By TERRY CHEA, Associated Press

SAN FRANCISCO (AP) — When Ryan Lee first played mahjong two years ago, he got hooked. He dug out sets of the classic Chinese tile game from his parents’ house and brought them to San Francisco, where he started hosting mahjong nights in his apartment.

The gatherings became so popular that the 25-year-old Chinese American began hosting pop-up mahjong parties in restaurants, bars and nightclubs around San Francisco.

Mahjong, invented in 19th century China, is gaining popularity with a new generation of players looking to get off their phones and socialize in the real world.

Lee’s Youth Luck Leisure (YLL) Mahjong Club now hosts bimonthly parties with up to 30 tables and 200 guests. They attract a diverse, young crowd drawn to the festive atmosphere, live DJs, custom cocktails and chance to meet new friends. Instructors are on hand to teach novices.

“A lot of people are just really intrigued even though they don’t really know how to play,” Lee said. “There’s a cultural component they’re trying to connect with. It’s kind of like a cultural nostalgia.”

Eventbrite reports there was a 179% increase in U.S. mahjong events on its platform from 2023 to 2024.

There’s been a 179% increase in mahjong events in the U.S. from 2023 to 2024, according to Eventbrite, a popular ticketing app. The event platform says Gen Z is also showing a growing interest in other “grannycore” activities such as baking workshops and needlework circles that happen offline.

In mahjong, four players draw and discard tiles with different suits, numbers and Chinese characters. The object is to build a winning hand of four sets of three and one pair.

“It’s a really tactile game, and it’s really a social game. It really easily builds community among people,” said Nicole Wong, a writer and audio producer in Oakland. “It’s a good way to unplug and not just be on your phone.”

Wong learned how to play when she visited her Chinese grandparents in New Zealand in 2009. Several years ago she found her parents’ mahjong table and game sets, and started hosting mahjong nights with her friends.

In 2019, she launched The Mahjong Project, an instructional guide and oral history project inspired by her family’s love of the game. That led her to publish “Mahjong: House Rules from Across the Asian Diaspora,” an illustrated book that explores the game’s history, strategies, traditions and styles of play.

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“For the Asian American community, I think there’s interest in connecting to your heritage and your culture in a way that was not the case when I was growing up,” Wong said.

YLL Mahjong Club has held nearly 20 events in San Francisco since it started last year. Lee said it’s an opportunity to introduce people to the game as well as bring business to local restaurants, bars and food vendors. Lee’s sister started hosting similar events in Los Angeles. There are plans to expand to other U.S. cities.

“The demand is rising,” said Lee, a management consultant in business school. “It’s not just an interest to learn how to play mahjong, but to find a third space or another community to do things with.”

Joyce Yam, YLL Mahjong Club’s sponsorship manager, helps manage the San Francisco events, which sell out fast and have long waiting lists.

“We welcome people who have no experience at mahjong at all, and we have TA’s who teach the people how to play the game. And they love it so much that they keep coming back,” Yam said.

Ethan Vuong, a Florida native who lives in San Francisco, started playing with friends a couple years ago. He saw it as a way to connect with his Chinese heritage and make new friends. He’s a regular at Oakland’s Baba House and YLL Mahjong Club events, where he volunteers to teach newcomers.

“It’s not just a skill or mechanics-based game, it’s an expression of your personality,” Vuong said. “I just keep playing because I have this goal that I’m going to beat my grandma one day.”

At University Avenue and Wheeler Street, the Midway YMCA is sporting a new name and will soon welcome children and parents to a new stand-alone family center.

Built in 1949, the two-story building that previously housed the YMCA’s programs for school-aged children looked every bit its 76 years, according to YMCA officials, up until the day this spring when it was demolished.

“It was showing some age,” quipped Michelle Edgerton, the chief advancement officer for the YMCA of the North, in a phone interview Tuesday.

