San Francisco Chronicle - (Sunday)
Top union helps state add funds for health
Major lobbying effort amid pandemic secures millions
SACRAMENTO — After more than a decade of fruitless entreaties from public health advocates, Democratic lawmakers have secured a landmark agreement that promises $300 million a year in new state funding to fortify and reimagine California’s hollowedout public health system, a complex network of services shouldered largely by the state’s 61 local health departments.
The deal, outlined last week as the Democraticcontrolled Legislature approved a record $262.6 billion state budget for fiscal year 202122, marked a dramatic reversal for Gov. Gavin Newsom, who had rebuffed requests the past three years to bolster annual spending on public health, arguing that federal funding would suffice. At Newsom’s insistence, the infusion for
public health won’t kick in until July 2022.
What persuaded Newsom to change course, according to people involved in the negotiations, was an unprecedented public health campaign buttressed by lobbyists and organized labor.
The state’s largest public employee union, the Service Employees International Union, joined health care leaders in January to create a coalition called California Can’t Wait, mounting a lobbying effort on behalf of public health, a core government function that for years has gone without a voice in California’s Capitol corridors.
Their target was Newsom, and they pressed their case with his Cabinet officials, advisers and the public.
“We knew we’d have to fight,” said Tia Orr, the top lobbyist for SEIU in California, whose 750,000 members include health care workers, janitors, and city, county and state employees. “I hate that it took a crisis, but COVID19 allowed us to push back collectively, and we all realized that we’d have to get louder than we’ve ever been on public health.”
From January to April, union leaders, public health advocates and the trade groups representing local health officials held more than 40 inperson and video meetings with state lawmakers to lay out how years of shrinking budgets had left them without the personnel, lab capacity and basic infrastructure needed to carry out public health functions.
Disinvestment had left counties unprepared for the pandemic, they argued, and systems essential to tracking and controlling an array of infectious and chronic diseases had been decimated.
In San Bernardino County, for instance, officials detailed the ground lost tackling problems like congenital syphilis and opioid misuse even before the COVID response sapped resources.
Officials in Mono County explained they had no public health lab and just one communicable disease nurse to conduct contact tracing for a county of 14,000 people.
Also critical to the effort: County health officials reached outside their inner circle, hiring veteran Sacramento public relations firm Paschal Roth Public Affairs, a power broker whose strategists represent multiple deeppocketed interest groups, including SEIU.
“Look, we had the key ingredients for a winning campaign: a razorsharp message, an incredible coalition and an undeniable sense of timing,” said Mike Roth, who operates the firm with his partner, Nikki Paschal. “After what we experienced last year with COVID, no one could argue that the stakes weren’t life or death. Public health officials knew they needed to approach this differently.”
Epidemiologists, public health nurses and other county workers who weren’t used to the spotlight became the face of the operation. As Newsom and lawmakers negotiated the budget, the campaign launched an aggressive Twitter campaign that accused Newsom of neglecting public health and extolled the two Democratic lawmakers who championed the budget request in the Capitol, state Sen. Richard Pan of Sacramento and Assembly Member Jim Wood of Healdsburg, who chair legislative health committees.
“I don’t think a lot of people understood the devastation that was happening — it really has been this quiet erosion of public health funding,” said Michelle Gibbons, executive director of the County Health Executives Association of California. “We had to get people to raise their hands and say, ‘We care,’ and this campaign helped us use our voice and tell our story in a way that we haven’t done before.”
Bruce Pomer, a former lobbyist for the Health Officers Association of California who went on to lead the organization representing local health officers from 1993 to 2014, said savvy lobbying and a strong political coalition made the difference this year.
“Having SEIU as part of the coalition makes a big difference in terms of whether the Legislature is even going to pay attention to you,” Pomer said. “I mean, I didn’t get invited to big, expensive fundraisers. I had to hang out by a door and wait until a latenight hearing was over in order to get a chance to talk to a legislator.”
The federal government finances most public health activities in California and significantly increased emergency funding during the pandemic.
Temporary funding increases have buoyed the statewide public health budget to $4.7 billion so far this year, but health leaders say much of that money is restricted in use and the portion of funding that comes from state and local coffers has not kept pace with the cost of doing business.
While details have not been released by the Newsom administration, Pan said the governor has committed to an additional annual investment of $300 million from the state general fund beginning next fiscal year.
Public health officials and lobbyists involved in negotiations say the money will target infrastructure, like increasing capacity at public health laboratories — California has lost 11 labs since 1999 — and modernizing data systems strained by the pandemic.
Counties say the money will also give them the opportunity to address public health threats associated with climate change, like wildfire; develop programs to tackle racebased health inequities; and build a workforce that can respond to infectious disease threats, as well as combat chronic diseases like diabetes.
“Our focus will be hiring disease investigators to build a robust communicable disease surveillance system,” said Kim Saruwatari, Riverside County’s director of public health. “It pains me to say this, but we have almost 13,000 chlamydia cases every year, and we can only investigate a small percentage of those, for pregnant women or highrisk individuals, because we just don’t have the workforce.”