Who is a member?
Our members are the local governments of Massachusetts and their elected and appointed leadership.
On behalf of cities and towns across the Commonwealth, we write to you today with great urgency to ask you to oppose the provision in S. 2564 (Amendment #320 added to the Senate’s COVID recovery bill), which would impose new spending mandates on local and regional public health departments in S. 2564. This provision would create a sweeping new unfunded mandate and place a huge financial burden on all municipalities.
While we appreciate the intent of the provision, which is to strengthen capacity, collaboration and investment in local and regional public health departments, we strongly oppose the provision in its current form. We urge you to take this critically important topic out of the COVID recovery package and instead include it as part of the normal legislative process.
If this provision were to pass, cities and towns would be mandated to meet new “foundational” spending standards for public health, creating a major financial challenge for municipalities, which must work within the confines of Proposition 2½. Municipalities would likely have to cut other essential municipal services in order to meet the new requirements.
This provision does not, however, mandate that the state meet its obligation to financially support the outlined goals. Instead, the state’s funding would be subject to available funds, while municipalities would not have that flexibility, and would be forced to fund the new costs imposed by the Department of Public Health. Also, there is no existing fiscal analysis of the proposal to fully understand the magnitude of financial impact this would have on cities and towns.
In essence, this provision would create a formula similar to the Chapter 70 education formula, but without first going through a fully deliberative process that offers essential visibility and transparency into the cost and financial implications, or any commitment to a permanent revenue stream from the state. In its current form, Amendment #320 is an unacceptable, unfunded mandate on cities and towns.
When the Special Commission on Local and Regional Public Health finalized its report in June of 2019, entitled “Blueprint for Public Health Excellence: Recommendations for Improved Effectiveness and Efficiency of Local Public Health Protections (“Blueprint”), one of their key findings was that most local boards of health were unable to keep up with a growing list of duties. Of course, this finding was pre-pandemic. The duties and importance have now grown exponentially. In an era of global pandemics, we understand the desirability of local public health performance standards more than ever. However, with no understanding of the costs associated with such mandated minimum performance standards, and no identified dedicated state-funding source, the responsibility to support these mandates would be a new burden placed on the backs of cities and towns as a significant new unfunded mandate.
The Blueprint contemplated a realistic two-step process to improve the local public health system (page 30). The first step was to transition local boards of health into compliance with existing statutes and regulations. The second was to help local boards of health build capacity in readiness to meet a minimum set of standards known as the Foundational Public Health Services. Using the pandemic as a backdrop, this provision is now seeking to fast-track the transformation of local boards of health, by mandating that they meet a minimum set of performance standards now. The Blueprint warned that, “To push them to upgrade to Foundational Public Health Services (FPHS) – without first developing the readiness and capacity to do so – will just intensify the crisis for these struggling cities and towns – and widen the gap between them and the small number of well-funded and supported health departments that will be able to implement the new standards” (page 71). The language included in Amendment #320 does not heed this warning. (The MMA also emphasized these points in testimony provided to the Joint Committee on Public Health in May.)
We welcome the opportunity to engage on this topic of improving local and regional public health departments, and the funding mechanisms required to do so. Please include municipal leaders in a decision-making process that would have far-reaching financial implications for every city and town before codifying this mandate in state law.
The partnership between state and municipal leaders was critical during the public health emergency, and it remains critical as we take steps to improve the delivery of services. Thank you for your attention to this important matter. If you have any questions, please do not hesitate to have your office contact me or MMA Senior Legislative Analyst Jackie Lavender Bird at 617-426-7272, ext. 123, at any time.
Geoffrey C. Beckwith
MMA Executive Director & CEO