Candy prices are up. Here’s why, and how to save on Halloween

• October 27, 2023

By Cara Smith | NerdWallet

Forget the ghouls and ghosts — inflation is spooky enough. And it’s coming for your Halloween candies.

Candy and gum prices rose 7.5% between September 2022 and September 2023, according to the Bureau of Labor Statistics. For context, the broader category of grocery prices increased 3.7% over that time frame.

Why is candy so expensive?

Beyond overall inflation, which rose 3.7% year over year since September 2023, there are a few more reasons why candy is so expensive right now. The cost of raw sugar reached an 11-year high in April, per CNBC, due to the effects of extreme weather on the crop, as well as rising demand.

And a U.S. agricultural policy that requires 85% of sugar purchases to come from domestic processors is further tightening an already strained supply, according to The Wall Street Journal.

Consumers are taking notice. In a survey of 1,000 U.S. households that celebrate Halloween, 41% of respondents said that inflation has impacted how much they plan to spend on Halloween candy this year, according to Advantage Solutions, an e-commerce analytics firm.

Go for this cheap Halloween candy in 2023

Thankfully, there are some candies whose prices actually fell year over year, according to a new report from Pattern, an e-commerce analytics firm. So you can still indulge in some sweet treats without exceeding your budget.

Pattern tracked the price changes of more than 30 types of candy on Amazon every day for one year. First, Pattern data scientists calculated a baseline price for specific candies — such as Twix, Milky Way or Skittles — by taking the average of the 10 most popular versions of those candies.

For example, Milky Way’s 10 most popular products may include a two-pack of candy bars, a 36-pack of candy bars and a bag of Milky Way “Fun Size” minis. Those prices, as well as the prices of the seven other most popular products, would then be averaged. That average would represent the Milky Way baseline price.

Then, Pattern compared that initial baseline cost from October 2022 with each candy’s baseline price one year later.

By measuring how each candy’s baseline price changes over time, a picture emerges of how each candy’s price rose or fell over a given time period — regardless of product.

In the 12 months leading up to Oct. 9, 2023, the analysis found that prices fell on Amazon for these candies:

Hot Tamales (-44.90%).
Mounds (-13.23%).
Heath (-10.24%).
Rolos (-9.83%).
Milk Duds (-7.58%).
Whoppers (-6.9%).
Reeses (-5.13%).
Milky Way (-4.28%).
Nerds (-2.96%).
Kit Kat (-1.63%).

Those percentages translate to significant real-world savings. Last year, Hot Tamales’ baseline cost on Amazon was $45.69 on Amazon. Today, that figure is 44.9% less, at $25.32, per Pattern. Even Milky Way’s much smaller percentage change of -4.28% means the candy’s average price dropped from $21.70 in 2022 to $19.01 in 2023.

To avoid inflation’s hardest-hit treats, stay away from these candies, whose prices rose the most dramatically over that time period: Airheads (+26.34%), Baby Ruth (+13.51%), candy corn (+13.24%), PayDay (+12.0%) and Tootsie Rolls (+11.36%). Airheads’ average cost was $10.15 in 2022; today, that figure is $15.32.

How to save money on Halloween

With expensive winter holidays like Christmas and Hanukkah just around the corner, here’s how to spend less on Halloween, beyond avoiding the priciest treats.

Avoid buying your favorite candy. Seems counterintuitive, right? But, as Fortera Credit Union notes, you’re more likely to munch on your favorite treats before Halloween, leaving you in a pinch on the big night. Stock up on sweets you won’t be tempted to eat.

Make your own costume. You can also ask friends if they want to trade costumes, recommends Farmers Trust & Savings Bank. If you’re responsible for kids’ costumes, reach out to other families in your social circle and see if any parents would be interested in a costume swap.

Trade home and yard decor with friends and family. For decorations, buy art supplies from a dollar store, per Advisors Management Group, an investment firm in Wisconsin.

The article Candy Prices Are Up. Here’s Why, and How to Save on Halloween originally appeared on NerdWallet.

​ Orange County Register 

Medical exceptions to abortion bans often exclude mental health conditions

• October 27, 2023

Nada Hassanein | (TNS) Stateline.org

If you are in need of support, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for free, confidential and 24/7 support, or dial 988 for the Suicide & Crisis Lifeline.

____

More than a dozen states now have near-total abortion bans following the overturning of Roe v. Wade, with limited medical exceptions meant to protect the patient’s health or life.

But among those states, only Alabama explicitly includes “serious mental illness” as an allowable exception. Meanwhile, 10 states with near-total abortion bans (Florida, Georgia, Idaho, Iowa, Kentucky, Louisiana, Ohio, Tennessee, West Virginia and Wyoming) explicitly exclude mental health conditions as legal exceptions, according to an analysis from KFF, a health policy research organization.

Abortion rights advocates and mental health experts say those laws could put women’s lives at risk. A report released last year by the federal Centers for Disease Control and Prevention analyzing maternal deaths between 2017 and 2019 found that that pregnant women and new mothers were more likely to die from mental health-related issues, including suicides and overdoses from substance use disorders, than any other cause. Mental health conditions in total accounted for 23% of maternal deaths with an identified cause.

The Alabama exception, which requires a diagnosis from a psychiatrist in practice for at least three years, doesn’t define “mental illness.” However, it specifies a diagnosis can only be used as an exception “if there is reasonable medical judgment” that the patient might engage in something that could result in her death or loss of the pregnancy.

Florida’s medical exception requires two physicians to certify an abortion is necessary to save the pregnant woman’s life or avoid “serious risk” of substantial impairment to a “major bodily function of the pregnant woman other than a psychological condition.”

