The irony is not lost on local health leaders that while U.S. Health and Human Services Secretary Robert F. Kennedy Jr. vocally pushes an agenda targeting leading causes of chronic disease like obesity and heart disease, local programs to address these issues and more have been gutted. His recent \u201cMake Our Children Healthy Again<\/a>\u201d strategy report called out poor diet and lack of physical activity as primary drivers of chronic disease among kids.<\/p>\n \u201cIt\u2019s not good enough to say this is important,\u201d said Bernadette Boden-Albala, dean of the school of population and public health at UC Irvine. \u201cThey talk about nutrition, but where\u2019s the money on nutrition?<\/p>\n Health departments are well-positioned to improve community health outcomes, Boden-Albala said, because their services are often aimed at improving systemic barriers that make it harder for people to be healthy. They focus on food insecurity, health education and access, disease prevention and surveillance, mental health and regulations to promote safety.<\/p>\n The work is preventative in nature, and without it communities will have more illness, higher costs and fewer health care options, said Long Beach Health and Human Services Director Alison King.<\/p>\n \u201cWhen public health funding is reduced, prevention work is often the first to be impacted,\u201d King said.<\/p>\n Long Beach has lost nearly $4 million in federal grants with the largest cut affecting its HIV and sexually transmitted infection prevention program.<\/p>\n These policies \u201cwill reverberate for the rest of this administration if not well beyond that,\u201d said Arthur Reingold, professor of epidemiology at UC Berkeley School of Public Health and global infectious disease expert.<\/p>\n Many of the cuts to local health departments started in March when Elon Musk, then-adviser to the Department of Government Efficiency, terminated more than $11 billion of public health funding nationwide<\/a>. California lost nearly $1 billion.<\/p>\n Those cuts targeted money that health departments had used to bolster their response to the COVID-19 pandemic by shoring up laboratory capacity, community outreach and immunization programs. In turn, many counties hired dozens of public health workers and were able to expand other services.<\/p>\n The grants were, in some cases, scheduled to last until 2027. Their abrupt termination left counties scrambling.<\/p>\n \u201cWe couldn\u2019t even prepare for the end of this funding. That was what was so catastrophic for us,\u201d said Brynn Carrigan, Kern County public health director. \u201cWe received notification the day after the stop-funding order was effective.\u201d<\/p>\n California sued<\/a> to prevent the Trump administration\u2019s cuts, and a federal judge ruled in May that the money must be restored<\/a> while the lawsuit plays out. But in many ways, the tug of war between federal cuts and state litigation still left local governments with no choice but to eliminate services. If the courts were to ultimately side with the Trump administration, counties would have to repay the money to the federal government.<\/p>\n \u201cAt the end of the day all of the liability and all of the risk is on the county, and we\u2019re talking millions of dollars,\u201d Carrigan said.<\/p>\n That\u2019s why programs like Pe\u00f1a\u2019s healthy habits team and others have been terminated.<\/p>\n Her team \u2014 called \u201cKnow Your Numbers\u201d \u2014 checked residents\u2019 blood pressure, glucose, cholesterol and body mass index before providing seven weeks of free dietary and exercise classes to show them how their numbers improved.<\/p>\n \u201cOur health should be a priority. We should want to combat the things that make us unhealthy: Diseases, tobacco, unhealthy foods,\u201d said Pe\u00f1a, a member of Service Employees International Union Local 721. \u201cIt\u2019s discouraging when the government doesn\u2019t want to care for the health of the public.\u201d<\/p>\n In Kern County, the department has also been forced to close a clinic serving rural farm communities, stop most mobile clinic services, reduce appointment availability at its primary Bakersfield clinic by 67%, and eliminate 35 jobs.<\/p>\n More than 170 miles south, Orange County Health Director Veronica Kelley has grappled with the same difficult decisions. Public health has \u201cnot been whole for decades,\u201d Kelly said, but the early federal grant terminations have been especially harsh. They cost Orange County $13.7 million over the next two years.<\/p>\n In May, the county closed its emergency dental clinic. A month later, the children\u2019s clinic and family planning clinic also closed. A federal program to help new moms with diapers, breastfeeding support and food has also been reduced. In October, the county will lose an additional $4 million to combat obesity and food insecurity.<\/p>\n \u201cIf we do care about the health of Americans and people who live here and the health of Orange County residents, then we need to put more focus on funding these services,\u201d Kelley said.<\/p>\n The department tried to make reductions in areas where other community providers could absorb the patient load and have the least impact on access to services, Kelley said. But the county isn\u2019t blind to the probability that more cuts will happen in the coming years, as federal support for Medicaid decreases substantially.<\/p>\n Most counties rely on Medicaid to provide mental health services and inpatient substance abuse treatment. It also helps pay for public health clinics where people can get immunizations and testing and treatment for sexually transmitted infections. Counties that run public hospitals are facing even greater uncertainty.<\/p>\n In Los Angeles County, the health services department projects it will have a $1.85 billion annual deficit by 2028-29 largely due to Medicaid cuts. The department operates four public hospitals, and 80% of its patients rely on Medicaid for health insurance.<\/p>\n At a recent county supervisors meeting<\/a>, county Chief Executive Fesia Davenport said federal cuts will likely result in thousands of layoffs and could precipitate the closure of a county hospital.<\/p>\n There are no current plans to close any hospitals, said Jorge Orozco, chief executive of L.A. General Medical Center, but the department has instituted a hiring freeze. County officials are also considering consolidating services that might be provided at multiple hospitals like radiation oncology and delaying maintenance and capital improvement projects.<\/p>\n Still, a deficit of that magnitude will be impossible for the county to fully absorb.<\/p>\n \u201cBelt tightening efforts and cost efficiencies really are not sufficient to make up $1.85 billion,\u201d Orozco said. \u201cThat\u2019s really catastrophic.\u201d<\/p>\n The L.A. County Department of Public Health earlier this year also lost $45 million in federal grants and has instituted a hiring freeze.<\/p>\n Orozco said cuts to the health care safety net will ultimately impact everyone in L.A. County. One-third of all trauma cases are taken to a county hospital, he added.<\/p>\n \u201cOur safety net system really serves a huge segment of our population here at L.A. General,\u201d Orozco said. \u201cSo the impact of service reductions, the impact of budget reductions, will be felt not only to the most vulnerable, but really all of our community.\u201d<\/p>\n Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.<\/em><\/p>\n This article was originally published on CalMatters<\/a> and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives<\/a> license.<\/em><\/p>\n<\/div>\nDOGE cuts billions of public health dollars<\/h2>\n
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California counties eliminate dental, other programs<\/h2>\n
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Los Angeles public hospitals brace for Medicaid cuts<\/h2>\n
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