Missouri health department heads push for more funding

JEFFERSON CITY, Mo. -- With their state facing a budget shortfall, many Missouri lawmakers have said they are focused on cutting state spending. Larry Jones doesn't want them to forget about whooping cough outbreaks when they do that.

"Whooping cough is not gone," Jones told a House appropriations committee last week. "Every time we think we've got something gone, it comes back on us."

Jones, the head of the city health department in Independence, is one of several Missouri public health officials who want lawmakers to spare funding for health care from deep cuts. In fact, they don't want any cuts and prefer an increase in state funding.

Local health departments received about $6.3 million in state general revenue funds in fiscal year 2011, about a 9 percent decrease from fiscal year 2010. Gov. Jay Nixon's budget proposal for fiscal year 2012 calls for that amount to stay roughly the same, although health programs would get $18.6 million more in federal health funding.

But Kevin Gibson, the director of the Springfield-Greene County Health Department, said the federal money goes to very specific projects outlined by the federal government and not to duties required by the state, such as restaurant inspections. He and others said they can't fulfill their state duties with less money than they get now, and their departments actually need more.

"It sounds like we're getting a lot more money," said Gibson, who did not testify at the Capitol. "But in terms of general funds we're not."

A report released last month by the Minnesota-based United Health Foundation showed only four states spent less money per person on public health than Missouri in 2010. The state spent about $45 per person, including state and federal funding, according to the report. The top-spending state -- Hawaii -- spent $235 per person.

The report also showed the result of Missouri's penny-pinching: It has the fifth-lowest rate of vaccinations of children under 3 in the country and the fifth-highest rate of tobacco use.

Lawmakers at the committee hearing asked whether some public health departments could save money by combining with others in nearby cities or counties. Jones said some counties may be more likely to share services.

But Kevin Lowrance, head of the Audrain City-County Health Unit, said combining operations could be difficult given how the departments are funded. Some get their money from a county health board, while others get money through a property tax. Lowrance, who did not testify before lawmakers, said two health departments looking to combine would need the same type of funding structure, and it could be difficult for counties to change methods.

He said his department has considered merging with the Montgomery County Health Department in the past but has been unable to get voter approval to switch to a property tax.

"It's tough to pass a tax if people don't know what a public health department does, especially given the economic climate of the nation," he said.

Jones told lawmakers that health departments need to be funded as well as other agencies that respond to public dangers.

"We would not think about funding police only when they have a crime to investigate," he said. "We would not think about paying fire departments only when they responded to a fire. We all have to be ready for emergencies."