Ma about tariffs. “(But) Brazil, in the month of March, exported more soybeans to China than they have in their entire history.”

The U.S. trade war with China has an outsize effect on California ports: Chinese goods have accounted for 40% of the imports at the Port of Los Angeles, 63% at the Port of Long Beach and 45% at the Port of Oakland.

Despite the temporary deal with China, the lack of clarity is a problem — and tariffs remain high, officials, business owners and others say. Continued changes in the costs of goods make it hard for businesses to plan. And only certain size businesses may be able to afford to take a leap and order goods from overseas now.

“We can't generalize here, because of those 125,000 importing companies (whose) goods come through the Port of Los Angeles,” Seroka said to CalMatters. “But safe to say, if there was a little bit of a shortage on stock, or if some felt that the 30% average tariff might go higher, sure, people jump back in.”

But the uncertainty persists, Seroka said. Case in point: On May 23, Trump complained about not being able to reach a deal with Europe on tariffs and threatened a 50% tariff on European goods — which he said over the weekend would be delayed to July 9. He also threatened a 25% tariff on iPhones unless Apple begins to make the devices in the United States.

A big deal

Long-term, the stakes are high and wide-ranging. Port of Long Beach CEO Cordero said a 10% decline in cargo could mean a 10% decline in jobs. “If you use a round figure of a million jobs stemming from the port operations, that’s a 100,000 job reduction,” he told CalMatters.

His port supports jobs worth tens of billions of dollars in income in the five surrounding counties, according to a report recently released by the port. The report estimates that in 2023, port activity contributed $84.4 billion in local, state and federal taxes. Those were taxes paid by individuals and businesses, said Kimberly Ritter-Martinez, the port’s manager of economics and funding, during the Long Beach media briefing.

“When workers and business owners earn income from working at the port or as one of our suppliers, they spend those dollars on groceries, entertainment, travel… and all of that activity supports the broader economy,” she said.

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

Millions of people use injectable drugs like Wegovy to reach a healthier weight. But the weekly injections aren't for everybody — or every wallet.

That's why experimental pills that could achieve similar results are drawing so much attention.

The medicines haven't yet won approval from the Food and Drug Administration, but the first one could get the green light by the end of the year.

"The patient community in the obesity space has … gone without treatment for so long," says Tracy Zvenyach, director of policy strategy and alliances at the nonprofit Obesity Action Coalition. "So new innovations, new treatments to treat this chronic disease — all are welcome. All are exciting." The coalition receives financial support from multiple drugmakers, including Novo Nordisk, Eli Lilly and Pfizer.

Here's what you need to know — from how much the pills might cost to how they work.

1. Two new pills are (probably) coming

Novo Nordisk's obesity pill is expected to be approved first. It has the same ingredient — semaglutide — that's in Wegovy, Ozempic and also in Rybelsus, the company's Type 2 diabetes pill that was approved in 2019.

The difference between this new pill and Rybelsus is the dose. There's more semaglutide in the new pill.

Novo Nordisk's main competitor is Eli Lilly, which makes Zepbound and Mounjaro. And it's working on an obesity pill, too. But instead of using the same ingredient that is in its blockbuster injectables, tirzepatide, the company is working on a new one for its obesity pill that is called orforglipron.

2. Patients will take the pills daily, not weekly

The pills need to be taken every day, but the injectables are once a week.

For Novo Nordisk, it was a challenge making a semaglutide pill that wasn't immediately broken down in the stomach before the medicine could be absorbed. So the scientists there added an ingredient that would protect the pill for 30 minutes while it is being absorbed. It's a mouthful: sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, or SNAC for short.

"If you think about dropping an Alka-Seltzer tablet in a glass of water, that immediate fizzy reaction that occurs, that is what happens in your stomach," says Andrea Traina, one of Novo Nordisk's obesity directors. "It creates this little foamy environment directly around the tablet."

That foam prevents a stomach enzyme from breaking the tablet down, lowers the stomach's acidity ever so slightly, and makes the cells under the pill a little bit more permeable so the semaglutide can get absorbed into the bloodstream more easily. The process takes about 30 minutes. It has to be taken on an empty stomach.

Eli Lilly's orforglipron is a little different. It's not as vulnerable to being broken down in the stomach.

"It has no food or water restrictions," says Dr. Max Denning, one of Eli Lilly's senior medical directors. "You can take it orally, and it's very effectively absorbed without any additional absorption enhancers or administration restrictions."

