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OPINION | CRAIG WILSON: Pandemic lesson

Risks to underfunding public health by CRAIG WILSON SPECIAL TO THE DEMOCRAT-GAZETTE | October 8, 2020 at 3:06 a.m.

One of the main reasons we buy insurance is to protect ourselves from loss due to unexpected events. Insurance provides us with a sense of security that if something unforeseen happens--such as a car wreck caused by a texting driver or an emergency department visit for an acrobatic toddler--we will not experience financial ruin.

Despite the benefits of health, life, or car insurance, however, millions of Americans forgo purchasing coverage due to cost, complexity or the belief that somehow it will not happen to us. Life inevitably happens, and the loss we experience is sometimes not even the result of our own actions. What is true is that you will not find any advertisements offering insurance coverage for the car wreck that has already happened.

This is exactly why--prior to the Affordable Care Act--many health insurers excluded people from coverage based on pre-existing conditions. Now that our nation has come around to the idea that we should protect people with pre-existing conditions, we have to acknowledge that through insurance we will all shoulder some of the costs that come with sharing in the risk associated with those conditions.

It's not a bad thing; it's a necessary tradeoff.

The coronavirus pandemic has undoubtedly revealed the readiness--or lack thereof--of our state and federal governments. On the positive front, the pandemic has shown the Arkansas General Assembly's 2013 decision to expand health-care coverage through Medicaid with funding through the Affordable Care Act to be a critical one.

With the job and income loss resulting from the pandemic, Arkansas Medicaid is operating as the safety-net program it was designed to be. Of course, our Legislature was not anticipating a 2020 pandemic when it made the 2013 decision to expand coverage, but the investment then--and each year since then--has protected Arkansans in 2020 by ensuring access to health-care services. Let's hope the Legislature recognizes how sage its 2013 decision was when the expansion program is considered for renewal in the 2021 session.

With its limited available resources, our state public health department has done an admirable job in its response to the coronavirus pandemic. The department has internally staffed testing labs on a 24-hour basis, activated a call center to respond to questions from health-care providers and the public, and issued a multitude of documents containing guidance for businesses, schools, and organizations. Until recently, the department participated in daily public briefings with the governor, and the Covid Tracking Project has given Arkansas a grade of A+ for coronavirus data reporting, including data reliability and completeness.

Perhaps most commendable has been the department's composure in spite of the woeful disorder displayed by federal officials, including outright discounting and distortion of scientific evidence by the White House.

Of course, the response by state public health officials has not been flawless. For example, relying on people's sense of responsibility and community to wear face coverings to protect others during the first several months of the pandemic fell short of the necessary mandate, and the state's contact-tracing efforts continue to face challenges in timely notifying exposed individuals.

Frankly, shortcomings in the state's response are reflective of the lack of perceived value and vast underfunding of public health departments and disease prevention efforts historically. According to a report from Trust for America's Health, funding for the Centers for Disease Control and Prevention's public health preparedness and response programs decreased between fiscal years 2019 and 2020, and it has been cut in half over the past decade.

The Prevention and Public Health Fund is at half of the level of funding it should have received for 2020, due to the reallocation of funds to other programs. In 2019, Arkansas had the 18th highest per-person state public health funding in 2019 with $48, but that's down from 15 years ago when spending was $51 per person. If funding levels from 2005 had merely kept pace with standard inflation, per-capita spending would have been approximately $66 in 2019.

Now here we are in the aftermath of a car wreck without insurance. We have consistently diverted funds or underfunded public health efforts, and the covid-19 pandemic lays bare this reality in the harshest way possible.

The disastrous pattern of scrounging up one-time funding when a crisis occurs compromises our ability to respond. State and federal policymakers must deliver adequate and sustained funding for core public health functions so that we are prepared for the next public health emergency.


Craig Wilson, JD, MPA, is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock.


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