Similarly, Tennessee’s law reads, “No abortion shall be deemed authorized … on the basis of a claim or a diagnosis that the woman will engage in conduct that would result in her death or substantial and irreversible impairment of a major bodily function or for any reason relating to her mental health.”

During a special legislative session on abortion in July, Iowa Republican state Rep. Shannon Lundgren defended the exclusion of mental health exceptions during a floor debate, after Rep. Austin Baeth, a Democrat and physician, cited the maternal mental health-related death statistics, the Iowa Capital Dispatch reported.

“I would like to recognize that abortion isn’t a treatment for mental illness,” Lundgren said. “Obviously if we have someone whose life is in danger, a doctor should take an approach to make sure they immediately refer them to inpatient care.”

The National Right to Life Committee, whose model state legislation on abortion bans explicitly exempts abortions “performed on the basis of a claim or a diagnosis that the woman will engage in conduct that would result in her death,” considers mental health exceptions to be untenable because conditions such as anxiety and depression can be treated.

But policies that dismiss mental health as less important than physical health endanger patients, said Dr. Paul Appelbaum, a Columbia University psychiatrist and former president of the American Psychiatric Association and the American Academy of Psychiatry and the Law.

“You can’t take into account a 90% possibility of postpartum psychosis. That clearly should be changed,” Appelbaum said.

“Psychiatric disorders are as real and as treatable as any other medical disorder,” he added. “And to discriminate against people with a vulnerability to disorders developing during or after the partum area is simply unacceptable and unjustifiable.”

Inequities, lack of safety net

When Cindy Herrick of Phoenix became pregnant and gave birth to her son 11 years ago, she felt crushed by intense anxiety.

Thoughts of failure plagued her. “Everyone else looks happy,” she recalled thinking. Meanwhile, “I was scared to touch the baby.”

Herrick suffered depression and anxiety before pregnancy, but they became worse.

“Mental illness wasn’t new to me. The severity of it was new to me,” she said. It took months to find a new combination of psychiatric medications to give her relief. She recalled her husband saying, “I was really worried you weren’t going to make it.”

One in 5 women suffer mental health conditions during pregnancy or postpartum, including depression, anxiety, obsessive-compulsive disorder and, although rare, postpartum psychosis, according to the Maternal Mental Health Leadership Alliance, an organization that advocates for improved mental health care.

Awareness of maternal mental health conditions as crises is critical, said Herrick, a peer support specialist certified in perinatal mental health.

“We have one child because of that,” she said of her own mental health crisis. “I do not want to get pregnant again. And I’m not alone in that.”

Even before the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization last year overturning the federal right to abortion, women with mental health problems faced disproportionate barriers to getting an abortion, said Sarah Roberts, a researcher with the University of California, San Francisco’s Advancing New Standards in Reproductive Health program.

As mental health care remains elusive for many people, experts worry those barriers will be exacerbated.

Fewer than 20 states have state-funded perinatal psychiatry access programs. Thirty-eight states and Washington, D.C., have extended Medicaid coverage for 12 months postpartum, but fewer mental health practitioners accept Medicaid or private insurance compared with other specialties, making it harder for patients to get care.

“People who reported using more substances or having more mental health conditions were more likely to report a policy-related barrier to obtaining an abortion,” Roberts said. In the aftermath of Dobbs, she said, “There’s no reason to believe that things would have become easier.”

Low-income women are disproportionately affected by bans, making cost and travel burdens to get abortions elsewhere. Additionally, the Hyde Amendment, a federal rule renewed annually since 1976, restricts use of federal dollars, including federal Medicaid funds, for most abortions. While 17 states have state-only abortion funds, Hyde affects about 7.8 million reproductive-aged women across more than 30 states where it has effect, according to reproductive health research organization the Guttmacher Institute. Half of those affected are women of color.

Joy Burkhard, the founder and executive director of the Policy Center for Maternal Mental Health, a California-based national nonprofit and think tank where Herrick is a project manager, said the issue should be a bipartisan opportunity to “put systems in place to support women’s mental health delivery.”

Burkhard also stressed that an already taxed health care workforce will be further stressed as more women give birth post-Roe and need care. A report by inequities research organization Mathematica estimated untreated maternal mental health conditions cost $14.2 billion for births in 2017, or $32,000 on average for every untreated mother and her child.

“Everyone’s going to be waiting longer, struggling to access care — and no one’s talking about that,” she said.

Already, an estimated three-quarters of women with mental health conditions are untreated, according to the nonprofit advocacy group Maternal Mental Health Leadership Alliance.

“They need to be offered [mental health care] in a way that a birthing person doesn’t have to scramble to find those services,” said Isha Weerasinghe, a senior mental health policy analyst at the Center for Law and Social Policy, a national nonprofit based in Washington, D.C., focused on addressing poverty barriers.

She said policymakers need to define “medical necessity” for abortions more broadly, by considering what a pregnancy and birth will mean for a woman’s mental health.

Many of the states with strict abortion bans have large communities of color, and Black women are three times as likely and Indigenous women twice as likely as white women to die of pregnancy-related causes.

The CDC’s analysis found mental health-related conditions were the top cause of maternal deaths among Hispanic, white, and American Indian and Alaska Native mothers.

Black women also face disproportionate risk — twice as likely as white moms to suffer from a maternal mental health condition but half as likely to get treatment, according to the Maternal Mental Health Leadership Alliance.

The CDC’s analysis also included a specific report on maternal deaths for American Indian and Alaska Native people, who are more than twice as likely as white mothers to die of pregnancy-related causes but often undercounted in health data due to misclassification. More than 90% of these mothers’ deaths were preventable, the CDC analysis found, with most of their total deaths due to mental health conditions, followed by hemorrhage.