3. They both work, but one appears to have an edge

In a study published in September in the New England Journal of Medicine, a 25 mg semaglutide pill led to a 16.6% reduction in weight on average over 64 weeks. That's about the same as Wegovy.

Eli Lilly's obesity pill, orforglipron, had a 12.4% average weight loss at its highest dose over 72 weeks, which means it's less effective than injections on the market.

The drugs have similar side effects to the injectables, including nausea and diarrhea.

4. These pills should cost less than the injectables

Pills tend to be cheaper than injectables, so patients are hoping they'll be more affordable than the brand-name injected medicines with list prices of over $1,000 a month — and that insurance companies will be more likely to cover them.

"It's easier to manufacture and the cost ultimately should be lower," says Dr. Richard Siegel, co-director of the Diabetes and Lipid Center at Tufts Medical Center. "One of the big problems with all of the medicines in this arena has been the cost. And can we equitably get these medicines to the millions, really, of people who might benefit from them?"

According to a recent poll by KFF, a nonprofit health policy research organization, 1 in 8 people is currently taking an injectable drug in this class. While most of them have at least some insurance coverage, more than half said they had difficulty affording the drugs.

Since early 2025, the drugmakers have made these medicines available at a discount to patients not using their health insurance, and the prices have come down a bit over time. As of early November, when Novo Nordisk and Eli Lilly announced deals with the Trump administration, the starting dose of Zepbound will be available for $299 a month for people buying without using insurance. And Wegovy will now be available for $349 a month.

While neither company has announced an official list price for the experimental pills, their Trump administration deals say that if their oral obesity medicines are approved, they'll sell them directly to consumers for $149 a month. That means patients can get this price if they don't use their health insurance.

Still, if the pills get better insurance coverage, copays could be significantly lower than that.

5. The FDA could act soon on the first two, and more new drugs are in the works

Novo Nordisk's obesity pill is expected to win approval before the end of the year.

Eli Lilly, on the other hand, has said it will submit orforglipron for FDA approval this year. The drug won a priority review voucher from the agency, which could mean the agency will make a decision "within months."

Novo Nordisk and Eli Lilly are also working on the next generation of these drugs, which could prove to be even more effective than the ones already on the market.

Novo Nordisk is studying another compound called cagrilintide and a combination of cagrilintide and semaglutide. And Eli Lilly is studying retatrutide. Both are in Phase 3 clinical trials.

Meanwhile, another company, Metsera, has several obesity drugs in its pipeline, though none is in late-stage clinical trials yet. Novo Nordisk tried to acquire the company, but it ultimately lost out to Pfizer, which completed the acquisition that could ultimately be worth more than $10 billion.

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With California electric rates stuck at nearly the highest in the nation, the state’s utility regulator is poised to lower the payout shareholders can receive from California’s three large investor-owned power companies.

In a proposed decision, the California Public Utilities Commission recommended dropping the “return on equity” by 0.35% each for Pacific Gas & Electric, Southern California Edison and San Diego Gas & Electric. If approved, shareholders of all three companies would see a potential return next year of just under 10%. Such returns for PG&E and Edison haven’t dipped below double digits in at least 20 years.

Utilities said the decline would affect their ability to bring in needed investment for their work. Critics of the decision said that the decline is too small to meaningfully impact ratepayers’ bills, even if it’s a step in the right direction.

“California and other [public utility commissions] authorize rates of return that are far in excess of the statutory requirement,” said Mark Ellis, former chief economist at Sempra, which owns San Diego Gas & Electric.

The California Public Utility Commission is expected to vote on the decision in December.

Californians pay the second-highest electric rates in the U.S. after Hawaii, according to the most recent figures from the U.S. Energy Information Administration. A number of factors go into those rates, including wildfire mitigation costs. PG&E in particular has attracted the ire of California customers for its frequent rate hikes within the last year.

Baked into those bills is the return on equity, money meant to compensate shareholders for the risk of doing business. These shareholder return rates are set by each state’s utility regulators and hover nationally around 10%. If approved, PG&E’s rate would be 9.93% (down from 10.28%), Edison would be 9.98% (down from 10.33%), and San Diego Gas & Electric would be 9.88% (down from 10.23%). These rates are not automatically guaranteed – utilities can fall short of this return if they don’t keep down costs, such as project overruns or unexpected lawsuit fees.

A small change in this rate can be a difference of millions of dollars for ratepayers. The return is a percentage of the rate base, the total value of a utility’s assets it can earn a return on; this includes projects such as building a new power plant, for example. The rate bases for California’s three large investor-owned utilities have steadily grown each year as they add new customers and projects, increasing the amount that shareholders can receive.

