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Republican lawmakers in more than a dozen states are working to limit the powers of local health services in a way, experts say, can lead to “preventable tragedies” during epidemics, including Covid-19 pandemic.
Attempts to limit the emergency powers of public health agencies come with harassment of individual public health workers, renewed concern over the spread of the highly transmissible variant of Covid-19 Delta, and a campaign US immunization rates down.
“The supposed rationale is that a lot has happened during Covid. People didn’t really like being restricted, ”said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials (Naccho).
“But if these laws and laws get past the pandemic, we have a big problem,” she said. “Basically, they prevent health officials from using age-old mitigation measures.”
Montana has banned local health authorities from quarantining people suspected of being exposed or infected with a contagious disease. This puts an end to an infection control measure used since at least the plague, known as the ‘black plague’, hit Italian cities in the 14th century.
North Dakota has banned state health officials from requiring a face covering for any reason, a move that could impact diseases such as tuberculosis. Florida has given the governor the power to “invalidate” any local emergency orders. Kansas has removed the governor’s ability to shut down businesses during a public health emergency.
Together, at least 15 states are considering new limits on the power of local public health authorities in a way that diminishes local expertise, the ability to locally adapt restrictions and lead to more politicized responses.
“I was a lawyer in the Massachusetts Department of Public Health for 10 years, then I was General Counsel for the next 26 years,” said Donna Levin, national director of the Network for Public Health Law. Levin has since been with the network for an additional seven years of his career.
“I can safely say that in my experience I have not seen an assault on public health officials, threats and worse across the country, and I have never seen this massive attack against public health authorities… in the context of an emergency response, ”Levin mentioned.
Lawmakers in at least nine states have focused on emergency health service powers to limit how people congregate in places such as churches, schools and businesses. Conservative Model Law has described these limitations as ordinances that “infringe the rights of individuals”.
Many of the limits on public health measures also came from the imprimatur of one of the country’s most powerful and well-funded conservative legislative machines – the American Legislative Exchange Council (Alec).
At least nine states have considered “emergency power limitation” legislation proposed by Alec that could directly limit the public health response, according to a report by Naccho. These states – Arizona, Idaho, Kentucky, Montana, North Dakota, Pennsylvania, Utah, Virginia and Washington – are rather conservative or purple.
Alec began circulating model legislation related to Covid-19 as early as last April. Emergency powers legislation was first published in December 2020. Since then, experts have said attempts to limit the emergency powers of health services have become more concerted and widespread as the pandemic is progressing, with states like Missouri reducing emergency health services powers in June.
Along with a slew of new laws pushed by Alec, a loose coalition of conservative groups has worked since April 2020 to boost participation in anti-lockdown protests, fund lawsuits against public health orders, and commissioned polls to support the outbreak. of a “grassroots” campaign for reform.
The legislation proposed by Alec aims to limit government spending, reduce regulation and impose “constitutional law”, according to the principles laid out by conservative economists in Alec at the start of the pandemic.
“As they should, each state will have a different solution and approach to reopening, and Alec will support lawmakers in these efforts,” Alec CEO Lisa Nelson said in April 2020.
Alec’s primary model for consolidating power in state capitals is to “preempt” or prohibit any locality except the state from legislating on an issue. Alec has used this strategy for issues as broad as workers’ rights to environmental protection.
“This is an organization that aims to consolidate power in the state, especially in conservative states,” said Kim Haddow, strategic consultant for the Local Solutions Support Center (LSSC), a group that works for maintaining the democratic rights of cities, counties and other municipalities.
This, Haddow said, allows Alec to deal directly with lawmakers in states that tend to be “disproportionately representative of white rural areas,” rather than thousands of localities. Preemption also deprives urban centers, which tend to be more racially diverse and democratic, of the ability to adopt incremental reforms.
“Around the pandemic, [Alec] took advantage and harnessed the ability to take more local power, ”said Haddow. “People are saying why vote” if states are constantly anticipating local laws, she said. “Well, why indeed? “
Missouri is one of the states struggling to limit the power of public health authorities. In June, its Republican governor, Mike Parson, signed a law limiting public health orders to 30 days in the event of a statewide emergency and 21 days in the absence of a state declaration. A local governing body must then vote to renew these restrictions.
Parson was a speaker at Alec’s 2020 conference, which was forced to go digital after Florida, where they planned to hold the conference in person, became the center of an outbreak.
“There is a long-standing unease with public health at its heart, but Covid-19 was immediately politicized in a way that other health issues were not,” said Dr Elvin Geng, infectious disease expert at the University of Washington in St. Louis, Missouri.
Missouri is also among the states currently experiencing the largest Covid-19 outbreak since the spring of 2021, when a rapid vaccination campaign and social distancing resulted in the lowest rates of new infections since the start of the pandemic.
Although cases remain low overall from the peak of the pandemic, Missouri is among the least vaccinated states in the country, with just 40% of people fully vaccinated.
“Local control is essential because epidemics are heterogeneous in terms of severity and timing,” Geng said. Missouri is currently experiencing one of the nation’s worst Covid-19 outbreaks.
Remarkably, Missouri has also been the target of another well-funded Conservative effort to avoid government spending that could affect taxes on the wealthy. Political advocacy group Americans for Prosperity, funded in part by billionaire oil and gas mogul David Koch, has worked to dissuade voters from expanding Medicaid.
The Medicare program for the poor and disabled has reportedly provided health insurance to 230,000 low-income Missourians. Voters approved the ballot measure, which state Republicans refused to honor, and swiftly took to court.
It ranks last in public health funding and spent just $ 7 per person on public health measures in 2020, according to an analysis by the State Health Access Data and Assistance Center, a health research center. state-oriented.
“Health, counseling and prescriptions weren’t considered for what they were,” said Tremmel Freeman, “who was trying to protect the health and well-being of the community.”
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