A new building sporting 12 classrooms, a small gym, a rooftop learning environment and services for parents, kids and tiny tots is expected to open by next fall, finally allowing all of the Midway YMCA’s family programming to land under one roof. Edgerton said the building, which will be located at 530 North Wheeler St., directly across the street from the YMCA parking lot, represents a $19 million, donor-driven investment in St. Paul’s Midway neighborhood and the families living along the Green Line corridor.

Well-wishers on Monday attended a groundbreaking for the future Peter J. King Family Foundation Center for Child and Family Wellbeing, which is named after the Golden Valley-based foundation that contributed $5 million toward its construction.

Spanning 27,000 square feet, the center will host dedicated space for arts and culture programming, STEM and healthy living classes. It will serve 2,000 children and 6,000 family members annually, and offer teaching opportunities for student teachers enrolled in institutions of higher education.

Visitors on Monday also took in another rare site — the renaming of the entire Midway YMCA campus after longtime donor Richard Schulze, the founder and former chief executive officer of Best Buy.

Schulze, who grew up in the Midway going to the YMCA and graduating from nearby Central High School, was on hand to help unveil new exterior signage marking the Richard M. Schulze Family Foundation Midway YMCA. In recent years, his foundation has donated $17 million of philanthropic support to YMCAs across the country, including financial gifts to support the new Peter J. King Family Center and another YMCA in South Florida.

“They have been involved for over 25 years, and in that time have just contributed wonderfully to the Y,” said Edgerton, who attended the dual renaming and groundbreaking on Monday alongside YMCA of the North President Glen Gunderson. “He really spoke wonderfully of the importance of the Y in his life, his family’s life and for the community.”

The YMCA of the North had once hoped to open a new facility in downtown St. Paul, but plans fell through during the pandemic.

“Since COVID, that was no longer an option,” Edgerton said. “We asked Mr. Schulze to transfer that support to the Midway Y. He did give some funding toward the building and the programming that takes place in the building, and offered up a match.”

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CHICAGO — Gen Z is an easy target. Born between 1997 and 2012, they’ve been blamed for everything from the downfall of skinny jeans to the end of basic phone etiquette. And now, if headlines are to be believed, they’re destroying the wine industry too. Health-conscious, sober-curious and strapped for cash, they say, Gen Z barely drinks. And if they, do, they’re skipping wine in favor of hard seltzers, cocktails or cannabis infusions.

But is Gen Z truly to blame for wine’s decline? Or are they simply the most visible face of a broader cultural shift?

Statistics about Gen Z, wine and alcohol are murkier than headlines suggest. Much attention has been paid to reports that young adults drink less alcohol than older generations. However, recent data from drinks industry research group IWSR suggests Gen Z is catching up.

What’s clear is that alcohol consumption overall is trending downward, especially when it comes to wine. In 2024, global wine consumption fell to its lowest level in more than 60 years. Moderation in alcohol has become a cross-generational trend and Gen Z (currently aged 13-28) is coming of age in an increasingly different drinking culture than their parents or grandparents.

“It may not be that Gen Z is drinking less,” says Ting Ting Shi, 25, a sommelier at Miru, the Japanese restaurant at the St. Regis Chicago. “But they’re probably drinking less often,” she says.

For a lot of younger people, drinking tends to be more intentional than habitual, she describes. It’s more likely to be focused on specific occasions, she explains, a Friday night out, for instance, rather than a routine glass of wine with dinner or beer after work each night. And for many Gen Z drinkers, wine isn’t an obvious choice yet.

The choice overload effect

More than any other generation, Gen Z has been inundated with options, explains Olivia Gardner, 22, a recent graduate of DePaul University and server at Homeslice, the Lincoln Park pizzeria and bar.

When her parents were Gardner’s age, besides beer and liquor, they may have considered boxed wines or wine coolers, she says. Today, she and her peers face aisle after aisle of different flavored seltzers, beers and ready-to-drink cocktails.

