As coronavirus arrives, Kansas confronts history of underfunding public health
Coffey County Health Department Administrator Lindsay Payer is preparing for the new coronavirus, just like other local authorities across Kansas. She jumps on conference calls, huddles with her staff of nine and reviews response plans.
She knows that even a single case can leave hundreds potentially exposed and require close monitoring to prevent an outbreak.
But the state grant money that Payer uses for disease investigation totals just $7,000. If the virus comes to Coffey County, with a population of less than 9,000 southeast of Emporia, Payer would use the money for a nurse to help identify the exposed and trace the infection’s spread.
“You can see we would far exceed the $7,000 pretty quickly,” Payer said, acknowledging an outbreak would force her to borrow from other parts of her $646,000 budget.
Across the country, local health departments are on the frontlines in the fight against COVID-19. They are the agencies closest to their communities, tasked with the crucial mission of containing outbreaks.
The same holds true in the Kansas City, Mo. metro area. Officials announced the state’s first confirmed case of the virus, a Johnson County woman, on Saturday.
The advent of the coronavirus is shining a spotlight on the chronic underfunding of public health — including local departments. Kansas, as well as neighboring Missouri, ranks near the bottom of states when it comes to public health spending.
A prolonged outbreak could strain the resources of health departments and force them to hit pause on other work.
The Kansas Department of Health and Environment, under the direction of Gov. Laura Kelly, readily admits the state has a public health funding problem. Kansas’s overall spot on America’s Health Rankings, a longtime compiler of health statistics, has dropped significantly over the past three decades, and the agency expects further decline unless funding ramps up.
Illustrating the depth of the problem, a key source of state aid to Kansas health departments hasn’t been increased in nearly 30 years. Almost two-thirds of Kansas counties, including Coffey, receive just $7,000 a year from the State Formula Grant, a program that provides health departments with discretionary funding.
“Sometimes, things are brought to our attention and then we act on them. I don’t think it’s any intentional thing,” Rep. Will Carpenter, an El Dorado Republican, said as he tried to explain how the Legislature hadn’t adjusted the grant in nearly three decades.
Carpenter is now pushing to increase its size.
“A lot of times folks have to hit a crisis and then react,” he said.
$7,000 doesn’t go far
Kansas ranked 40th among states in 2019 in funding for public health, according to America’s Health Rankings. State and federal outlays amounted to an estimated $60 per person.
Missouri invests even less, ranking 44th and spending about $57 per person. At the top is Alaska, with $281 per person. The U.S. average is $87.
The neglect of the State Formula Grant helps explain Kansas’s low position.
Every year, Kansas provides the grant to health departments based on population. Local officials prize it because departments have broad discretion in how they spend it.
In Coffey County, the $7,000 from the State Formula Grant is about 10 percent of the total dollars her department receives from Kansas, she said. The other 90 percent goes toward programs such as family planning and education for breastfeeding mothers.
“Our financial picture looks a lot different than others,” she said, noting the county contains the Wolf Creek nuclear power plant. “But increasing that 7,000 is still valuable to us.”
The grant is one of the few sources of funding that don’t include “extremely specific” criteria, Kansas Department of Health and Environment spokeswoman Ashley Jones-Wisner said in an email. Most departments use the fund for basic needs, such as salaries, training and supplies, she wrote.
But $7,000 doesn’t go very far in 2020. “I was in middle school when that last went up,” said Dennis Kriesel, director of the Kansas Association of Local Health Departments.
The state’s largest counties receive hundreds of thousands. Sedgwick County gets about $347,000; Johnson County receives about $403,000.
They’re in the minority. Sixty-eight of the state’s 105 counties only qualify for $7,000.
In total, the grant pays out $2.2 million each year -- a miniscule amount in a state with annual budget of more than $6 billion.
Health departments, led by Kriesel, are asking lawmakers to increase the size of the grant and a bill has been introduced that would raise the minimum threshold from $7,000 to $15,000. The House Appropriations Committee is currently considering a $1.9 million boost that Carpenter is advocating.
The Kansas Department of Health and Environment supports increasing the grant and public health funding in general, Jones-Wisner said. Kansas ranked among the top 20 states during the 1990s, according to America’s Health Rankings, but has steadily slid over time to 29th in 2018. No other state has fallen as far during that time.
“Unless public health funding in Kansas increases, we expect to see our health rankings continue to decline,” Jones-Wisner said. “Kansas will be a less desirable place to live and work and our economy will suffer.”
Virus could strain resources
Unsurprisingly, the coronavirus is now looming over funding discussions. Carpenter, who sits on House Appropriations, said the virus “kind of helps us make our case.”
An extensive outbreak could strain the capabilities – and financial resources – of local departments.
Sedgwick County Health Department Director Adrienne Byrne said money will be important at the local level in slowing the spread of the virus and fighting an outbreak.
“We don’t have a separate pot that’s waiting for outbreaks to come. There’s more supplies that are going to be needed and possibly volunteers,” Byrne said. “There’s a lot of need for additional resources (in case of an outbreak). The county will definitely step up and support in the meantime.”
In rural Wallace County, which borders Colorado, health department administrator Aften Gardner expects one of her two nurses would take on additional hours if needed.
Gardner is also consulting with the county EMS director because the nearest hospital, located outside the county, is 30 miles away.
She’s placing her confidence in the county commission, which she predicted would approve more funding if her budget doesn’t cover the cost of responding to the virus.
“We do have a plan in place,” Gardner said.
A prolonged response could ultimately require local health departments to sacrifice some programs in order to fight the virus. As the number of cases rise, Kriesel predicted departments will begin diverting resources from non-emergency public health programs.
Programs put on the backburner could include things like an educational campaign about childhood trauma, for example.
“Those other things will suffer because we’re talking finite resources,” Kriesel said. “Something has to give.”
Lee Norman, the secretary of the Kansas Department of Health and Environment, said at a news conference on Wednesday that a “terrific influx” of cases would stretch resources. But right now, the state hasn’t had to curtail any of its public health work because of the virus.
Norman is keeping open the possibility of asking for more dollars.
“We have met with legislative leaders to let them know what the magnitude of the issue is and that it could result in a request for supplementary funding,” Norman said, referring to a Wednesday briefing officials provided to Senate leaders.
After the meeting, Senate President Susan Wagle, a Wichita Republican who frequently tussles with the governor, said she is open to providing additional resources.
At the federal level, Congress has approved $8.3 billion in funding to combat coronavirus and President Donald Trump signed the package into law on Friday. Each state is expected to receive at least $4 million in grants for preparation and response.
It’s unclear how much Kansas could receive in total.
Cutting public health ‘shortsighted’
Some public health experts contend the rush to approve funding, while needed, highlights how ill-prepared the country overall is to the confront serious threats.
The United States has demonstrated it can ramp up to respond to infectious disease disasters, said Boris Lushniak, a professor of public health at the University of Maryland who served as U.S. Deputy Surgeon General during the Obama administration. He named previous crises over anthrax, SARS and Ebola as examples.
But the lessons of those crises don’t seem to stick.
“And then what happens? We forget. Things go to the wayside,” Lushniak said.
“I think the real sort of shift change has to be ‘this isn’t the end,’” he said. “When we solve the issue with COVID-19, let’s learn our lesson and let’s make sure that next time we’re not rebuilding the wheel yet again.”
The Star’s Nicole Asbury and The Eagle’s Chance Swaim contributed reporting
This story was originally published March 8, 2020 at 5:00 AM.