Before coronavirus, California let its public health funding stall for a decade
Fourteen years ago, California made a huge investment in public health by creating a standalone state department and seeding it with tens of millions of dollars in special funding for emergency supplies.
In 2009, former Republican Gov. Arnold Schwarzenegger put it to work, using the new department to lead the state’s response to a swine flu outbreak that year.
Then, the Great Recession hit, and California’s spending on its public health department plateaued, even as a 10-year economic expansion swelled the state’s budget by nearly $100 billion.
Now, Democratic Gov. Gavin Newsom is pulling all the financial levers he can to curb the spread of COVID-19, which has already infected 675 people as of Thursday and killed more than a dozen. He projects 25.5 million Californians, more than half the population, will be infected in the next eight weeks if the public doesn’t cooperate with aggressive social distancing measures.
Newsom late Monday secured $1.1 billion through bipartisan legislation that frees up emergency funds for hospitals, schools, day care centers and local governments in the fight against the rapidly spreading coronavirus.
The urgency reminds some health advocates of an era that prioritized public health funding.
California allocated $3.4 billion — about 2.8 percent of its $119 billion budget — for the public health agency in its 2009-2010 financial blueprint.
A decade later, Newsom allotted the same amount of money, now 1.5 percent, in his current $215 billion budget.
“There was a time there that Arnold Schwarzenegger had a bold vision and a responsible one,” said Jack Lewin, former CEO of the California Medical Association and current chairman of the National Coalition on Health Care. “But I think that got diluted over the course of time. People get complacent, and money goes elsewhere.”
The department is charged, among other things, with funding lab services, chronic disease prevention, family health programs, infectious disease control and Alzheimer’s research.
Because some of the department’s funding is tied to specific diseases, the state lacks flexibility to move money and resources where they’re needed, said Michelle Gibbons, executive director of the County Health Executives Association of California.
The budget earmarks outbreak prevention money for public health issues like STDS, HIV and Hepatitis C.
“It’s not just the funding levels but the categorical nature of funding,” Gibbons sad. “You get funding for diabetes in a grant form the government, but you can’t necessarily use that for communicable diseases.”
Modest investments
State. Sen. Richard Pan said he’s for a long time known the state needed to better prepare for a potential health emergency. On March 6 of last year, Pan said, he held a hearing as the chair of the Senate Committee on Health about how California would handle an inevitable outbreak.
“Even though we don’t know what the disease will be, usually there is at least one, if not more, diseases out there,” Pan said. “There’s never nothing going on.”
The Sacramento Democrat and pediatrician said he worked with Newsom’s office last year to rebuild funding.
Last year’s budget provided $775 million and funded 350 positions for infectious diseases, a more-than-$100 million bump from 2018. The financial blueprint also provided $96 million for emergency preparation.
But Pan said more money is needed so local agencies can hire more expert personnel, invest in lab testing and maintain the resources to juggle both intervention and prevention work.
“Our county health departments are already struggling with the ongoing stuff they have, like sexually transmitted diseases,” he said. “What things didn’t get done because (officials) got pulled away to deal with the outbreak? That’s a question we’ll need to ask when this is over.”
Although Pan said the state is now increasing spending, public health advocates are bracing for cuts from the federal government this year.
President Donald Trump’s 2021 budget request he released in February decreases the federal Department of Health and Human Services’ budget by 10 percent. His proposal further would have shaved funding by nearly 16 percent for the Centers for Disease Control and Prevention. The CDC provides block grants to states, which funnel the funds into local health departments.
Lee Saunders, president of the American Federation of State, County and Municipal Employees, said Congress has to take “bold steps” to help state and local governments fund the resources necessary for public service workers “to fight this pandemic and protect our communities.”
“For years, our nation’s public service workers have been asked to do more with less,” Saunders said. “They are rising to the current challenge, but this crisis exposes how shortsighted austerity measures have hurt our ability to respond when our communities need help the most.”
How’s California doing?
An independent health care advocacy group still ranks California’s emergency preparedness among the middle of states. A 2020 report applauded the Golden State’s strong vaccine laws, but cited the state’s water infrastructure inequality, wildfires and last fall’s emergency power outages as health emergencies.
Only 35 percent of the state’s hospitals received an “A” rating for patient safety, but California was among 48 states that reported having a “plan in 2019 for a six- to eight-week surge in laboratory-testing capacity to respond to an outbreak or other public health event.”
The California Emergency Medical Services Authority does have “budgetary resources” to deploy shelters and medical emergency structures, said Jennifer Lim, deputy director of legislative, regulatory and eternal affairs with the agency.
The resources come from an investment Schwarzenegger and lawmakers made in 2006 when they bought $172 million worth of emergency “surge capacity” supplies and spent $18.3 million for three mobile hospitals.
The $1.7 million needed to store the hospital supplies was “zeroed out” under former Gov. Jerry Brown in 2011, Lim said, and the hospitals were instead divided into smaller units for the state and local agencies to use. Some of the structures were deployed during recent disasters like the Camp, Carr and North Bay fires. One hospital was transferred to the California National Guard.
EMSA has not deployed these shelters in response to COVID-19, though some local agencies have used their structures, Lim said.
“Were the state to deploy this program as part of the COVID-19 response,” Lim continued, “there are a number of budgetary resources available to support that deployment.”
Former Newsom aide Daniel Zingale, who has shaped health policy in California for decades through his work in state government and influential advocacy groups, said he thinks the state has taken strong steps to prepare for a pandemic.
“I would give the state of California very high marks, at least from Gray Davis on,” he said. “The past four governors have built a public health infrastructure that is second to none in the nation.”
California officials learned from their mistakes during the AIDS epidemic, which disproportionately hit San Francisco, Zingale said. Although California and the nation eventually responded effectively to the spread of the virus, officials were slow to act.
“It provides the most sobering, cautionary tale because we did get off to such a slow start with the failure of state and federal leadership at that time,” he said. “We are so far from that dark history today.”
Lewin, the former CMA executive, said he agrees California is better prepared than most states because it has a “much more effective Department of Public Health” that’s well-connected to county departments.
He added that COVID-19 offers an opportunity for California to reinvest in its system and end a cycle of putting public health “at the bottom of the totem pole.”
“When this whole thing starts to resolve, we need to stop and look at our public health infrastructure,” Lewin said, “and decide where we need to invest to protect us from the inevitable next time. We know that we will see some kind of crisis in the future.”
Sacramento Bee reporter Sophia Bollag contributed to this report.
This story was originally published March 20, 2020 at 5:00 AM.