“There are 16 different stores around you and DoorDash will deliver it all to your door,” she adds. With so many fast, easy choices, wine doesn’t often register as the most approachable or inviting choice.

Health and intentionality

Health is a driving force in this cultural shift surrounding alcohol. Gen Z came of age just as wellness culture entered the mainstream, and as drinking was increasingly framed in terms of mindfulness, balance and control. Sobriety and sober-curious lifestyles, once considered uncommon or taboo, are celebrated.

Ting Ting Shi, the sommelier at the restaurant Miru, 401 E. Wacker Drive in Chicago, walks through the dining room there on Wednesday, July 23, 2025. (Terrence Antonio James/Chicago Tribune/TNS)

It’s a generation with an innately “health-first mindset,” explains Daisy Siders, 26, a sommelier at RPM Italian in River North. “We drink, but we’re conscious, even overly conscious about the effects of alcohol on our bodies,” she says.

It’s somewhat of a Gen Z cliché, she admits, but “we close out our bar tabs (after each round) because we want to keep track of how much we’re drinking and spending.”

The crossroads of values and affordability

The wine industry has rushed to court younger drinkers, shaking off its stuffy, elitist reputation with appeals to perceived millennial and Gen Z values like authenticity, sustainability or emotional connection. Gen Z often favors products that align with their ideals, says Shi, but “overwhelmingly, I would argue that cost has been the biggest driver in Gen Z drinking habits.”

That reality isn’t unique to Gen Z, but rather a reflection of where they are in life. “As a younger demographic, we have less purchasing power,” says Shi. “And especially with so much talk about inflation and tariffs, it’s impossible not to be price conscious.”

Wine, in time

It shouldn’t be a surprise that many young Americans aren’t instinctively drawn to wine. In a country where wine culture is still relatively young, wine hasn’t been the obvious entry point for any generation of Americans.

“It’s really a familiarity thing,” says Shi. “Most young people know more about a margarita or an espresso martini than they do about sauvignon blanc or chardonnay.”

But Gen Z has so much potential to grow into an appreciation for wine, explains Jill Zimorski, a master sommelier and adjunct professor at DePaul University’s School of Hospitality and Sports Business, who describes herself as “an elderly millennial.”

Gen Z drinkers may not exhibit the confidence to navigate wine yet, but they’ve grown up in “a much more evolved wine culture than previous generations of Americans,” she says. More than any previous generation, Gen Z Americans are likely to have been raised by wine-drinking parents. “They’re already light years ahead of previous generations,” she says.

Ting Ting Shi, right, the sommelier at the restaurant Miru, 401 E. Wacker Drive in Chicago, talks to diners on the terrace there on Wednesday, July 23, 2025. (Terrence Antonio James/Chicago Tribune/TNS)

With time, career growth and more disposable income, their interest in wine is likely to deepen. “Our incline might not be as linear, but I do think we’ll get there eventually,” says Gardner, who took several of Zimorski’s courses.

After all, there’s a universality to what draws curious people to wine. Beyond its appeal as a beverage, wine offers a cultural and historical depth to explore. “The education journey never ends,” says Shi. “There are always more stories to tell, more places and techniques to learn about.”

But as Gen Z embarks on their journey, they ask for patience too.

“Older generations can be harsh” to younger wine drinkers, Siders says. “There’s still a lot of snobbery and gatekeeping, and it’s very much a ‘go out and figure it out yourself’ kind of culture.”

Despite the negative hype, there’s a lot to celebrate. With a new generation of moderate drinkers comes a greater consciousness of responsible alcohol consumption, and hopefully, a higher appreciation for better quality products, ethics and sustainability.

“Who knows,” Zimorski says. “Gen Z might actually be the saviors of wine culture.”

By Bram Sable-Smith, KFF Health News

Amy Frank said it took 17 hours on the phone over nearly three weeks, bouncing between her insurer and her local hospital system, to make sure her plan would cover her husband’s post-surgery care.