PG&E, for example, had a 10% shareholder return in 2023, a possible return of about $125 million. Had it been 1% lower, the potential return would have been $12.5 million less.

“The proposed cost of capital decision needs refinement to better reflect California’s unique risks and market realities,” said Edison spokesperson Jeff Monford. “Making those refinements in the final decision will enhance SCE’s ability to finance essential infrastructure projects for a more reliable, resilient and ready electric grid.”

PG&E spokesperson Jennifer Robison echoed this sentiment, saying the decision “fails to acknowledge current elevated risks to help attract the needed investment for California’s energy systems.”

Anthony Wagner, spokesperson at San Diego Gas & Electric, said, “A decision that accurately reflects these realities is essential to enabling investments that reduce wildfire risk, strengthen reliability, replace aging infrastructure and advance California’s clean energy transition for the benefit of the communities we serve.”

Utilities routinely request these rates be pushed higher because they are a key part of what goes into utilities’ credit rating, affecting the interest they pay on loans for infrastructure investments. But in recent years, experts and consumer advocates point to a mismatch – the utility industry is typically considered low-risk, but critics say the shareholder return rates don’t reflect that. Rates for U.S. 10-year treasury bonds, which are considered the benchmark for a risk-free investment, are about half of the national average for approved utility shareholder return rates. And it’s costing utility ratepayers across the country as much as $7 billion annually, according to academics.

Ellis, the former Sempra economist, said there is a way to lower shareholder returns while keeping customer bills in check and maintaining credit ratings that the commission has not yet explored – changing the balance of debt and equity each utility has.

“You really need to understand credit,” he said. “This is where they’re going to get you.”

The commission is allowed to set the debt-equity balance when it determines shareholder returns, but it left this unchanged for all three utilities in its proposed decision for 2026. Keeping shareholder return rates high as the main means for keeping credit ratings up, Ellis said, unnecessarily burdens ratepayers.

A little-noticed provision in the sweeping "One Big Beautiful" legislation enacted by the GOP over the summer sharply limits the amount of federal student loans that students earning professional degrees — including medical school — can borrow.

It also imposes even stricter borrowing caps for other health fields including nursing and public health. The Education Department does not consider graduate education in those fields "professional" education, though officials described that as a technical and regulatory decision, rather than a value judgment.

The loan changes will hit next July when an open-ended federal loan program known as Grad PLUS will stop making new loans. From that point on, med students won't be able to borrow more than $50,000 a year — or more than $200,000 over the four years. Many private med schools already cost north of $300,000, including living expenses.

"That will automatically give a lot of people some pause to think about where they're accepted and what their finances are," said Vineet Arora, vice dean of education, at the University of Chicago's Pritzker School of Medicine.

Given that most medical students already come from the upper 40% of family income, Arora added, "we already have fewer medical students coming from sort of middle class and lower income families." Lack of access to loans, she said, may well skew it even more.

On top of those new restrictions, a federal regulation posted October 30 — already facing a court challenge — adds new conditions to the Public Service Loan Forgiveness program, which enables health workers who work in high needs areas and make payments for 10 years to erase debt.

The new Trump administration policy said loan forgiveness won't be an option for people working for an entity engaging in, among other things, illegal activities involving immigration, gender-affirming care, or "terrorism" aimed at "obstructing or influencing" federal policy. It will be up to the Education Secretary to decide which organizations will be ineligible.

These limits on how aspiring doctors or other health providers — nurses, occupational therapists, social workers, dentists and more — can finance their education likely foretell a more affluent, and less diverse, health care work force in the future, said Atul Grover, who recently stepped down from his long-time policy post at the Association of American Medical Colleges. He is now a visiting scholar at Stanford and a health sector consultant.

But champions of the legislation, including Senate HELP Committee chairman Sen. Bill Cassidy, who put forth a version of this legislation earlier this year, have argued that it will bring about changes in higher ed financing that will push down tuition costs and protect people beginning careers from "from drowning in debt."

These new loan changes come on top of a slew of recent court rulings and administration policies that crack down on diversity, equity and inclusion initiatives in higher ed.

Grover said the new policies will "disproportionately discourage and decrease the likelihood" that students from lower income families attend — or even apply — to med school.

"Once you tell them, 'Oh, you're going to have to borrow $300,000 to go to med school,' they're like, well, that's out, right?'" Grover said.

Narrowing who can afford medical education

Since the landmark June 2023 Supreme Court ruling banning consideration of race in admissions, Black and Latino enrollment to medical school has dropped.