Dr. Allison Kelliher, who is Koyukon Athabascan, Dena, from Nome, Alaska, is a family medicine physician and a researcher at Johns Hopkins School of Nursing and Bloomberg School of Public Health Center for Indigenous Health. She’s practiced and taught medical students in North Dakota, and said the strict abortion bans ignore the disproportionate illnesses and lack of access to care Indigenous people in rural areas already face. Indian Health Service-run clinics are allowed to provide abortions only in rare circumstances, and patients are often forced to cross state lines or drive hours for care.

But, Kelliher said, many young Indigenous people may not have “the privilege of money, of a vehicle, of a provider who knows them.” In addition to disproportionate poverty rates, tribal women are at higher risk of violence and assault, all of which contribute to increased risk of mental health burdens, she added.

“When you couple that with the very stressful experience of pregnancy … you can see why we’re so vulnerable during that time, when we might be suffering from increased risk of mental illness,” she said.

Higher risk, opportunities for prevention

Clinicians, advocates and policy experts fear that abortion bans will cause even more pregnant women and new mothers to need mental health care.

“There’s no question that there’s going to be increased demand for mental health services, both during pregnancy, for women with unwanted pregnancies … and after delivery,” Applebaum, of Columbia University, said.

UC San Francisco’s landmark, oft-referenced Turnaway Study, which followed women for more than a decade who were denied abortions because their pregnancies were past the gestational age limits, found these women were more likely to suffer anxiety and poverty and to stay tethered to an abusive partner.

Pregnancies as a result of rape and incest often need law enforcement involvement to allow for an abortion, and can have chronic, traumatic repercussions on a woman.

Women with previous mental health conditions are at higher risk of developing depression during pregnancy or postpartum according to the National Institutes of Health, and if a woman experienced postpartum depression previously, she’s at higher risk of developing it again. While postpartum psychosis is rare, women with a history or family history of bipolar disorder or psychosis are at higher risk, but many women may develop it for the first time in their life postpartum, said Dr. Adjoa Smalls-Mantey, a psychiatrist at New York-Presbyterian Brooklyn Methodist Hospital.

Some medications to treat psychosis or bipolar disorder, particularly lithium and valproic acid, may cause severe birth defects, especially during the first trimester, she said. Women on these medications are strictly placed on contraception.

But unexpected pregnancies may still occur.

“Say you do have a pregnancy that is unexpected, and you end up having a fetus that has a severe defect that for some may not result in a viable pregnancy, or if it does, can be extremely challenging and devastating,” Smalls-Mantey said. “A lot of options are restricted, and then the child, the mom, have a lot of challenges in their life going forward.”

“I just really fear for the people that don’t even have the resources, what options they’re turning to, and if even more women are becoming suicidal or attempting suicide as a result of this very sentinel event in their lives that they’re not ready for,” she said. “How desperate they could become that they would try to end their life.”

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2023 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

FivePoint Amphitheatre has closed. Will there be live music in Irvine in 2024?

• October 27, 2023

Before country music act Zac Brown Band took the stage at FivePoint Amphitheatre in Irvine on Saturday, Oct. 21, vocalist Zac Brown was informed that his band’s performance would be the last ever for the venue.

“Glad we got to shut it down with you, Irvine,” the band posted on its official Instagram account along with photos and video from the final show. “Honored to have been the last band to play the @fivepointamphitheatre stage last night. Where should we play next time we’re in SoCal?”

The temporary 12,000-capacity space was constructed in 2017 after the 2016 demolition of the long-running, 16,000-capacity Irvine Meadows Amphitheatre, which was located on the opposite side of the 5 Freeway.

Brown was just as shocked as the fans were to learn this news. And Tom See, president of Venue Nation, who overseas 150 venues including amphitheaters, theaters and clubs at Southern California concert production company Live Nation, said he was pretty surprised, too.

“I thought we had a 2024 season at FivePoint Amphitheatre and that came to a screeching halt,” See said during a recent video call.

Despite the ongoing back-and-forth between Live Nation and the city of Irvine — which have worked together for more than four decades to bring live music to the area until the city abruptly ended its partnership with the company and scrapped proposed plans for a permanent amphitheater inside the Irvine Great Park back in July — See said he was confident they’d be able to continue on since there certainly wouldn’t be a permanent venue constructed in less than a year. However, because of the ongoing FivePoint residential development, there’d be no way to continue producing shows in the current space.

“It was one of those bittersweet weekends,” See said of the final two shows with Zac Brown Band, while also noting that the group later posted the song it recorded live at Irvine Meadows, a cover of “The Way You Look Tonight,” with more kind words about playing in Irvine.

“I had to give Zac a heads up on Friday night (Oct. 20) and he was blown away and instantly started thinking about all of the times he’d played in Irvine,” See said, adding that the band had performed a total of seven times between the two venues. “He took photos from this last show and melded them with the live song from Irvine Meadows and continued to reiterate how sad and sorry he is to see live music go away in Irvine and this was days after the final show. That just goes to show how important a connective audience is to these artists. They don’t take it for granted.”

What happens now

During a City Council meeting on July 25, city officials effectively ended the agreement with Live Nation to build a new, 14,000-capacity amphitheater inside the Great Park. With all of those plans suddenly scuttled, City Manager Oliver Chi was tasked with coming back to the council in 90 days with a new proposal and timeline for an amphitheater — which would replace the temporary FivePoint Amphitheatre — and include up to 10,000 seats an an in-house speaker system to reduce residential noise impacts.

