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The Brief

The most important stories for you to know today
  • Turner’s Outdoorsman linked to CA gun crimes
    An illustration featuring a Turner's Outdoorsman store front and, a rack of rifles and an image from a White House press briefing.

    Topline:

    Between 2022 and 2024, California law enforcement traced nearly 8,000 crime guns — those used in a crime, suspected to have been used in a crime, or illegally possessed — back to Turner’s Outdoorsman stores. A first-of-its-kind analysis of California Department of Justice data by The Trace shows that Turner’s is connected to more crime guns than any other California dealer or chain. The retailer also sold a shotgun to the White House Correspondents’ Dinner attacker.

    What the data shows:

    • Turner's stores account for a fifth of guns sold in California, but make up a quarter of all crime guns.
    • The chain accounted for 7,922 crime guns from 2022 to 2024. Guns it sold showed up at crime scenes at a rate 35 percent higher than other dealers in the state.
    • Guns sold at Turner’s locations wound up at crime scenes quickly — less than a year after purchase — 40 percent more often than guns from other dealers. (Regulators consider a “time-to-crime” of less than one year an indicator of trafficking.)
    • The Torrance store where Allen bought his shotgun sold 642 firearms later recovered as crime guns, the second-highest number of any store in the state. 
    • Eight of the 10 stores with the most crime gun traces were Turner’s locations in Southern California.

    Why Turner’s? It’s not clear why Turner’s is overrepresented in the data, but there are several potential reasons some dealers are tied to high numbers of crime guns. Factors such as store location, lax sales practices, the types of guns sold, and low prices can contribute to higher numbers of traces, according to academics and former law enforcement. However, the large numbers of crime guns traced to Turner’s Outdoorsman stores warrants regulatory scrutiny, said Steve Lindley, the former head of the Bureau of Firearms at CADOJ, who now works at the Brady Campaign to Prevent Gun Violence.

    Eight months before Cole Tomas Allen sprinted past a security checkpoint with his shotgun in an alleged attempt to kill President Donald Trump, he walked into Turner’s Outdoorsman in Torrance, California, and purchased the weapon, a Mossberg pump-action 12-gauge.

    If convicted, Allen would join a long list of criminals armed with guns from the Turner’s Outdoorsman chain. Between 2022 and 2024, California law enforcement traced nearly 8,000 crime guns — those used in a crime, suspected to have been used in a crime, or illegally possessed — back to Turner’s locations.

    With over 30 outlets across California, Turner’s Outdoorsman is the biggest gun seller in the nation’s most populous state. A first-of-its-kind analysis of California Department of Justice data by The Trace shows that Turner’s is connected to more crime guns than any other California dealer or chain. And that’s not only because Turner’s sells so many guns. Among the findings:

    • Turner's stores account for a fifth of guns sold in California, but make up a quarter of all crime guns.
    • The chain accounted for 7,922 crime guns from 2022 to 2024. Guns it sold showed up at crime scenes at a rate 35 percent higher than other dealers in the state.
    • Guns sold at Turner’s locations wound up at crime scenes quickly — less than a year after purchase — 40 percent more often than guns from other dealers. (Regulators consider a “time-to-crime” of less than one year an indicator of trafficking.)
    • The Torrance store where Allen bought his shotgun sold 642 firearms later recovered as crime guns, the second-highest number of any store in the state. 
    • Eight of the 10 stores with the most crime gun traces were Turner’s locations in Southern California.
    • Sales at Sacramento and Stockton Turner’s stores ended up at crime scenes in under a year at some of the highest rates in the state.

    It’s not clear why Turner’s is overrepresented in the data, but there are several potential reasons some dealers are tied to high numbers of crime guns. Factors such as store location, lax sales practices, the types of guns sold, and low prices can contribute to higher numbers of traces, according to academics and former law enforcement.

    However, the large numbers of crime guns traced to Turner’s Outdoorsman stores warrants regulatory scrutiny, said Steve Lindley, the former head of the Bureau of Firearms at CADOJ, who now works at the Brady Campaign to Prevent Gun Violence. “It was shocking how many of the top 25 crime gun dealers in California were Turner's Outdoorsman,” Lindley told us. “Turner's has a responsibility to figure that out and do whatever they can to try and minimize that,” he said, including reviewing its training and hiring practices.

