Budget cuts and layoffs in healthcare

Even as federal aid flowed into state budgets in response to the COVID-19 pandemic, public health leaders warned of a boom-and-bust funding cycle on the horizon as the emergency ended and federal funding dried up. Now, that drought is a reality, with state governments slashing the budgets that support local health departments.

Congress has allocated more than $800 billion to support states’ response to COVID-19, which has contributed to an escalate in health care employment across the country.

According to a report by the National Association of County and City Health Officials, which examined 2,512 of the nation’s roughly 3,300 local health departments, local health department employment grew by about 19% between 2019 and 2022. The same report explained that half of their revenue in 2022 came from federal sources.

But those jobs and the safety net they provide for residents of the communities they serve are in jeopardy as money runs out, worrying public health leaders — especially in sparsely populated rural areas that already faced long-standing health inequities and low resources.

Officials in states including Montana, California, Washington and Texas now say they face budget cuts and layoffs. Public health experts warn that accompanying cuts to services — such as contact tracing, vaccinations, family planning, restaurant inspections and more — could plunge communities into crisis.

In California, Democratic Gov. Gavin Newsom has proposed cutting $300 million in state public health funding. And the Washington state Department of Health eliminated more than 350 positions overdue last year and expected to cut another 349 this year as federal funding to combat COVID-19 dries up.

“You can’t hire firefighters when the house is already burning,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, a public health advocacy group.

In some places, that pandemic money has done little more than keep tiny health departments afloat. The Central Montana Health District, a public health agency for five rural counties, hasn’t received the same flood of money that others have seen, but it has received enough to lend a hand staff respond to increased workloads, including testing, contact tracing and COVID vaccine rollouts.

The department filled the vacancy with a federal grant provided by the state when an employee left during the pandemic. The federal funding allowed the department to break even, said Susan Woods, the county’s public health director.

The health district currently has five full-time employees. Woods said the team is doing well with its constrained resources, but a drop in funding or another public health crisis could tip the scales in the wrong direction.

“Any kind of crisis, any kind of, God forbid, another pandemic, would probably bring us to the point of collapse,” Woods said.

Adriane Casalotti, head of government and public affairs for the National Association of County and City Health Officials, said she expects more layoffs and budget cuts at the health department. Those cuts will come as health officials address issues that have taken a back seat during the pandemic, such as increases in sexually transmitted diseases, suicides and substance abuse.

“There’s a ton of work being done right now to pick up the pieces of these other public health challenges,” she said. But it will be challenging to catch up with constrained resources.

From 2018 to 2022, reports of chlamydia, gonorrhea, syphilis, and congenital syphilis increased by nearly 2% nationwide, totaling more than 2.5 million cases. A recent KFF report found that routine immunization rates for preschool children have not returned to pre-pandemic levels, while the number of families requesting exemptions has increased. Nearly three-quarters of states have not met the federal target of 95% vaccination coverage for the 2022–2023 school year for measles, mumps, and rubella, increasing the risk of outbreaks.

In the face of these challenges, public health leaders are clinging to the resources they have acquired over the past few years.

County officials in Lubbock, Texas, a city of more than 250,000 people in the northwestern part of the state, have hired four sexually transmitted disease intervention specialists through a five-year grant from the Centers for Disease Control and Prevention.

The posts come as the number of syphilis cases in the state has risen sharply from levels seen in the past decade, and increases in congenital syphilis have outpaced the national average, according to the CDC. State officials recorded 922 cases of congenital syphilis in 2022, for a rate of 246.8 per 100,000 live births.

But federal officials, grappling with a shrinking budget, cut the grant for two years, leaving the district scrambling to fill a nearly $400,000 annual budget gap while trying to contain the outbreak.

“Even with that funding, it’s very arduous for staff to keep up with the cases and actually make sure that everyone gets treated,” said Katherine Wells, Lubbock’s public health director.

Wells said state officials could redirect other federal money from the budget to keep the program going when the grant ends in December. Wells and other health leaders in the state have been constantly pleading with state officials for more money, but Wells said that “whether we’re going to be successful in a state like Texas is very uncertain.”

Castrucci said making public health a priority in the absence of a national crisis is a challenge. “The boom-and-bust funding cycle is a reflection of the attention of the American public,” he said; as the national emergency has ended, enthusiasm for public health has also waned.

And rural health departments like the one in central Montana deserve more attention, said Casalotti, a spokeswoman for county and city health officials. That’s because they serve a critical role in communities that continue to see hospital closures and the loss of other health services, such as maternity and women’s care. Local health departments can act as “a safety net for the safety net,” she said.

Healthbeat is a nonprofit public health newsroom published by Civic News Company and KFF Health News.

This article was reprinted from khn.orga nationwide editorial office dedicated to health journalism, one of the main operational programs of KFF – an independent source of health policy research, polling and journalism.