“Right now, the situation at hand with FivePoint Amphitheatre now closing down is creating a lot of uncertainty for music fans in Orange County,” Dave Brooks, Senior Director of Live Music and Touring at Billboard said in a recent phone interview. “Not only that, but fans are now questioning if the City of Irvine can even pull off bringing back a new amphitheater.

“What’s most interesting about what’s going on here is that concertgoers in Orange County and overall in Southern California, they know what they are losing right now, they just don’t know what they are even getting,” Brooks continued.

Recent calls to connect with Chi have gone unanswered, but councilmembers Tammy Kim and Kathleen Treseder, who voted against the original proposed venue and agreement with Live Nation, were available to discuss some possibilities for a venue for next season. Since these processes and decisions have historically worked very slowly in Irvine, Kim pointed to setups at some local music festivals as examples of a temporary venue that Irvine could emulate.

“Look at Coachella or even Head in the Clouds. That just comes up and then goes back down,” Kim said. “It’ll take maybe a week to build a stage. … We could totally do that.”

A potential spot that’s been brought up is near the sports complex at the Great Park, said Councilmember Treseder. A temporary venue, Treseder said would most likely be bare-bones — just enough to ensure noise mitigation, safety and performances, she said.

“I’m not expecting it to be amazing design-wise. I just want to make sure we have continuity of musical programs,” she said.

Treseder and Kim both said being able to host the Pacific Symphony in a temporary venue is most important.

“We need to figure out a temporary solution for next summer,” Kim said. “Pacific Symphony has no place to play for the Fourth of July. They typically will do four or five shows for the season. They’re left without a home right now.”

City leaders are still moving forward to construct a permanent venue within the Great Park. Irvine is looking at a 10,000-seat venue that provides flex space and an in-house sound system to mitigate residential noise impacts. Several design consultants have already looked at the site, Kim said, and she’ll be having additional meetings with them next week. Kim said the ideal venue would be one that is large enough to attract A-list talent but not so large that it scares off smaller talent, and it should “tap into the diversity that is Irvine.”

“We want to provide a place where we can have various music festivals across all genres,” Kim said. “Opportunities for Pacific Symphony, opportunities for a jazz festival, K-pop, a Bollywood festival, a Farsi music festival. There’s a proven market for world music that quite frankly hasn’t been accomplished in the FivePoint Amphitheatre.”

She added: “We need the common denominator bands that work for everyone. The Goo Goo Dolls, Dave Matthews Band. That’s great because those are draws, but we also need to have opportunities where creative promoters can book their acts.”

Other potential locations

While no longer partners, See said that Live Nation would continue to support the city of Irvine and the company is open to working together in the future.

“They have the ability to get it done and I’m sure it will be a wonderful venue and we’ll be there to support them in any way we can,” he said. “We’re open to dialogue, too, if they all of a sudden say ‘Hey, we want to reopen our conversations with Live Nation and talk about what the future might look like.’ There’s no ill will here, we’re all open ears.”

While there’s no ill will, it’s still business and since parting ways with Irvine, See said neighboring cities have reached out with interest in bringing an amphitheater to their area.

“First and foremost we were committed to Irvine,” he said. “We weren’t dating, we were in a very long-term relationship and one that we thought through and had mutually agreed upon the venue, the size, and had got two approvals through the City Council and then there was a right hand turn all of a sudden and we weren’t dating any longer. Since the world has been advised of that, our phone has been ringing and our emails have been lit up. We know a permanent amphitheater takes time, it takes years, but we’re also sitting on the assets of FivePoint and are actively in conversations to determine what’s next. We can’t get into details of who, where or when. … That will come in time.”

What’s special about Irvine

For more than four decades See said that major artists have included Irvine, and the temporary FivePoint Amphitheatre, among their massive tour stops including Dave Matthews Band, Miranda Lambert, Darius Rucker, Iron Maiden, Brad Paisley, Incubus, Pitbull, Weezer, The Offspring, Snoop Dogg and more.

“Irvine has been on the back of concert T-shirts for more than 40 years, almost putting Irvine on the map and getting people to learn what Irvine is all about over all of those years,” he said.

It’s also important, he said, that a venue in the area have the ability to accommodate a certain number of fans, which is why the original concept for the permanent venue included a capacity of 14,000. This make it financially and economically possible for those big acts — usually with semi trucks full of staging and gear — to come to the area.

“Irvine and the Orange County market is a massive market with millions of residents and concertgoers and the one thing we’ve learned over time is the less friction you can provide a fan to enjoy live music, the better,” See explained. “They don’t necessarily want to get in their cars or take mass transit, they want to go out within their community. Orange County is as big as some states within the U.S., so it’s important to an artist to spend time cultivating an audience in Orange County. And Orange County, San Diego and Los Angeles, those are three entirely different markets. You can go to San Bernardino, too, and have an entirely different market.”

Related links

FivePoint Amphitheatre in Irvine hosts its final show
Irvine ends partnership with Live Nation for Great Park amphitheater
Irvine and Live Nation to hash out Great Park concert venue plans
Irvine’s partnership with Live Nation for Great Park concert venue could be in jeopardy
A permanent amphitheater at Irvine’s Great Park would look like this

In booking tour routes, See said that the artists look carefully at these markets and use curated data to see where they could potentially maximize their revenue since acts now make a majority of their income on the road and increasingly less from selling actual music.

“They know their worth,” he said. “A big act that’s historically played Irvine and can sell 10,000-plus seats is going to want to continue to generate that income in the market somehow or some way and if they can’t there, there are other markets they can play. They can wind up playing two dates in L.A., two nights in San Diego or end up in San Bernardino. They can go to Anaheim and play The Pond (Honda Center) or head to (Inglewood) to play The Forum. There are a lot of choices for an artist and it’s a highly competitive business.”