    Authorities should give Turner’s stores “some extra love and attention when it comes to inspections, because there’s something going on there different than other dealers,” he added.

    Turner’s Outdoorsman did not respond to interview requests.

    “There’s something beyond just, ‘You sell a lot of guns, you have more crime guns,’” said Hannah Laquer, a professor at the Violence Prevention Research Program at University of California, Davis. Laquer’s research has found just 15 percent of California dealers account for 98 percent of the state’s crime guns.

    Guns take several paths to crime scenes. Some are stolen from their owners. Others are bought through straw purchases — the act of buying a gun on behalf of someone else — or trafficked into the underground market. And some are legally purchased by a person who later commits a crime.

    Turner’s past customers include Syed Rizwan Farook, the San Berardino mass shooter, who purchased a pistol at a San Diego Turner’s store. An acquaintance of Farook’s also bought rifles from Turner’s locations in San Diego and Corona, which Farook and his wife used in the 2015 massacre. The couple killed 14 people and injured 22 in the worst terrorist attack in the United States since 9/11.

    California — where the most recent data covers 2022 to 2024 — is the only state that releases detailed figures on the dealers connected to crime guns. The federal government does not, because Congress has prohibited the ATF from sharing retailer-level data since 2003.

    Allen’s shotgun purchase was reported by Bloomberg, citing law enforcement records. The firearm would not appear in the data because he purchased it after the period captured by the numbers, and it was recovered by law enforcement outside the state.

    Challenges Tracking Crime Guns

    Those who investigate and study crime guns say there’s likely no single reason Turner’s accounts for a disproportionate share of those traced by CADOJ — and no obvious path for the public to determine why that disparity exists. But they cite several general reasons Tuner’s may account for large numbers of crime guns.

    “It’s a question of geography, it’s a question of social economics. It’s a question of, is there any competition within a legitimate walking area or driving area?” said Scot Thomasson, a former special agent with the ATF.

    A store’s inventory, prices, and clientele are all related to how many crime guns are traced back to it. According to research done in California by Laquer and her colleagues:

    • Cheaper handguns are more likely to be recovered in crimes
    • Dealers where a greater percentage of background checks are rejected have higher rates of sales later traced as crime guns
    • Younger buyers purchase a disproportionate share of crime guns
    • Dealers in areas with higher gun robbery and assault rates sell more crime guns

    Large chains are unlikely to engage in risky sales, much less trafficking, said Joseph Bisbee, a former ATF agent who has trained over 1,000 officers on firearms trafficking investigations. “It doesn’t make sense from a business perspective,” he said. Lax sales practices may be a factor in other crime gun sales, he said, including dealers “not taking the responsibility seriously enough, or making a mistake that allows that straw purchase.”

    At least one Turner’s location, in Pasadena, displays posters from the gun industry’s anti-straw purchase program “Don’t Lie For The Other Guy.” The ATF calls dealers “the first line of defense” against straw purchasing.

    Four current and former Turner’s employees said the company’s sales and inventory practices are relatively tight. ATF inspection paperwork from 2015, while citing one store’s failure to file required reports, noted that “overall, [Turner’s] recordkeeping is meticulous.” The chain doesn’t allow sales in which a background check comes back “undetermined” to proceed. A former employee called the chain’s more stringent sales practices a notable distinction from dealers that take a less cautious approach. The current and former employees interviewed for this story asked not to be named because they are not authorized to speak on behalf of the company.

    Most dealers and employees make a genuine effort to follow federal and state laws, according to Michael Eberhardt, a former firearms operations division chief at ATF. But dealers often fail to draw a line between their sales and subsequent criminal activity, he said. A store employee should realize that a gun “is just my carelessness — or my ignoring of the rules — away from being used to kill somebody,” he said.

    Eberhardt advocates for informing dealers when guns they have sold turn up at the scenes of violent crimes. “I guarantee you that changes behavior without enacting another gun law,” he said. For its part, the public rarely learns where guns used in crimes were sold.

    Experts interviewed by The Trace called for additional regulatory scrutiny on stores with high numbers of crime guns or low times-to-crime. In practice, that step might be difficult. The ATF’s inspections division, long a target of Republicans on Capitol Hill, has been understaffed for years. And last year, the Department of Justice shuttered an ATF program that monitored stores that had sold significant numbers of crime guns with low times-to-crime.