Many of her calls never got past the hold music. When they did, the hospital told her to call her insurer. The insurer told her to have the hospital fax a form to a special number. The hospital responded that they’d been instructed to send faxes to a different number.

“It was just a big loophole we were caught in, going around and around,” Frank said.

The couple was among 90,000 people in central Missouri caught in the middle of a contract dispute between University of Missouri Health Care, a Columbia, Missouri- based health system, and Anthem, the national health insurance provider. (Amy Frank/KFF Health News/TNS)

Frank and her husband, Allen, faced that ellipse of frustration because they were among 90,000 central Missouri patients caught in the middle of a contract dispute between University of Missouri, or MU, Health Care, a Columbia, Missouri-based health system, and Anthem, the couple’s health insurance provider. The companies let their contract expire in April after failing to strike a deal to keep the hospital system and its clinics in-network.

A growing number of Americans find themselves in a similar pinch. In New York City, negotiations between UnitedHealthcare and Memorial Sloan Kettering Cancer Center missed a June 30 deadline, briefly leaving some patients in limbo until a deal was reached the next day. In North Carolina, Duke Health recently announced it could leave the Aetna network unless the insurance company agreed to pay more favorable rates to the health system. And the Franks were nearly caught out-of-network previously, when a 2023 contract dispute between Anthem and a primary care group in Jefferson City, Missouri, prompted the couple to switch some providers to MU Health Care.

Indeed, 18% of non-federal hospitals experienced at least one documented case of public brinksmanship with an insurance company from June 2021 to May 2025, according to preliminary findings by Jason Buxbaum, a health policy researcher at the Brown University School of Health. Over the same period, 8% of hospitals ultimately went out-of-network with an insurer, at least for a time.

Industry observers say long-standing trends like hospital consolidation and rising health care costs contribute to the disputes, and Trump administration policies could make them more frequent as hospitals brace for about $1 trillion in cuts to federal health care spending as part of President Donald Trump’s sweeping budget law.

“They’re going to be more hard-nosed at negotiating with the health plans because they’re going to be in a survival mode,” said John Baackes, a retired insurance executive and former board member of America’s Health Insurance Plans, the national trade group representing the health insurance industry.

During the three-month stalemate between the insurer and the health system in Missouri, patients with Anthem plans lost in-network coverage with the region’s largest — and, for some specialties, only — medical provider.

Most people were unable to switch insurance midyear and faced the choice of paying higher prices upfront, delaying care, finding new providers, or running a paperwork gauntlet in hopes their medical conditions qualified for a 90-day coverage extension.

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The dispute came at a particularly inconvenient time for the Franks. Allen Frank was recovering from complications from falling off the roof while cleaning the siding of the couple’s home in Rich Fountain in October. When it happened, Amy drove him 24 miles to the nearest emergency room. The facility in Jefferson City had recently been taken over by MU Health Care, and Allen was soon transferred 30 miles farther by ground ambulance to the system’s main hospital in Columbia for surgery to insert two metal plates and several screws to repair his collarbone.

Health care consolidation has been booming nationwide for 30 years, with over 2,000 hospital mergers announced since 1998, including 428 from 2018 to 2023. Mergers may lead to some efficiencies and benefits for consumers, but they also reduce market competition and strengthen the hand of hospitals in negotiations with insurers.

“Insurer markets have been consolidated for a long time,” Brown’s Buxbaum said. “What’s changed is how consolidated the hospital markets have become.”

Now if a hospital system drops out of a network, he said, “it’s not just going to be one key hospital. It’s much more likely to be all the key facilities, or many of the critical mass of providers” in an area.

It’s a scary prospect for patients, making the public threat of a rupture a potent tool in negotiations between hospitals and insurers. That typically works in a hospital’s favor, Baackes said, “because the general assumption is the insurance is being greedy and the hospital is doing God’s work.”