“Irvine is a great location when it comes to touring,” Brooks echoed. “It’s a known market, so artists who bring shows there have a pretty good idea of what’s going to happen, not to mention the great weather all year long. Most importantly, it’s just been a reliable stop when connecting both Los Angeles and San Diego residents. There’s nothing really else in the surrounding cities that features a great amphitheater experience.”

​ Orange County Register 

Tiny, rural hospitals feel the pinch as Medicare Advantage plans grow

• October 27, 2023

Sarah Jane Tribble | (TNS) KFF Health News

When several representatives from private health insurance companies called on him a few years ago to offer Medicare Advantage plan contracts so their enrollees could use his hospital, Bleak sent them away.

“Come back to the table with a better offer,” the chief executive recalled telling them. The representatives haven’t returned.

Battle Mountain is in north-central Nevada about a three-hour drive from Reno, and four hours from Salt Lake City. Bleak suspects insurance companies simply haven’t enrolled enough of the area’s seniors to need his hospital in their network.

Medicare Advantage insurers are private companies that contract with the federal government to provide Medicare benefits to seniors in place of traditional Medicare. The plans have become dubious payers for many large and small hospitals, which report the insurers are often slow to pay or don’t pay.

Private plans now cover more than half of all those eligible for Medicare. And while enrollment is highest in metropolitan areas, it has increased fourfold in rural areas since 2010. Meanwhile, more than 150 rural hospitals have closed since 2010, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. Largely rural states such as Texas, Tennessee, and Georgia have had the most closures.

Medicare Advantage growth has had an outsize impact on the finances of small, rural hospitals that Medicare has designated as “ critical access.” Under the designation, government-administered Medicare pays extra to those hospitals to compensate for low patient volumes. Medicare Advantage plans, on the other hand, offer negotiated rates that hospital operators say often don’t match those of traditional Medicare.

“It’s happening across the country,” said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association, whose members include small-town hospitals.

“Depending on the level of Medicare Advantage penetration in individual communities, some facilities are seeing a significant portion of their traditional Medicare patient or beneficiary move into Medicare Advantage,” Cochran-McClain said.

Kelly Adams is the CEO of Mesa View Regional Hospital, another rural hospital in Nevada. He said he applauds Battle Mountain’s Bleak for keeping Medicare Advantage plans out of his hospital “as long as he has.”

Mesa View, which is a little more than an hour’s drive east of Las Vegas, has a high percentage of patients enrolled in Medicare Advantage plans.

“Am I going to say I’m not going to take care of 40% of our patients at the hospital or the clinic?” Adams said, adding that it would be a “tough deal” to be forced to reject patients because they didn’t have traditional Medicare.

Mesa View has 21 Medicare Advantage contracts with multiple insurance companies. Adams said he has trouble getting the plans to pay for care the hospital has provided. They are either “slow pay or no pay,” he said.

In all, the plans owe Mesa View more than $800,000 for care already provided. Mesa View lost about $1.3 million taking care of patients, according to its most recent annual cost report.

NRHA’s Cochran-McClain said the growth in the plans also narrows options for patients because “the contracting that is happening under Medicare Advantage frequently has an influence on steering patients to specific types of providers.” If a hospital or provider does not contract with a Medicare Advantage plan, then a patient may have to pay for out-of-network care. That generally wouldn’t happen with traditional Medicare, which is widely accepted.

At Mesa View, patients must drive to Utah to find nursing homes and rehabilitation facilities covered by their Medicare Advantage plans.

“Our local nursing homes are not taking Medicare Advantage patients because they don’t get paid. But if you’re straight Medicare, they’d be happy to take that patient,” Adams said.

David Allen, a spokesperson for AHIP, an industry trade group formerly known as America’s Health Insurance Plans, declined to respond to Bleak’s and Adams’ specific concerns. Instead, he said enrollees are signing on because the plans “are more efficient, more cost-effective, and deliver better value than original Medicare.”

Centers for Medicare & Medicaid Services press secretary Sara Lonardo said CMS has acted to ensure “that private insurance companies are held accountable for providing quality coverage and care.”

The reach of private Medicare Advantage plans varies widely in rural areas, said Keith Mueller, director of the Rural Policy Research Institute at the University of Iowa College of Public Health. If recent trends continue, enrollment could tip to 50% of all rural Medicare beneficiaries in about three years — with some regions like the Upper Midwest already higher than 50% and others lower, such as Nevada and the Mountain States, but trending upward.

In June, a bipartisan group of Congress members, led by Sen. Sherrod Brown (D-Ohio), sent a letter urging federal agencies to do more to force Medicare Advantage insurers to pay health systems what they owe for patient care.

In an August response, CMS Administrator Chiquita Brooks-LaSure wrote that a final rule issued in April made “impactful changes” to speed up care and address concerns about prior authorization — when a hospital and patient must get advance permission for care to ensure it will be covered by an insurer. Brooks-LaSure noted another proposed rule that, once finalized, could mandate that insurers provide specific reasons for denying care within seven days.

Hospital operators Adams and Bleak also want more federal action, and fast.

Bleak at Battle Mountain said he knows Medicare Advantage plans will eventually move into his area and he will have to contract with them.

“The question is,” Bleak said, “how can we match the reimbursement so that we can sustain and keep our hospitals in these rural areas viable and strong?”

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

​ Orange County Register 

Arrest made in death of man found inside 55-gallon drum at Malibu Lagoon State Beach

• October 27, 2023

MALIBU — A suspect has been arrested in connection with the killing of a man whose body was discovered in a 55-gallon drum on a beach in Malibu, authorities said Friday.

According to KCAL 9, Joshua Simmons was arrested and charged with murdering 32-year-old Javonnta Murphy, who was found inside the drum on July 31 at the 23200 block of Pacific Coast Highway.