    Even when inspections happen, the agency has no baseline to compare stores against one another because it doesn’t track sales. “It’s insane how in the dark we are on so much of this stuff,” said Daniel Semenza of the New Jersey Gun Violence Research Center at Rutgers University.

    In addition to federal oversight, states can employ their own inspectors, which California does. But in 2024, the majority of those positions — 12 out of 23 — were empty. “A very small percentage of dealers across the country are getting audited, in a way that is really shocking,” said Semenza.

    Chains as the source of crime guns haven’t been the subject of academic research, he said, in part because the data simply doesn’t exist in most places. Semenza’s work has found that, in Atlanta, the presence of gun dealers in disadvantaged communities appeared to drive additional gun violence. Another study documented that shootings increase in neighborhoods after a gun dealer opens.

    California’s data exists thanks to a 2021 measure introduced by Assemblymember Kevin McCarty. “This bill was a way to better trace and track guns that were used in serious crimes,” said McCarty, who is now the mayor of Sacramento. The measure drew bipartisan support in the statehouse, where only a single legislator voted against it.

    “If you look at our gun violence rates versus other industrialized places across the globe, it’s atrocious,” McCarty said.

    Advocates say data like California’s can assist dealers in preventing sales to suspicious buyers, equip lawmakers with the knowledge to craft better policy, and help law enforcement fight gun trafficking.

    Law enforcement sources said that regulators should assess operations across chains, something that is not standard practice in an industry in which locations are individually licensed.

    In late February, the Midwestern chain Fleet Farm settled a suit brought by Minnesota Attorney General Keith Ellison. The company agreed to pay $1 million, change training and discipline related to straw purchases, and implement a new system that informs staff when a buyer’s previous purchases were recovered as crime guns. Federal prosecutors had previously alleged the retailer sold dozens of guns to a straw purchaser.

    “States have mechanisms and abilities to push dealers to be responsible,” said David Pucino, legal director at the gun safety nonprofit Giffords Law Center. “And they also have the ability to take action against those who fail to do so, or refuse to do so.”

    Editorial support for this story was provided by The California Newsroom, a collaboration of public media outlets throughout the state, with NPR as its national partner. 

  • Ballots are hitting mailboxes. What to know
    A close up of dozens of gray and white ballot return envelopes in a mail tray.
    Mail-in ballots in their envelopes await processing at the Los Angeles County Registrar Recorders' mail-in ballot processing center at the Pomona Fairplex in Pomona, Oct. 28, 2020.

    Topline:

    Keep an eye out at your mailbox: Today is the deadline for California counties to begin mailing ballots for the upcoming primary election on June 2.

    Already have yours? Nice. If you’ve already received your ballot, that’s because some counties got ahead of the deadline to mail them.

    Need to register? The last day to register or update your registration address is May 18, but same-day registration is also available in person at county elections offices, polling places and vote centers. You can register at LA VOTE dot GOV.

    Mailing in? The Secretary of State’s Office recommends voters who want to mail in their ballots do that at least one week before Election Day on June 2.

    Don’t stress. We’ve got all your voting questions covered with our Voter Game Plan. Our guides have started publishing, but you can jump directly to the L.A. or O.C. guides. Check in regularly to see what’s new.

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  • How Steyer's brother could shape CA's AI future
    A man with light skin tone, wearing a blue checkered suit and striped unbuttoned shirt, speaks behind a podium with signage that reads "Shine Global Resilience Awards."
    Jim Steyer accepts an award at the 2024 Shine Global Resilience Awards at Paramount Pictures Studios in Hollywood on Oct. 15, 2024.

    Topline:

    Tom Steyer’s arguably equally famous older brother Jim is a well known force in Sacramento working on tech regulations and protecting kids online. Does that mean he’d have an open ear in the governor’s office on a hot-button issue if Tom wins?

    Who is Jim Steyer? The investor-turned-climate activist’s older brother, Jim Steyer, is CEO of the influential California nonprofit Common Sense Media, known for helping parents choose suitable media for kids and warring with the entertainment industry over violent video games. A forceful and well-respected crusader for stricter content regulations for children, Steyer has in recent years turned his attention to social media and artificial intelligence chatbots.

    Why it matters: That means if Tom Steyer wins the election, the governor would be close with a prominent advocate of stricter tech laws as Democrats scramble to regulate AI. It would be a shift from current Gov. Gavin Newsom, who has sought to balance AI regulations with a desire to keep technology flourishing in California.

