After watching the COVID-19 pandemic put a strain on local public health systems, Senate leaders this week will propose investing $250 million in federal relief money to begin to restructure public health infrastructure in a way top lawmakers and advocates hope will ensure cities and towns are better prepared for the next health crisis.
The funding, if approved, would exceed the $150 million set aside in the $3.82 billion House-approved plan to allocate American Rescue Plan Act funds, and would match what public health organizations for months have been advocating to see in the legislation.
“I feel like this is the moment to seize,” said Sen. Jo Comerford, the co-chair of the Committee on Public Health.
Senate leaders are expected as soon as Wednesday to unveil their proposal to spend billions of dollars of ARPA funding and the fiscal year 2021 tax surplus.
House and Senate leaders have already agreed to spend $500 million on unemployment insurance relief for businesses and another $500 million on bonus pay for low-income, frontline workers, but the public health proposals highlight how the priorities of the two branches might diverge as Democrats try to complete a bill by the Nov. 17 start of the mid-session recess.
Comerford described investing in public health systems as “among the most perfect ways” to spend ARPA funding because of the relief money’s origin in a public health crisis that strained local systems and exposed inequities for residents depending on where they lived.
“I think coming out of COVID there’s a shared awareness that we have a public health system that doesn’t equitably work for the commonwealth and by investing $250 million the Senate is not accepting that status quo. We are no longer willing to leave communities behind,” Comerford said.
The Northampton Democrat said she was “not worried” about finding compromise with the House because of the commitment that branch already showed to the issue in its bill.
Over the past year-and-a-half, local boards of health were thrust into the middle of the state’s response to the COVID-19 pandemic, but some municipal agencies were better equipped than others to handle the demands of testing, contact tracing, vaccine distribution and other functions.
Michael Curry, CEO of the Massachusetts League of Community Health Centers, said underinvestment in local public health systems became evident as departments tried to meet those demands.
“This is an opportunity to reposition our local public health departments in a way that’s not just about this pandemic but about longstanding health inequities across the commonwealth, whether you live in rural communities or whether you live in urban communities and in pockets where there is higher rates of morbidity and mortality,” Curry said.
“This is putting the necessary resources into the hands of our cities and towns and our local public health departments to respond in a way that has long-term implications and $250 million is a welcome contribution,” he added.
In concert with what public health advocates have been calling for, the House bill broadly directs the Department of Public Health to use the funding over three years to address community-by-community disparities in public health capabilities, workforce development and data collection systems.
Curry said, “Those buckets are the right buckets,” and he expressed confidence that, in conference negotiations between the House and Senate, Speaker Ron Mariano and Senate President Karen Spilka would find the right balance of transparency and accountability for how the funds get spent.
“We know that Chelsea and parts of Boston and Lawrence and Lynn and Springfield and Brockton did not bear the same weight of this pandemic as other communities did, so how can we resource those public health departments in a way that’s necessary based on the populations they serve?” Curry said, describing the challenge.
Comerford said the Senate bill will share the three main objectives of the House bill, though she said conversations were ongoing about whether the final Senate bill should be more specific in how and how much gets spent in each area.
“I wouldn’t want to be so prescriptive. We will set the amount in motion and trust that our smart partners at the Department of Public Health will be able to break it down,” Comerford said.
With her focus on the public health portion of the bill, Comerford said she was unaware if any tradeoffs were required to make the extra investment by limiting spending in other areas. The size of the spending plan Senate leaders have assembled is still unknown. The $3.8 billion final House bill left aside more than $2.5 billion to be spent later.
Maddie Ribble, director of public policy at the Massachusetts Public Health Association, said the $150 million in the House bill is a “real good step,” but he said the full $250 million will be needed over the next five years to bring all cities and town up to the same public health standards.
“Over the next five years, I think of it a little like trying to fill in potholes in the roads,” Ribble said.
Ribble said longer-term structural reforms will also be needed, and advocates are hopeful that a policy bill will also advance “in the near term as well.”
At the start of the pandemic, the Legislature approved a small pot of funds to incent local boards of health to share resources and regionalize services. That program was funded with $15 million in the fiscal 2022 budget, according to Ribble, and received an additional $6 million in the fiscal year 2021 closeout budget.
Both Comerford and Ribble, however, noted that a bill known as SAPHE 2.0 would go further to establish minimum health standards for every community, credential public health workers, create uniform data collection and reporting systems and build state funding mechanism for local boards of health.
“The challenge right now is the system is so inconsistent across communities that there’s very little enforcement of those existing statutes and regulations,” Ribble said. “Both branches are recognizing that we really need to transform the system and not just nibble around the edges.”
Diego Huezo, a government affairs specialist with the Metropolitan Area Planning Council, said the House plan would put the state’s public health system “on really good grounding,” but a $250 million investment would enable better data collection and more training for workers entering the field.
“The more we go up, the more we’ll be able to do,” Huezo said, adding, “Because we suffered a public health crisis, I think it only makes sense that we invest in a system that was on the frontlines.”