A Los Angeles County Sheriff’s Department official told reporters at the scene that the drum had been seen in the water at Malibu Lagoon State Beach the previous night by sanitation workers, but they were unable to retrieve it.

A lifeguard spotted the same barrel the following morning and was able to bring it to shore, then opened it and saw the body inside.

Sheriff’s homicide investigators determined that Murphy was shot to death and stuffed inside the barrel.

Simmons, 37, was arrested on Oct. 3 and is being housed at the Men’s Central Jail in downtown Los Angeles, according to county jail records.

Related Articles

KCAL reported that Simmons was also involved in an attempted jewelry store robbery in El Monte on Sept. 3.

It was not immediately known on what charge Simmons was being held but according to KCAL, law enforcement authorities confirmed he had been charged with murder.

His next court date is scheduled for Nov. 3.

Anyone with information on the case was urged to call the Sheriff’s Homicide Bureau at 323-890-5500. Tipsters may also call Crime Stoppers at 800-222-TIPS, or use the website lacrimestoppers.org.

​ Orange County Register 

How spooked is California’s housing market? 12 factors to watch

• October 27, 2023

A witches’ brew of economic forces is stirring unnerving thoughts about what’s next for California’s homebuying market.

One particularly ghoulish factor in these spooky times is that most Californians can’t afford to buy a home in the state – whether they are a first-time house hunter or an owner looking for a new place.

That’s largely due to a scary reversal of mortgage rates, which have risen to 23-year highs, less than three years since we saw record lows.

Yes, prices have not cracked and remain near record highs.

Still, these gut-twisting gyrations walloped the pace of statewide home sales, which are eerily slow and run 35% below average this year.

Forecasting California’s homebuying future requires a peek into a spine-chilling concoction of market forces that may not mix well.

Remember, housing’s history is filled with painful memories of the Great Recession and the very gloomy days of the early 1990s.

But any California outlook means pondering a potentially haunted house with a dozen real estate characters lurking.

No. 1 Central bankers: The scariest thing about the Federal Reserve has been its resolve to fight the worst bout of inflation in 40 years. Driving up interest rates – notably home loans – “higher for longer” to cool the overheated economy has iced homebuying. Spooky stat: A borrower’s buying power has shrunk by 45% from its peak when mortgage rates fell to 2.65% in January 2021.

No. 2 Lenders: It’s frightening to see the pullback in mortgage-making. Loans counts have tumbled as layoffs multiplied. Meanwhile, lenders seem fearful. So borrowers face increased qualification standards. Spooky stat: The Mortgage Bankers Association’s Credit Availability Index this summer hit an 11-year low.

No. 3 Bond traders: This normally anxious flock seems extra antsy. To protect their mortgage investments from inflation’s ravages, they’ve demanded premium rates to keep funds flowing to homebuying. Spooky stat: Thanks to rising rates, mortgages as an investment have lost 8% of their value this year – and 20% over three years.

No. 4 Investors: It’s spine-tingling to think how dark homebuying might be without this often-derided slice of the market. But how long can deep-pocketed investors keep buying amid market turmoil? Spooky stat: 34% of California home purchases in the second quarter were made by investors – the highest share in the nation, according to CoreLogic.

No. 5 Owners: The move-up market is a ghost. This group is petrified of selling because they likely can’t afford to buy another home – an inability to move which cuts demand and supply. Spooky stat: California listings have run below 2022’s slim pickings for five consecutive months, says California Association of Realtors.

No. 6 House hunters: Jittery first-time homebuyers are staring down an unsettling clash of lofty prices and low affordability. Plus, there’s worry high rates could stick around and limit future refinancing savings. Spooky stat: Only 32% of Californians could qualify to buy in the second quarter – the lowest level in 17 years, a Realtor starter-home index shows.

No. 7 Builders: The ghastly cold market for resale homes created opportunities for sellers of new construction. But developers have run into various shortages – materials, labor and land to build. Spooky stat: How short are builder supplies of property lots? San Diego (71% below normal), Los Angeles-Orange County (66%), San Francisco (48%), and the Inland Empire (46%).

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No. 8 Landlords: Soaring rents pitchforked folks into ownership two years ago. But 2023’s fears of empty rentals nudged apartment owners to chill their pricing – motivation for tenants to stay put. Spooky stat: California rents were rising at a 16% annual rate as recently as April 2022. In August 2023, they were falling at a 2% yearly rate.

No. 9 Employers: Jobs drive homebuying. And a strong hiring pace has helped keep the California housing market stable. But bosses now seem skittish and slowed staffing growth. Spooky stat: California hiring is off 10% this year.

No. 10 Consumers: Shoppers’ overall psyche is the bedrock for homebuying. And that foundation seems a tad creeky of late amid a host of economic and political tensions. Spooky stat: California’s future looks 15% gloomier over the past year, according to the Conference Board’s consumer confidence index.

No. 11 City planners: California’s horrifying inability to build enough housing seems like a never-ending nightmare. Getting residential projects through local approval mazes remains daunting. Spooky stat: California is home to 11 of 25 US metropolitan areas with the largest housing shortages.

No. 12 Movers: The hair-raising cost of California living is pushing residents out and scaring off potential relocations to the state. Perhaps that exodus lessens congestion and helps a housing shortage short term. It could strangle the state economy long term, too. Spooky stat: In 2021-22, California lost 1.65 million residents to other states but only 900,000 people moved here.

Postscript

Want to see just how “spooked” you are by these dozen housing worries?

Take our online “Spooky Housing” quiz at bit.ly/spookyhousing to gauge your real estate anxieties.