    Read on... for more on what this could mean for tech regulation.

    Long before billionaire Tom Steyer was pouring record-breaking sums into his run for California governor, the family name held significant sway in Sacramento.

    The investor-turned-climate activist’s older brother, Jim Steyer, is CEO of the influential California nonprofit Common Sense Media, known for helping parents choose suitable media for kids and warring with the entertainment industry over violent video games. A forceful and well-respected crusader for stricter content regulations for children, Steyer has in recent years turned his attention to social media and artificial intelligence chatbots.

    That means if Tom Steyer wins the election, the governor would be close with a prominent advocate of stricter tech laws as Democrats scramble to regulate AI. It would be a shift from current Gov. Gavin Newsom, who has sought to balance AI regulations with a desire to keep technology flourishing in California.

    The Steyer relationship makes some advocates optimistic. Lawmakers and advocates for tech regulations said they expect Jim Steyer not to be shy about his policy views with his brother.

    Tom Steyer, one of the Democratic leaders in the race, is running as a progressive and promising to strictly regulate industries like oil, utilities and tech. He has promoted an aggressive tech policy agenda that includes privacy and safety restrictions on AI in the workplace, collecting fees from AI data processing to pay for worker retraining and cash benefits, and requiring safety audits on social media.

    In his plan, Tom Steyer cites his work with Common Sense Media, which he says he “helped (his) brother Jim Steyer found and build.”

    “After watching the experiment that social media companies ran on our children, I know we cannot let the same thing happen with AI,” his tech policy plan states. “As governor, I will do everything in my power to keep California’s kids safe and prepare them for the AI era.”

    A greater say on tech policy?

    Tech industry advocates are wary. Common Sense and Big Tech have recently clashed over age limits and industry liability over harmful content, though they have also collaborated on promoting tech education and equitable internet access.

    “Certainly Jim Steyer and Common Sense Media will have a greater say,” said Peter Leroe-Munoz, a senior vice president at the business group Bay Area Council. “Common Sense Media would have an outsized influence on California tech policy if Mr. Steyer ends up becoming the governor.”

    The council’s membership includes Meta, Google, Microsoft and OpenAI.

    A Common Sense push to restrict social media use for children under 16 has united many Democrats, including Newsom. The proposal amid findings that the platforms are harmful to youth mental health and are designed to be addictive. Tom Steyer supports an age ban, along with several of his Democratic competitors.

    The industry balks at the proposal, in part because it would require tech companies to collect mass amounts of user age data, Leroe-Munoz said.

    A man with light skin tone, wearing a blue suit, speaks behind a podium in front of a green screen, both with text and signage that read "Common Sense Summit on kids and families."
    Jim Steyer speaks at the Common Sense Summit on Kids and Families 2025 in San Francisco on March 25, 2025.
    (
    Kimberly White
    /
    Getty Images for Common Sense Media
    )

    Tom Steyer told CalMatters last week that he hasn’t spoken with his brother about social media and AI policy. He also said he doesn’t have an opinion on two bills inspired by Common Sense and OpenAIthis year to more strictly regulate how chatbots interact with minors.

    Asked if the relationship with his brother would influence his tech policy, he said he trusts Jim Steyer’s expertise but would not “slavishly follow what my brother says.”

    “My brother’s been protecting kids for 50 years and I listen to him, but it’s not like he’s suddenly going to become me,” he said. “I don’t think it is a conflict of interest for him to try and do his job and for me to try and do my job.”

    Jim Steyer did not respond to repeated interview requests sent to a Common Sense Media representative. The nonprofit’s spokesperson, Edda Collins Coleman, wrote in an email that while “Jim strongly supports his brother in his personal capacity,” the nonprofit “does not get involved in electoral politics.”

    Strange bedfellows

    Jim Steyer has praised his younger brother’s candidacy, writing on X after a televised debate last month that Tom Steyer is “the fighter that California needs right now.” He also helped his brother campaign during a short-lived presidential run in 2020.

    Jim Steyer founded Common Sense Media in 2003 as a service to rate movies, TV shows, websites and digital content to help parents evaluate their age-appropriateness. Tom Steyer is a member of the board of advisers, and he and his wife Kat have given the nonprofit at least $5 million over the years.

    In 2005, the organization pushed hard for a California law banning the sale of violent video games to children without parental consent. The law was later struck down by the U.S. Supreme Court on First Amendment grounds.

