Muni Matters: Lawmakers, MMA Working Through Local Health Funding
May 10 Hearing Planned for Local Public Health Empowerment Bills
By Meg McIntyre
Special to State House News Service
APRIL 29, 2021.....Before Shrewsbury joined the Central MA Regional Public Health Alliance more than a decade ago, the town had only a couple of employees dedicated to public health and the workers spent most of their time on tasks like restaurant inspections.
But since joining the regional alliance, Shrewsbury now has access to 26 specialized staffers who can do more proactive work in the community, an essential resource during a pandemic that's illuminated the importance of public health.
"We have an epidemiologist, we have an environmental team, we have an emergency response team to work on all these critical aspects of public health," Town Manager Kevin Mizikar said. "An individual municipality doesn't have the resources to provide that level of support."
A bill (S 1386/H 2329) being considered at the State House this session aims to further incentivize this kind of regionalization across the commonwealth, while also formalizing data collection, directing funds to local health departments and setting minimum standards for their operation. The legislation is designed to build on the public health law Gov. Charlie Baker signed last April, according to primary Senate sponsor Sen. Jo Comerford (D-Northampton).
Advocates say the proposal would be a historic investment in the state's public health system, which is unique in its decentralized approach. While many states operate county-level health departments, each of the Bay State's 351 cities and towns has its own board of health. Local departments received no dedicated state funding prior to the pandemic, which public health officials say has led to wide variation in services depending on a community's level of resources.
"This bill, if approved, will go a long way in ensuring we don't have the inequity in the delivery of public health services that we have now," Cheryl Sbarra, executive director of the Massachusetts Association of Health Boards, said.
But the bill also has its critics. The Massachusetts Municipal Association has raised concerns about paying for the mandates of the legislation and submitted testimony to that effect when it was first proposed last fall.
Executive Director Geoff Beckwith said the association supports improvements to the state's public health system, but is concerned the costs of implementing the proposed plan would ultimately fall on municipalities' shoulders. The organization would like to see a cost analysis and an independent, guaranteed funding source identified in the bill, he said.
"Who decides what is the adequate level of state funding? Ultimately, the state decides, not cities and towns, so that you end up having this circular discussion about whether or not the state revenues are adequate," Beckwith said. "We want all of the new mandated costs to be funded by the state, and that's not what the legislation says."
The bill specifies that the standards won't be enforceable if sufficient funds are not available for local health boards, and describes state dollars as "supplemental" to local funds. The level of funding for each city and town would be determined using a formula to be developed by the state Department of Public Health, which would be based on population and equity factors, according to the bill text.
It's one of 366 pieces of legislation set to be heard by the Public Health Committee this session and on Wednesday the committee announced that the bills would get a virtual public hearing on May 10. More than 80 lawmakers have signed on as co-sponsors. Rep. Hannah Kane, a Shrewsbury Republican, filed the House version of the bill (H 2329) alongside Needham Democrat Rep. Denise Garlick.
Last session, the Public Health Committee endorsed the House and Senate versions of the bill, which went on to die in the Health Care Financing Committee and Senate Ways and Means Committee, respectively.
Comerford, who co-chairs the Public Health Committee, said the legislation is sorely needed to support local public health officials who were already overburdened before the pandemic. She believes the Legislature recognizes the importance of investing in public health after seeing the effects of the COVID-19 crisis.
"We certainly understand that we don't want to pass an unfunded mandate on to communities, so that's not the intention of this in any way, shape or form," Comerford said. "And it is something that we're working through, because we ultimately want the MMA to see this as we do, which is a really exciting chapter for the commonwealth."
The role of local health departments has been a source of political tension during the pandemic, especially when it comes to the state's vaccine rollout.
Some lawmakers alleged the Baker administration prioritized mass vaccination sites over clinics run by local health departments. The administration defended its use of mass vaccination sites and its decision to not use local emergency response plans, citing the unique challenges of the COVID-19 vaccines. Local public health -- and funding for the departments -- has been a central focus of the COVID-19 Oversight Committee, which Comerford also co-chairs.
In response to a request for comment, a spokesman for Baker's office said the administration will "carefully review any legislation that reaches the Governor's desk."
The Massachusetts Public Health Association doesn't want to see costs shifted to municipalities either, according to Assistant Policy Director Kristina Kimani. But she said the association believes the language of the bill ensures that "sustainable" state funding must be tied to its requirements.
"The way we look at it is that local public health is already an unfunded mandate," Kimani said. "They have obligations from the state with no attached funding to implement those obligations. So really, it already is unfunded."
And after years of relying on local governments to fund public health, advocates say it's time for an overhaul of the whole system.
"We have been trying to fix the system by applying bandaids. We've been trying to deliver crucial public health services by applying bandaids," Sbarra, of the Massachusetts Association of Health Boards, said. "And what COVID has taught us is that we really need to do major surgery now."
[Muni Matters reports on key issues and breaking news affecting cities and towns in Massachusetts. Send news, material and tips to firstname.lastname@example.org]
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