By the way, my score was 50% – so let’s just say I’m half-spooked!

Jonathan Lansner is the business columnist for the Southern California News Group. He can be reached at jlansner@scng.com

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​ Orange County Register 

ADU loan program has $100,000 for OC homeowners who rent to low-income tenants

• October 27, 2023

On Oct. 14, Gov. Gavin Newsom signed Assembly Bill 1033, paving the path for additional dwelling units to be sold separately from the primary residence, creating two-unit condos.

This week, I’ll dive into how homeowners can finance the construction of an ADU.

While there are myriad ways to finance such construction, at the top of my list is the Orange County Housing Finance Trust. The nonprofit’s program — which came online Oct. 24 and is only for Orange County homeowners — finances construction loans for up to $100,000. And there are no monthly payments. Homeowners won’t need to make any interim payments, either. What borrowers will face is a balloon payment 20 years later.

So, what’s the catch? Owners must rent the ADU to very low-income tenants for the first 10 years.

The trust also says that if you follow the rules (renters’ income must be less than 50% of the area median income), you could see almost half, or 48%, of your debt forgiven, assuming a $100,000 original loan.

There is no formal mortgage qualifying required either.

“There is no income evaluation,” said Amanda Grill, compliance manager at Orange County Housing Trust.

The trust was founded in 2019 between participating cities and the county. Its purpose is to support the homeless population and those who are living with extremely low incomes. Non-participating cities include Brea, Cypress, La Palma, Laguna Woods, Los Alamitos, Rancho Santa Margarita, San Clemente and Villa Park.

“We’re a government bank,” said Adam Eliason, trust manager at OC HFT. “We’re not here to advise on loan qualifying. We don’t want the liability. We approve applications for funding.”

The accruing interest rate on the construction financing is zero to 3%. For any period in the first 10 years in which the tenant falls outside the very low-income parameters, the borrower’s accruing interest rate will be higher. For example: a tenant with a Section 8 housing voucher means the borrower’s interest rate would be zero. If the tenant is within the low-income limits but without a voucher, the interest rate rises to 3%.

Homeowners must submit lease information to the trust. Annual audits are performed by HFT to validate the information.

Examples from the trust’s lending brochure offer tenant examples including a parent, child, new neighbor, an old friend, or a voucher-holder.

In a nutshell, if you want this nearly free money offered by the trust, it’s best to rent to a very low-income tenant. And owners must occupy the primary home to qualify.

More information and financing programs for Southern California homeowners can be found at housingsocal.org, according to Eliason.

It’s worth noting that an ADU from the ground up will likely cost a homeowner much more than $100,000. That means more complex financing for most homeowners.

ADU construction costs range broadly from $350 to $400 per square foot, according to Mark Lefitz, vice president of business development at EZ Plans. And those costs depend on whether the new construction is attached or detached from the primary residence, garage conversion, lot flatness or not, etc.

A 1,000-square-foot ADU at $400 per square foot might cost $400,000. Homeowners will likely need to string together several financing sources. Savings, borrowing from a retirement account or a securities account, home equity lines-of-credit or perhaps the bank of mom and dad.

There are other ADU institutional construction financing programs available but they come with subsidized money like the Orange County Housing Trust For example, there’s the FHA 203(k), Fannie Mae Homestyle, Freddie Mac Choice Renovation and USDA Renovation, all of which have some financing available for ADUs.

And what about VA loans?

“Due to the unique nature and complexity of the bill (AB 1033), it will take some time for the Loan Guaranty Service to analyze the impacts from policy and legal prospectives,” said VA press secretary Terrence Hayes (in part) via email. “VA is working diligently to address this matter.”

Excluding the no-income qualifying Orange County Housing Trust program, if you struggle to qualify for ADU/condo construction financing, private money might be the road to go.

Sandy MacDougall, CEO and founder of Mortgage Vintage, points out that homeowners can much more easily qualify to build an ADU using hard money loans because it’s an owner-occupied business purpose loan.

The combined loan to value or CLTV caps out at 65% on a second lien, according to MacDougall. For example, a homeowner’s first mortgage balance is $500,000 and they are securing a private second loan for $250,000. Your home is worth $1.2 million. So, the $750,000 loan total divided by $1.2 million value equates to 62.5% CLTV. That math works.

“We do ask for a couple of months of bank statements only to analyze the borrower’s ability to repay,” said MacDougall. “We are less FICO sensitive.”

Terms are 12-24 months with 2 points cost plus a $1,995 underwriting fee (each 1 point is 1% of the loan amount). The second mortgage rate is 12% to 14.5% depending on credit and CLTV, MacDougall said.

Let’s say the construction is completed and now you want to do the condo conversion.

Very briefly stated and overly simplified, you will need to go to your city’s building department to get a detailed list of what it requires to create the condo association and the legal condo unit entities. I’d sanity-check everything through a sharp real estate lawyer.

If you have mortgage liens, you may find yourself in an untenable situation of trying to clear the mortgage liens and change the legal vesting requirements. In other words, the original mortgage encumbers all of the land and all of the dwelling(s) built on it. When a homeowner splits up a property (say, for a two-unit condo) they cannot split up the loan. The lienholder could foreclose on the borrower for violating the note terms. Therefore, owners have to get separate financing.

The good news is Fannie and Freddie allow two-unit condo financing. So, you could get your legal documents in order with the city. Consider paying off any existing mortgages with two separate first liens on the two units.

No matter what else, find a knowledgeable mortgage professional to advise you.

My next column will dig into California’s lot-splitting laws which are required to separately sell your ADU and its lot.

Freddie Mac rate news

The 30-year fixed rate averaged 7.79%, 16 basis points higher than last week. The 15-year fixed rate averaged 7.03%, 11 basis points higher than last week.