    The organization soon turned toward tech and social media, becoming one of Sacramento’s most influential voices on digital safety for kids and regularly testifying in legislative committee hearings. In 2016, as Common Sense sought to build political clout on children’s issues, Jim Steyer told the San Francisco Chronicle it had “nothing to do with my brother’s political career.” The nonprofit has supported dozens of proposed regulations in the past few years, including a major privacy law passed in 2018 that allows users and customers to have businesses delete personal data collected about them.

    Now, Common Sense regularly publishes studies of the effects of social media and AI on child mental health. It also reviews AI tools for parents, rating how they handle young users who express suicidal thoughts or encourage kids to develop healthy human relationships.

    Last fall, Newsom vetoed a Common Sense bill that would have created an effective ban on AI chatbots for minors. Lawmakers passed the measure in the wake of a rash of reports of teenagers dying by suicide after developing relationships with ChatGPT, which is made by OpenAI. Some parents, in lawsuits, have alleged that the chatbot encouraged or coached children to harm themselves.

    Jim Steyer moved to put a restrictive chatbot measure on the statewide ballot; OpenAI planned to pursue a counter-measure that essentially reflected current law. The pair surprised other regulation advocates in January when they announced they were partnering on a joint ballot measure instead.

    Jim Steyer recently drew criticism from fellow advocates when Politico reported that Common Sense was seeking financial support from OpenAI and other companies to form an AI safety institute. Critics worry the partnership would allow the industry to audit itself — especially concerning since many advocates already believed the compromise ballot measure doesn't go far enough.

    “Jim might have a harder audience with Tom than another governor.”
    — Jamie Court, president of the advocacy group Consumer Watchdog, on Jim Steyer’s pull if his brother is elected governor

    The discussion has mostly moved to the state Legislature, where lawmakers are advancing two bills based on the compromise measure. They would require tech companies to verify the ages of their users and redesign their platforms to prevent chatbots from encouraging harmful behavior and delivering the sycophantic responses that alarm children’s advocates.

    “Children and younger people, they don’t have the ability in the same ways as adults to differentiate between human and quasi-human relationships with these types of technologies,” said bill author Assemblymember Buffy Wicks, an Oakland Democrat who used to work at Common Sense Media.

    The legislation also requires third-party audits of chatbot safety, which Wicks said the tech industry opposes.

    Neither Coleman of Common Sense Media nor a representative for OpenAI responded to inquiries about the potential safety institute.

    “We will be as rigorous and honest as ever in evaluating tech products that pose harms to kids and teens and young people’s educational and cognitive development,” Coleman wrote in a statement. “We have long supported third-party child safety audits, which much of the industry opposes.”

    Jamie Court, president of the advocacy group Consumer Watchdog, has worked with both Steyers on policy and is among those who want more stringent restrictions on tech platforms. He said it “bothers” him that Common Sense, the most powerful advocate on tech policy in Sacramento, may partner with the industry, but he doesn’t begrudge Jim Steyer.

    “Jim might have a harder audience with Tom than another governor” on tech policy, Court joked. “Jim’s a little bit more accommodating to the companies because he has to work with them. Tom shoots more from the hip. Tom might be a little more radical.”

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

  • Supreme Court gives Mifepristone a 1-week reprieve

    Topline:

    Supreme Court Justice Samuel Alito on Monday put a one-week hold on major changes to how the abortion pill mifepristone can be prescribed.

    Why now: On Friday, an appeals court had said the Food and Drug Administration needed to revert to rules that the pills, part of a two-drug regimen for medication abortion, must be prescribed only in-person. The change was effective immediately for the whole country.

    Why it matters: The appeals court order meant that mifepristone could not be prescribed via telehealth or sent through the mail; Alito's order reverses that for one week.

    Read on... for more on the hold.

    Supreme Court Justice Samuel Alito on Monday put a one-week hold on major changes to how the abortion pill mifepristone can be prescribed.

    On Friday, an appeals court had said the Food and Drug Administration needed to revert to rules that the pills, part of a two-drug regimen for medication abortion, must be prescribed only in-person. The change was effective immediately for the whole country.


    The appeals court order meant that mifepristone could not be prescribed via telehealth or sent through the mail; Alito's order reverses that for one week.


