Divided Congress could signal gridlock for public health
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* Kim Krisberg

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A worker waits at an empty COVID-19 testing center in Seattle in March. Even as the pandemic wanes, public health advocates are hopeful Congress will support funding for preparedness.

Photo by John Moore, courtesy Getty Images

As the nation shifts out of emergency COVID-19 mode, advocates hope lawmakers will seize the opportunity to invest in and modernize public health systems. But with a newly divided Congress, many are bracing for a tough sell.

Republicans won back the U.S. House of Representatives in November, gaining a slim majority. Democrats kept a majority in the Senate. The new make-up is certain to mean gridlock on a range of issues. Public health agencies and officials, in particular, are expected to face the glare of partisan-fueled investigations, as well as serious questions about the nation’s response to COVID-19 and what went wrong.

“Knowing Republicans want to investigate — that could have implications for funding,” said Erin Morton, MA, executive director of the Coalition for Health Funding in Washington, D.C. “That worries me.”

The split Congress and possibility of hyper-politicized oversight could leave little room for movement on public health priorities during this year’s legislative session. But advocates are cautiously optimistic that even a divided Congress can find areas of common interest, such as improving access to mental health care and addiction treatment.

“The hope is that there will be enough (members of Congress) who can look past the polarization of the moment and really work together to learn the lessons of the pandemic,” Joshua Sharfstein, MD, a vice dean and professor at Johns Hopkins Bloomberg School of Public Health, told *The Nation’s Health.* “There is so much at stake for the country in focusing on the needs of public health.”

Sharfstein, who is also on faculty in the school’s Institute for Health and Social Policy, said he found it hard to imagine the new Congress passing the kinds of sustainable investments that public health advocates have long argued for, which are especially needed post-COVID-19.

Major public advocates from across the U.S. — including APHA — have backed a plan for investing an annual $4.5 billion in public health infrastructure at the state, local, tribal and territorial levels. Researchers estimate that amount is needed to ensure all Americans have access to minimum public health protections. But such goals seem less realistic after the midterm elections, Sharfstein said.

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Electricity-generating wind turbines span the top of a mountain in Oakland, Maryland. Clean energy policies may have a harder time gaining traction in the new divided Congress.

Photo by Chip Somodevilla, courtesy Getty Images

Sharfstein said he is also concerned about ongoing federal dollars for COVID-19 response. As of November, the Biden administration was trying again to secure billions to support research on next-generation coronavirus vaccines and treatments; Republicans had blocked a similar funding request in the spring.

Adriane Casalotti, MPH, MSW, chief of government and public affairs at the National Association of County and City Health Officials, said she is also concerned about Congress’ willingness to keep funding a robust COVID-19 response and maintain the one that local health workers just spent years scaling up.

For example, Casalotti said health departments have made considerable progress on ensuring equitable access to COVID-19 vaccines and therapeutics. But if funds dry up and people have to rely solely on the health care sector for access, it could leave millions of Americans behind as the coronavirus evolves.

“We don’t want to go from a no-wrong-door approach to one where’s there’s no right door,” Casalotti said. “Equitable access is needed to try to prevent large (COVID-19) spikes and outbreaks.”

Beyond COVID-19 funding, Congress will have an opportunity to beef up the country’s pandemic readiness via the Pandemic and All-Hazards Preparedness Act, which comes up for reauthorization this year. President George W. Bush first signed the landmark preparedness law in 2006, and Casalotti said its reauthorization is a chance to make sure public health systems are fully included.

Attracting more workers to governmental public health is another NACCHO priority this legislative session, Casalotti said. One bill the organization hopes to advance is the Public Health Workforce Loan Repayment Act, which had bipartisan support in the last Congress.

“We’ll continue our focus on funding for public health infrastructure and data modernization,” she said. “COVID has shown what the field already knew — that disease-specific funding alone is not sufficient to build a health department.”

A split Congress will mean gridlock on some public health priorities, but hopefully not all, said Chrissie Juliano, MPP, executive director of the Big Cities Health Coalition. For example, Juliano said two areas with potential for bipartisan efforts are access to mental health care and overdose prevention — needs that soared after COVID-19 arrived, with spikes in fatal overdoses and suicide.

“These areas seem ripe for compromise,” Juliano told *The Nation’s Health.* “They are issues that those of us in public health can weigh in on and really help move the needle on.”

But one public health issue that could hit a wall in the new Congress is U.S. work to mitigate climate change. The Biden administration has made progress, reducing methane emissions, boosting the offshore wind energy industry and recommitting the nation to the Paris climate agreement, among other measures. But some Republican leaders, who have traditionally been less friendly to embrace measures that stem climate change, are threatening to overturn progress that has been made, particularly when it comes to energy policies.

But while bills that prioritize energy supplies over human health may sail through a Republican-controlled House, they will most likely hit a snag in the Democrat-controlled Senate. And unlike last term, Democrats will have a voting majority in the Senate in 2023, allowing them to torpedo measures that would undermine work to address climate change. On the flip side, climate measures that pass the Senate will likely die in the House. The same pattern could hold true for other public health-friendly legislation.

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Asia Hartford, LVN, center, provides a vaccination in a Los Angeles park in May. New funding will be used to boost the U.S. public health workforce, but more is needed.

Photo by Francine Orr, courtesy Los Angeles Times/Getty Images

## New health funding stream offers hope

Despite the barriers, 2023 could be a transformative year for public health, thanks to new funding. In November, the Centers for Disease Control and Prevention awarded $3.2 billion — authorized via the 2021 American Rescue Plan Act — to help state, local and territorial health jurisdictions hire more workers and invest in infrastructure.

The first-of-its-kind funding pot will send money directly to states, territories and dozens of local health departments, which is unique. More than 100 public health departments in all 50 states and three national partners are receiving funding to reinforce the nation’s public health workforce and infrastructure and protect residents from health threats.

“This investment is a really big deal for public health,” Juliano told *The Nation’s Health.* “It’s certainly a much-needed down-payment on supporting the governmental public health workforce across the country.”

Everyone in the U.S. lives in a jurisdiction that will receive funding under the new grant, according to CDC. The infrastructure grants range from $147 million for the Florida Department of Health to $6 million for the Virginia Beach Department of Public Health.

Jeffrey Ekoma, MS, MBA, senior director of government affairs at the Association of State and Territorial Health Officials — one of the national partners that received funding to support the work — said the $3.2 billion could be “transformational” for public health. Now the challenge is to persuade legislators in Congress to sustain that support going forward.

Ekoma said he also sees areas with bipartisan potential in the new Congress, including substance use and maternal health. But practitioners and supporters should be ready with stories about the importance of public health and ready to defend its role, especially with new congressional investigations on the horizon, he said.

“I am actually extremely optimistic for public health,” Ekoma told *The Nation’s Health.* “The gridlock will be there, but I’m excited for what the future holds.”

For more information on the new CDC public health infrastructure grants, visit [www.cdc.gov/infrastructure](https://www.cdc.gov/infrastructure).

*   Copyright The Nation’s Health, American Public Health Association