Recently, Trump’s irresponsible proclamations and missives about COVID-19 have made national headlines. Instead of bringing our country together in a time of crisis, Trump has used the coronavirus as an opportunity to throw Democrats under the bus, while spuriously claiming they’re using the epidemic as a political tool.
The truth is that, on his watch, the federal response to this growing pandemic has been slow and hampered. And this is in no small part due to severe financial cuts sustained by our national public health budget.
In 2018, Trump’s budget slashed funding to disease security programs and the CDC was forced to cut its global disease outbreak prevention program by 80%. You read that correctly: an 80% reduction. Overall, CDC funding has fallen by 10% over the past decade, and Trump’s 2021 budget calls for an additional 9% cut. Other federal programs that touch public health preparedness have been slashed over time too—for instance, federal funding for the Hospital Preparedness Program was cut essentially in half from 2003 to 2019.
All the while, the CDC and other federal agencies are scrambling with the nominal amount of resources they have to get a handle on the spreading threat. And with the main focus on the federal government’s response to the novel coronavirus, we often forget that a substantial amount of autonomy over this emergency, where the rubber hits the road, is at the state and local level. But at this critical point this international pandemic, we cannot push the importance of states to the side.
In fact, under the US Constitution’s 10th Amendment, state governments have historically had significant responsibility over the public’s health as part of their police powers. Certainly the federal government carries out important public health functions through regulatory agencies like FDA, and non-regulatory agencies like CDC. But a tremendous number of public health rules—and their effective implementation—are set and exercised by states.
And as the crisis continues to unfold, we are seeing in real-time the need for states to pick up the Trump administration’s slack. As you might expect, there is significant variability among state laws and regulations, as well as large differences in terms of state capacity and preparedness. This means that public health crises will affect people differently based on where they happen to live—making who our state and local elected officials are extremely important.
These state and local governments wield incredible power during public health emergencies, including the ability to close schools, businesses, and events; close public transit systems; expand nurses’ and other providers’ ability to provide care; order quarantine and isolation of certain people; prioritize treatment of certain populations; allocate emergency funding; and order insurance companies to cover testing and treatment.
Local electeds, including governors and state legislators, are playing a number of critical roles during this crisis. A growing number of governors are exercising their emergency powers. At least 33 states have declared emergencies. Related executive orders include those from Governor Andy Beshear (KY-D) extending pharmacies’ authority to fill prescriptions, Governor Ron DeSantis (FL-R) allowing nurses and doctors from other states to work in the state, Governor Andrew Cuomo (NY-D) allowing expedited procurement of testing supplies and equipment, and Governor Gavin Newsom (CA-D) delaying tax filings and waiving waiting periods for disability insurance coverage.
State legislatures are also jumping into action. Maryland legislators have introduced emergency legislation to prohibit price gouging and reduce costs of virus testing, expand access to telehealth, and make sure that workers under quarantine—both public and private sector workers—don’t lose their jobs. Pennsylvania state senators have introduced legislation preventing employers from firing workers when they take time off due to medical quarantine or isolation. The legislatures in Massachusetts, New York, Maryland and others have approved tens of millions in emergency funding. And members of state legislatures like Arizona are pushing for special legislative sessions to allow them to address the crisis.
Beyond formal legal authority, state legislators and other electeds can and must also use their voice to push other state officials and private sector stakeholders to act in the public’s interest, including pushing for insurance companies to cover testing and treatment, and for employers to provide wages to ill workers. They can also serve an important function as trusted disseminators of information and serve as an advocate for those who are hit hardest and least likely to have political power to protect themselves—including low wage workers and those who are under-insured or who completely lack health insurance.
So while we see the news cycle continue to hit on the same rotation of national topics—the presidential race, the stock market, and COVID-19—we can’t forget that the actions of our governors, state legislators, city councils, and state and municipal agencies wield incredible power. How we’re seeing them respond to the current pandemic serves as a sobering reminder that state and local elections are integral to our public health and well-being.
We know it is going to be a crowded election come November, but let this epidemic teach us one critical takeaway: we simply cannot forget about the seats in 86 of the country’s 99 state legislative chambers that are up for election. Now more than ever, we need to elect competent people who are committed to science-based governance. In the next pandemic, our very lives might well depend on it.