    Alito responded to a request for emergency relief filed by the two companies that make mifepristone. He blocked the appeals court's decision from going into affect until next Monday, May 11, at 5 p.m.

    Alito also asked all the parties in the ongoing lawsuit brought by the state of Louisiana to file briefs by Thursday, May 7, at 5 pm.

    Copyright 2026 NPR

  • Distressed hospitals lobby for help
    The front entrance of a grey steel and glass building with a sign that reads, "Matin Luther King Jt Community Hospital." A few pedestrians and two vehicles are pictured out front.
    The front entrance of Martin Luther King , Jr. Community Hospital in Los Angeles , a 152 - bed facility on a sprawling medical campus near the predominantly Latino and Black neighborhood of Watts.

    Topline:

    The Republican budget measure known as the One Big Beautiful Bill Act, signed into law by President Donald Trump last July, is expected to cut federal Medicaid spending by $911 billion over 10 years. The law does include a special fund to boost rural healthcare but the rural health fund does little or nothing to help the numerous urban hospitals, such as Martin Luther King Jr. Community Hospital in Watts.


    Martin Luther King Jr. Community Hospital: The 152-bed hospital is struggling for financial stability. MLK, like many other hospitals, is scrambling to secure outside financing to avert serious disruptions of medical services when the brunt of the policies contained in the federal law begins to hit early next year. The hospital’s leadership team projects a revenue hole of $80 million to $100 million annually for the foreseeable future. It would be MLK’s largest budget gap since it opened in 2015.

    Why it matters: Its patients are poorer and sicker than average, many of them are uninsured, and three-quarters of MLK’s patient care revenue comes from Medi-Cal, the state’s version of the Medicaid program, which pays low rates. For hospitals statewide, by comparison, less than one-third of patient revenue comes from Medi-Cal.

    At Martin Luther King, Jr. Community Hospital, patients on gurneys line the hallways of the emergency department waiting for care, and overflow mental health patients are consigned to outdoor tents.

    The 152-bed hospital, which sits on a sprawling medical campus close to the predominantly Latino and Black neighborhood of Watts, is struggling for financial stability. Its patients are poorer and sicker than average, many of them are uninsured, and three-quarters of MLK’s patient care revenue comes from Medi-Cal, the state’s version of the Medicaid program, which pays low rates. For hospitals statewide, by comparison, less than one-third of patient revenue comes from Medi-Cal.

    And MLK Community Healthcare, which comprises the hospital and two nearby clinics, is independent, so it cannot fall back on a larger chain to absorb some of the financial pressure.

    Similar problems plague hundreds of financially vulnerable hospitals around the country, in rural and urban areas. And their financial woes are about to get worse.

    A woman wearing a black top and black and white polka dot skirt stands smiling in front of a sign that reads "Empath Unit. Martin Luther King Jr. Community Hospital. A man wearing a light blue shirt and dark pants stands smiling next to her.
    Elaine Batchlor, the CEO of MLK Community Healthcare in Los Angeles, and Atul Nakhasi, MLK’s vice president of government affairs and community relations, stand outside the entrance to Martin Luther King, Jr.Community Hospital’s new emergency psychiatric assessment, treatment, and healing —or EmPATH—unit, scheduled to open this summer.
    (
    Bernard J. Wolfson
    /
    KFF Health News
    )

    The Republican budget measure known as the One Big Beautiful Bill Act, signed into law by President Donald Trump last July, is expected to cut federal Medicaid spending by $911 billion over 10 years. And it could contribute to an increase of more than 14 million in the number of uninsured people, many of whom will go to already crowded emergency rooms to get care they can’t pay for.

    The law does include a special fund to boost rural healthcare, totaling $50 billion over five years. But that’s far less than the $137 billion it is expected to cut from rural health spending over the next decade. And the rural health fund does little or nothing to help the numerous urban hospitals, such as MLK, that also face serious financial troubles.

    MLK, like many other hospitals, is scrambling to secure outside financing to avert serious disruptions of medical services when the brunt of the policies contained in the federal law begins to hit early next year. The hospital’s leadership team projects a revenue hole of $80 million to $100 million annually for the foreseeable future. It would be MLK’s largest budget gap since it opened in 2015.

    “Even if we cut services that our community needs — maternity care, behavioral healthcare, diabetes management — it wouldn’t make a significant dent in the gap we’re facing,” said Elaine Batchlor, the CEO of MLK Community Healthcare. ”Many of those same people would still come to us through our emergency department, only they’d be in worse shape and might need more expensive care.”

