Health officials from Alabama to Washington state say that congressional gridlock over providing billions in new money has undermined efforts to transition to a steady, long-term approach to Covid-19.
“They’re cutting the legs out from under a solid Covid response in the future,” Arkansas Secretary of Health José Romero told POLITICO. “This is going to cripple the response.”
The new plans, from Oregon’s “Resilience in Support of Equity” to North Carolina’s “Moving Forward Together,” map out how state health departments intend to transition from crisis response to disease management while maintaining the capacity to ramp up public health operations when new waves of the virus arrive. The policies, which state health officials announced over the last few weeks, vary in specifics, but center around the idea that the public health interventions should be predictable even when the virus isn’t.
But the congressional stalemate has left states uncertain about whether they can implement their new strategies even as they face the Omicron subvariant BA.2, which sent case numbers in Europe skyrocketing in recent weeks and is now the dominant Covid variant in the U.S. While cases have continued to decline nationally over the last two weeks, they have started to rise in some states, especially in the northeast.
“We are well positioned, but not if somehow we can’t get our act together and come to a consensus on a way to continue to have some funding for this,” said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials.
The Biden administration asked Congress for $22.5 billion to continue fighting the pandemic in the near term. Senators are instead closing in on a roughly $10 billion aid package. That proposal could advance through the upper chamber in the coming days but would still need approval in the House.
Lawmakers have been at an impasse for weeks as Republicans demand an accounting of how previous pandemic aid has been spent — as well as insist any new dollars be offset by cuts to other programs — and Democrats advocate for more cash.
A proposal agreed to by party leaders but scuttled in the House earlier this month had proposed clawing back $7 billion in federal recovery dollars from 30 states to help pay for a new round of roughly $15 billion in pandemic aid.
States are adamant they need both the recovery aid approved by Congress last spring — a broad pot of dollars states can use to rebuild their economies, invest in health care infrastructure and support essential workers — as well as the additional Covid-specific dollars.
Arkansas Gov. Asa Hutchinson and New Jersey Gov. Phil Murphy, the chair and co-chair, respectively, of the National Governors Association, have asked the White House and Congress to ensure states “have the necessary resources to continue to respond to COVID-19, while also protecting current commitments from the federal government, including State and Local Fiscal Recovery Funds.”
In Washington state, Gov. Jay Inslee’s office has been in contact with the White House to underscore that the state legislature has already appropriated federal recovery funds and that there would be “significant direct impacts if that promised funding wasn’t received,” Inslee spokesperson Jaime Smith said. Washington state stood to lose nearly $400 million in funding under the original $15 billion Covid-19 deal.
“We would like to be able to trust that when the feds commit funding to us, we can budget accordingly and know they’re going to follow through,” Smith said.
The Congressional deadlock has left some states hastily making contingency plans, particularly to help the uninsured. In Utah, state health officials are debating covering Covid treatment and vaccination for uninsured people through Medicaid as they already do for testing, as allowed by Congress during the pandemic. But that’s a short-term solution that could put the state in a bind if the public health emergency ends this summer.
Georgia officials are continuing to offer Covid tests, vaccinations, and boosters at no cost to any resident at health departments and contracted partners. In Arkansas, state health officials are scraping together funding to support in-house testing for uninsured individuals.
But health officials in red and blue states alike say they won’t be able to quickly ramp up testing efforts, provide treatment and offer booster shots to their residents if the tests, treatments and vaccines don’t exist.
“If Congress doesn’t approve additional funding, then we’re going to have a disaster,” said Scott Harris, Alabama’s health officer. “You would think at some point, somebody could do a cost benefit analysis here and say paying for people to get tested and to get vaccinated or to get antivirals for Covid is going to be a cost-saving measure compared with ignoring that problem and letting more outbreaks happen.”
North Carolina Gov. Roy Cooper, in a letter to the state’s Congressional delegation this week, said states would once again be pitted against each other to compete for scarce resources, as they were in the early days of the pandemic unless the federal government continues to procure them.
North Carolina saw its allocation of monoclonal antibody treatments reduced by more than 30 percent this week because of the lack of federal funds to pay for them, and the state has exceeded its budgeted dollars for testing as a result of the back-to-back Delta and Omicron surges.
“If they don’t have the funding to both continue to procure and, more importantly, to drive the development of more treatment and therapeutic options, then shifting that to the states and releasing that into a private market space will create chaos unimaginable,” said Kody Kinsley, North Carolina’s health secretary.
While Covid vaccines and therapeutics may be ordered directly by health care providers at some point in the future, making that transition will take time, Dean Sidelinger, Oregon’s health officer and state epidemiologist, said. And state health officials say it can’t be done while the world continues to compete for limited supplies of vaccines and treatments.
“To build a separate system, where providers or states are going individually to the distributors or to manufacturers to purchase those doesn’t happen overnight,” Sidelinger said. “You layer on funding uncertainty or the actual prospect of decreased funding and resources and need to invent new systems, that really hobbles our ability to do some forward planning and to be ready to respond more nimbly.”
Public health experts are cautiously optimistic the severity of the Omicron surge this winter will blunt some of BA.2’s impact on the U.S. But state health officials worry that a small BA.2 wave that passes relatively quickly could be perceived as proof they can successfully weather new Covid variants without additional federal dollars — rather than evidence that public health interventions work and deserve ongoing support.
“When I think back to the beginning of this pandemic two years and two months ago, we would have all loved to be as prepared then as we are now,” Kinsley said. “We can manage this outside a crisis scenario. We can manage this in a way that is more akin to other respiratory illnesses, notwithstanding major curveballs, because we’re prepared and because we have the tools. This is not the time for us to let off the gas in any way around being prepared.”
Uncertainties around the future of Covid-19 make it all the more important that the response — and, by extension, the federal dollars that support them — remains predictable, state health officials say.
“I would just remind everybody that this pandemic is not over. It’s just in a different phase. We’re at a point where we need to make sure that people don’t forget that, including our policymakers,” said Umair Shah, secretary of health in Washington state. “Doing the job 95 percent or 90 percent is just not good enough.”