The Mortgage Bankers Association reported a 1% mortgage application decrease compared to last week.

Bottom line: Assuming a borrower gets the average 30-year fixed rate on a conforming $726,200 loan, last year’s payment was $352 less than this week’s payment of $5,223.

What I see: Locally, well-qualified borrowers can get the following fixed-rate mortgages with one point: A 30-year FHA at 7.125%, a 15-year conventional at 7%, a 30-year conventional at 7.5%, a 15-year conventional high balance at 7.875% ($726,201 to $1,089,300), a 30-year high balance conventional at 7.875% and a jumbo 30-year fixed at 7.75%.

Note: The 30-year FHA conforming loan is limited to loans of $644,000 in the Inland Empire and $726,200 in LA and Orange counties.

Eye catcher loan program of the week: A 30-year adjustable, interest-only and fixed for the first five years, rate at 7.75% with 1 point cost.

Jeff Lazerson is a mortgage broker. He can be reached at 949-334-2424 or jlazerson@mortgagegrader.com.

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​ Orange County Register 

‘I just want peace’: Vigil held in Irvine for victims of the Israel-Hamas War

• October 27, 2023

Two hundred chairs, filled only with photos of the Israeli hostages taken by Hamas earlier this month, sat on a busy Irvine intersection Thursday evening.

Peppered among them were several strollers, representing the children kidnapped by Hamas.

“This entire situation is deep-rooted and complicated,” said Aaron Recter, an Irvine resident. “My main focus right now is on the innocent children who have lost their lives to this. As a father myself, I could never imagine the pain and hurt these families are feeling.”

The vigil took place at the corner of Culver Drive and Alton Parkway on the evening of Oct. 26, with about 100 people of all ages in attendance.

Many carried large Israeli or American flags in their hands. Attitudes were somber as shouts rang out with the names of the lives taken in the ongoing Israel-Hamas war, but some were angered and upset over the events that have unfolded.

Genna Kirta, an Israel native, said all she wishes for is peace.

“It is unimaginable seeing your people experience this,” she said. “My hope is for calmness, for reconciliation and ultimately for the people causing terror to receive justice for their actions. Who knows when and how that will take place, but all I want is the people wrongly affected by these actions to be saved and out of harm’s way.”

A consistent stream of honks came from the cars passing by the intersection; some people even hung out of their vehicles to shout in support.

“I am thankful that this event was organized,” said attendee Michael Broder, who was in tears. “It gives the people who may not be too familiar with the Israeli perspective a chance to see the impact that this war is causing.”

“I get that there are two sides to the story, but my heart stands with those who have had family members pass or hurt,” he said. “My heart stands with the children who have been taken from this world. My heart stands with the 200 chairs that are placed on this corner.”

The event was organized by the Orange County chapter of the Israeli-American Council. Rallies for Israel organized by the IAC have been held coast to coast following Hamas’ attack on Israel earlier this month, the deadliest one in decades.

Hamas militants launched a surprise attack on sleepy Israeli towns on Oct. 7 from the blockaded Gaza Strip. A stunned Israel ordered a complete siege on the Gaza Strip, launching waves of airstrikes on the Hamas-ruled territory.

More than 1,400 people in Israel have been killed — mostly civilians slain during the initial Hamas attack, the Israeli military said this week — and an estimated 200 people were kidnapped and are being held captive by Hamas in Gaza.

Additionally, more than 7,000 Palestinians have been killed during the war, according to the Gaza-based Health Ministry, the only official source for deaths in Gaza.

Stephaney Avital, a Newport Beach resident and member of Orange County’s Jewish community who helped put together the rally, said the point of the vigil is to keep the kidnapped men, women and children at the “forefront of people’s minds.”

“We’re trying to keep awareness of the 200+ kidnapped victims that are in Gaza still because we feel like the international community is not giving it the attention it needs or not taking it seriously to get these people out of Gaza,” Avital said. “And so here in Orange County, we’re feeling helpless.”

Tragically, she and her husband, Asher Avital, have a deeply personal connection to the Israel-Hamas war. One of Asher Avital’s cousins, 33-year-old Or Levy who attended the Supernova music festival in the Israeli desert on Oct. 7, is missing. Or Levy’s wife, 32-year-old Eynav Levy, was killed at the festival.

Or Levy holds an executive role at a technology company. Eynav Levy was a product designer. They were just two people who wanted to live their lives, have fun and listen to music, Asher Avital said.

“They had dinner with their parents the night before leaving for a day of fun, to spend time with friends and listen to music,” said Asher Avital. “Or and Eynav were hiding in a bomb shelter with maybe 20 or 30 people. And the Hamas terrorists kept throwing grenades inside.”

“And you can imagine what happened,” Asher Avital said.

The family thought it would be a matter of hours before they heard about Or Levy’s death, Asher Avital said, but Israeli military officials informed them that they thought he was kidnapped. They had located Or Levy’s phone in Gaza, Asher Avital said.

“We need our men, women and children returned from Gaza. That’s the whole point of doing this,” said Stephaney Avital.

The Israeli-American Council is a group that spans over 22 regional offices, 73 communities and 104 campuses, each with the goal to engage a “coast-to-coast community that strengthens the Israeli and Jewish identities of our next generation.” The council began in 2007 and has been expanding ever since — the Orange County chapter was founded in 2018.

The organization’s mission, according to its website, is to “build an engaged and united Israeli-American community that strengthens the Israeli and Jewish identity of our next generation, the American Jewish community, and the bond between the peoples of the United States and the State of Israel.”

The Associated Press contributed to this report. 

​ Orange County Register