Kentucky’s county health departments have one more year to come up with a $38 million dollar payment into their pension system, following last-minute action by the legislature on Saturday.
But after 10 years of funding cuts, health departments are already stretched thin, and receive almost no general funding from the state. For instance, at the Bourbon County Health Department, Director Drew Beckett said they went from 17 full-time employees five years ago to 13 because of budget cuts. And they still have the same programs, just with fewer workers to run them.
“We’ve been kind of 'right-sizing' here for as many years as I’ve been here,” Beckett said.
At the Kentucky River District Health Department in southeast Kentucky, director Scott Lockard said his department’s share of that $38 million payment is $1.5 million dollars. But now, he’ll owe it in July of 2019, instead of this year.
“We will have a pension increase a year from now, but it gives us much more time to put in solutions and deal with that increase,” Lockard said.
To raise that extra money, some county health departments will turn to medical staffing agencies, where a nurse or social worker would no longer be employed by the health department. Some will go to their county board of health to ask for a raise in property taxes to make up the difference.
But others say they'll be forced to lay off staff, as well as to cut back on services they aren’t mandated to offer under state law.
And in some cases, this could mean cutting or shutting down programs that help prevent disease and promote health in a community.
Cuts Now Could Mean Costs Later
The outcome of those cuts will likely mean an increase in the number of people with diseases and higher medical costs to the health care system. University of Kentucky researcher Glen Mays recently published a study looking at a thousand communities across the country, and how much money they put toward public health.
“Those communities that were able to spend more and increase spending, they saw significant reductions in mortality, and particularly in deaths from potentially preventable causes,” Mays said.
And last year, Mays published another study showing a relationship between an increase in public health funding and a small decrease in Medicare enrollee’s costs. That means if Kentucky did pour more money into those programs, the primary beneficiary would eventually be the federal government — Medicare, which provides health insurance to people with disabilities and people over 65 years old. Economists call this the "wrong-pocket problem."
“If [the state] invest[s] in public health it’ll be good for the population of Kentucky. But the federal government will be the one saving at least a large share of dollars,” Mays said. “That’s a challenge for states like Kentucky.”
And a lot of public health programs — like parenting or tobacco cessation classes — take months or years to show a final outcome.
Drew Beckett, the director of the Bourbon County Health Department, used the example of a diabetes education class his department held recently.
“I can’t show you in two months that we prevented some relapse for diabetics going to the emergency room, just from what we’ve taught them over the month-long class,” Beckett said. “We’re helping change behaviors for the long term by instilling some of those healthy habits.”
But if diabetes rates in Bourbon County go down over the next decade, Beckett said it’s also impossible to prove that the diabetes education classes were the thing that moved the needle.
“But proving that it was exactly our program? It’s difficult for public health to do,” Beckett said.
Cuts To Public Health
Beckett will owe a little over half a million dollars in July 2019 to the pension system. That’s a third of his yearly operating budget.
“You tell me where I’m supposed to find that money when we’ve already been running this organization as responsibly as possible,” Beckett said.
Beckett might cut down on the number of diabetes education classes his department offers. Another thing that might go: the health-department-run health clinic. They accept Medicaid and also take sliding scale payments from people without insurance. But Beckett said it’s the program that runs on the biggest operating loss year over year.
Beckett said the clinic also administers women’s gynecological exams and pregnancy tests. And they make a point of getting newly-pregnant women to a doctor for prenatal care.
“We’ll even send one of our Spanish-speaking staff to the doctor’s office with them to help translate to make sure they understand what the physician is telling them,” Beckett said.
And Bourbon County doesn’t get any reimbursement for this service. Beckett said he’s worried about the clinic closing down.
“It’s even more difficult in a small county like this because there’s really no one else to take on the extra patient load that we’re currently seeing,” Beckett said. “If we’d just invest on the front end, we could prevent so much more. And it’s a lot cheaper to prevent something than take care of it afterwards.”
At Three Rivers District Health Department in northern Kentucky, Director Georgia Heise said the pension payment delay gives them time to slowly close down their department-run home health agency. This provides care for people who are over the age of 65 or have a disability. In addition to that closure, the pension crisis also creates problems in trying to retain employees and in making new hires. Heise said two employees have already resigned because of the instability.
“Everything about this makes it difficult to entice new hires, all of the instability or not knowing what’s happening is very scary,” Heise said.