That trend, and the new Trump administration policies, could mean fewer young doctors practicing in underserved communities, both rural and urban. Some new doctors will of course still choose to practice there, including some who themselves grew up in such communities. But many may feel like they have to choose high-paying specialties over primary care to get out from piles of loans.

The Association of American Medical Colleges said the new loan limits will likely worsen the physician shortage, already forecast to hit up to 86,000 doctors by 2036 — on top of existing shortfalls in underserved communities.

"If future medical students face greater financial barriers — especially those from low-income, rural, or first-generation backgrounds — we risk shrinking the supply of qualified applicants. Fewer students entering medical school now means fewer residents and practicing physicians later," the AAMC said in an emailed statement.

The AAMC declined further comment, as did several administrators and spokespeople for med schools.

Along with physicians, the changes will affect students in dentistry, and various advanced pharmacy and psychology degrees considered professionals, along with chiropractors and podiatrists, according to an Education Department memo.

But advanced nursing degrees, along with health practitioners like occupational and physical therapists, are not on that list. And for these "nonprofessional" graduate school tracks, the annual loan limits would be $20,500. Organizations representing those practices hope to win some changes in policy before the regulations are finalized but they have not been successful during months of debate.

"Misinformation on TikTok has caused confusion about the Trump Administration's ongoing actions to implement student loan caps for graduate students," The Department of Education's Press Secretary for Higher Education Elle Keast said in a statement Monday. "The Trump Administration is implementing long-needed loan limits on graduate loans to drive down the cost of programs."

Nurses disagree.

"At a time when health care in our country faces a historic nurse shortage and rising demands, limiting nurses' access to funding for graduate education threatens the very foundation of patient care," American Nurses Association president Jennifer Menik Kennedy said in a statement. "In many communities across the country, particularly in rural and underserved areas, advanced practice registered nurses ensure access to essential, high-quality care."

Benefits of a diverse health care workforce

Making graduate training in the health professions less attainable could change the makeup of the health care work force.

That runs counter to mounting evidence, outlined in a major National Academies of Science, Engineering and Medicine report last year called Ending Unequal Treatment , that a health care work force that looks like America is actually good for America's health.

It's not that a white doctor or nurse can't provide excellent care to a Black or Latino or Asian patient — or vice versa. That happens each and every day. But shared experience, the racial, linguistic and cultural matches between patient and provider known as "concordance," can improve doctor-patient communication. Some data show it improves patients' ability to manage chronic conditions like diabetes or hypertension.

"What the data says is that when we have a diverse and inclusive workforce that is representative of the populations that are served, that we actually see improved health outcomes," said Vincent Guilamo-Ramos, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, who served on the National Academies panel.

"Across all the health professions," he said, "we see that there's underrepresentation in terms of the people that need providers who can bring to their practice their sort of lived experience." That can include speaking languages in addition to English to enhance communication with patients.

According to data from the AAMC and its osteopathic medicine counterpart reported in JAMA Network Open, since the 2023 Supreme Court ruling incoming Black or African American student enrollment fell 11.6% and Latino by 10.8%. Asian and White student enrollment rose.

A number of universities run assorted "pipeline" enrichment programs to help high school students, or even younger kids, explore and prepare for careers in science and medicine. Some of those are still ongoing, and structured to avoiding running afoul of the DEI rules.

But an approach that med schools used after the Supreme Court, sometimes called "holistic admissions," ran into opposition from the Trump administration. The idea was to look broadly at med school applicants -- at those who may have overcome adversity for instance, not just those with the highest MCAT scores.

That was encouraged under the Biden administration. But President Donald Trump in August issued a "presidential memoranda" outlining how the Department of Education should crack down on "overt and hidden racial proxies."

"Greater transparency is essential to exposing unlawful practices and ultimately ridding society of shameful, dangerous racial hierarchies," Trump wrote.

Many health educators say the primary problem though, is the high cost of education for health fields.

Champions of the changes, including Cassidy and the Department of Education, argue that as borrowing is limited, the pressure will mount on schools to cut tuition.

But some in the education field say that while they too would like to see education become more affordable, they don't think these policies will achieve that. With NIH support under threat, taxes rising on endowments on some large prestigious universities,, and feuds between the administration and elite institutions relief is not likely, Guilamo-Ramos noted

But more affordable education, he said, would be good for students – and good for patients.

"One way that we can optimize health for everyone and save money is by ensuring that we have the best workforce, which means it being representative and then motivating people, all different kinds of people, to pursue careers in health and not only ones that would be the most lucrative."

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