In a statement, Buddy Castellano, spokesperson for Anthem’s parent company, Elevance Health, wrote, “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted. Health plan rate discussions are complex and require thoughtful collaboration to ensure long-term sustainability. Our commitment remains clear: ensuring access to care while keeping coverage affordable for the families, employers, and communities we serve.”

Allen Frank needed follow-up care in the months after his initial surgery, including a second surgery in July.

A federal law dubbed the No Surprises Act, which took effect in 2022, offers protections for some patients whose provider drops out of network due to a contract dispute. People getting treatment for serious conditions can keep their in-network rates for up to 90 days with their current providers, delaying the need to find a new one or face higher rates. So Amy Frank worked the phones to get that continuity of care for her husband.

“Our deductible was already met. If we go out-of-network, we’re going to have to start completely over for the out-of-network deductible,” she said.

Eventually, Anthem agreed to let Allen Frank continue his care with MU Health Care. But when he showed up for an appointment to get an injection in his injured shoulder, he was told the health system didn’t have a record of the approval. He refused to leave without being seen, and, eventually, a nurse was able to get through to Anthem to get a confirmation number and approval for the appointment.

“It’s just very frustrating,” Amy Frank said in early July, before the sides had reached a deal. “I’ve got my own medical issues, and I don’t feel like mine are bad enough to be fighting for a continuity of care.”

In an email, MU Health Care spokesperson Eric Maze wrote: “While our goal was to reach agreement prior to our contract terminating and to avoid disruption in care, we established processes and resources well in advance to facilitate continuity of care and reduce the burden for our patients. We understand and are sorry for the stress and concern being out of network created for many, and we are deeply grateful for the patience and trust placed in us during this time.”

Rising health care costs are fueling contract disputes. Hospital expenses grew 5.1% in 2024, according to a recent brief from the American Hospital Association, outpacing the 2.9% inflation rate. Labor costs are the biggest driver, with advertised nursing salaries rising 26.6% faster than inflation from 2020 to 2024, the brief noted.

Hospitals want to recoup those costs by pressing insurance companies to pay more for services.

Washington University in St. Louis health economist Tim McBride said that dynamic could be further enflamed by the massive tax-and-spending law. The measure makes significant cuts to federal health care spending over the next decade, including a $911 billion drop in Medicaid spending, and is expected to cause 10 million Americans to lose their insurance.

As negotiations between MU Health Care and Anthem broke down, the insurer claimed the hospital was seeking a 39% rate increase over three years, while the hospital said the insurer wouldn’t budge past 1%-2%.

On June 30, three months into the standoff, the Missouri Senate Insurance and Banking Committee called the two sides in for a hearing that broke months of deadlock and prompted new proposals from Anthem.

“Anthem doubled their rate increase offer,” Missouri Senate President Cindy O’Laughlin, a Republican whose district includes parts of central Missouri, wrote in a Facebook post on July 8, encouraging a deal.

“Yes I know that I’m not on the inside nor the CEO of either but from what I’ve been told this seems a reasonable offer.”

The sides announced an agreement one week later that was retroactive to April 1, the day the previous contract expired.

Amy Frank got several texts from friends and family about the agreement. She’d been so vocal about her frustrations, they wanted to make sure she’d seen the news. But her relief was subdued.

“So you put everybody through all of this for nothing?” she said the day after the deal was announced.

She had already sunk hours on the phone to ensure Allen’s July 31 surgery to repair the plates holding his clavicle together would be covered. She was in no rush to call her doctors to reschedule the appointments she’d skipped, figuring their phone lines would be busy. The experience had her wondering if the two sides were trying to get people upset as a bargaining tactic.

“That money that they’re fighting over — is that really worth all of the stress?” she said.

And after going through two disputes in three years, she can’t help but wonder: How long until the next one?

©2025 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC. ©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.