    Across the U.S., hospitals and patient advocates are looking to state lawmakers and local officials to help shore up shaky finances. In California, Assembly member Esmeralda Soria, a Democrat representing Fresno, is pushing legislation to expand a 2023 “distressed hospital loan fund” that allocated nearly $300 million in zero-interest loans to 16 hospitals in the state, including $14 million to MLK. The state would pony up another $300 million under Soria’s bill.

    At least two other states are weighing similar programs. A bill in Pennsylvania would create a $100 million “distressed hospital grant” program. And a funding bill for the Illinois Department of Healthcare and Family Services contains a provision to create an $85 million loan program for troubled hospitals.

    Carmela Coyle, the CEO of the California Hospital Association, said the original $300 million disbursed by the state legislature helped but was not enough.

    “This program is focused on those who are standing on the edge of that financial cliff, and it’s intended to give them a little space, brush them a little bit back from the edge,” Coyle said. “But we’ve got many more hospitals that are taking giant leaps toward the edge of that cliff every day.”

    Despite the association’s influence, an expansion of the loan program is far from certain, given fiscal constraints that have already induced state leaders to roll back California’s ambitious healthcare agenda, with restrictions on coverage for immigrants and funding cuts for community clinics. Democratic Gov. Gavin Newsom recently warned lawmakers to expect more cuts in his revised May budget — and that’s before the main federal spending reductions kick in.

    “This is a very difficult budget environment,” said Kristof Stremikis, director of market analysis and insight at the California Health Care Foundation, a nonprofit that advocates for healthcare improvement. “It is hard to come up with funding for new programs and even existing programs right now.”

    Some lawmakers noted skeptically that the initial loans are now on their way to at least partial debt cancellation, which is allowed under existing law. Soria’s bill spells out a clearer path to loan forgiveness.

    “Are these loans or are these grants? Because they seem to be turning, really, into grants,” Assembly member Pilar Schiavo, a Democrat in Santa Clarita, said during an April 21 hearing on the bill.

    Ultimately, it might not be desirable to save struggling institutions by pouring dollars into them, because care is increasingly offered outside of hospitals, Stremikis said.

    In the short term, though, the financial health of hospitals that received loans appears to have improved, according to a KFF Health News analysis of state data. The average operating margin of the 15 loan recipients for which comparable data is available shifted from a loss of 15.4% the year before the program to a gain of 2.3% after the money was disbursed.

    It is unclear how much of the improvement can be attributed to the loans. Hospitals also secured other sources of funding, and they adopted efficiencies as a condition for the interest-free money.

    MLK reduced the use of high-cost temporary labor by hiring more permanent staff, cut the average length of patient hospital stays to decrease staffing hours, streamlined billing, and negotiated more-favorable contracts with insurers, said Atul Nakhasi, a practicing physician who is also MLK’s vice president of government affairs and community relations. Batchlor said that the loan helped MLK get through a cash flow crunch and that a second loan, if it became available, would be used for the same purpose.

    Rows of empty green reclining chairs in a wood floored room.
    The main patient area of Martin Luther King , Jr. Community Hospital’s new psychiatric assessment unit contains large reclining chairs for people who are in the throes of a mental health emergency and need to be evaluated and stabilized.
    (
    Bernard J. Wolfson
    /
    KFF Health News
    )

    This summer, MLK expects to open a psychiatric assessment unit, where patients in mental distress can be stabilized in an environment replete with plush reclining chairs and “calming” rooms. Hospital executives hope the new unit will provide a significant new source of revenue, while taking pressure off the emergency department.

    Kaweah Health in Visalia, California, suspended some services, temporarily stopped contributing to employees’ retirement, and briefly froze wages in exchange for a loan of just under $21 million, said the organization’s CEO, Marc Mertz.

    Madera Community Hospital got a $57 million loan — the largest disbursement from the state fund — to reopen after being shuttered for more than two years. The hospital reopened early last year, but it has not yet stabilized financially, said Matthew Beehler, the chief strategy officer at American Advanced Management, a privately held company that bought Madera out of bankruptcy.

    “You can definitely say the hospital would not have been opened without the distressed hospital loan,” though the company has also invested more than $50 million, Beehler said. He said Madera would hope for another loan if the program were extended.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.