Public health departments face a post

Good morning. I'm Jazmin Orozco Rodriguez, a KFF Health News correspondent based in Elko, Nev., which is about as high in elevation as Denver, the Mile-High City. Email me about your experiences with health care in rural America at .

Today's edition: The Harris-Walz campaign rolled out a plan to improve rural health care. Nebraska voters are set to weigh in on two conflicting abortion-related ballot initiatives. But first ...

The boom-and-bust funding cycle for public health hits states

During the coronavirus pandemic, states received a rush of funding from the federal government to bolster their fight against the disease. In many cases, that cash flowed into state and local health departments, fueling a staffing surge to handle, among other things, contact tracing and vaccination efforts.

But public health leaders quickly identified a familiar boom-and-bust funding cycle as they warned about an incoming fiscal cliff once the federal grants sunset. Now, more than a year since the federal Department of Health and Human Services declared the end of the coronavirus emergency, states — such as Montana , California and Washington — face tough decisions about laying off workers and limiting public health services.

In California, Democratic Gov. Gavin Newsom proposed cutting the state's public health funding by $300 million. And the Department of Health in Washington state slashed more than positions at the end of last year and more than this year.

Public health experts warn that losing staff who perform functions like disease investigation, immunization, family planning, restaurant inspection and more could send communities into crisis.

"You cannot hire the firefighters when the house is already burning," said Brian Castrucci, president and CEO of the de Beaumont Foundation, an organization that advocates for public health policy.

In late September, HHS Secretary Xavier Becerra declared a public health emergency for states affected by Hurricane Helene, allowing state and local health authorities in Florida, Georgia, North Carolina, South Carolina and Tennessee to more easily access federal resources. Last week, ahead of Hurricane Milton's landfall in Florida, Becerra declared another public health emergency to aid the state's response.

If states don't have robust public health resources ready when disasters like this hit their communities, it can have devastating effects.

Local health department staffing grew by about 19 percent from 2019 to 2022, according to a report from the National Association of County and City Health Officials that examined of the nation's roughly local departments. The same report found that half of those departments' revenue in 2022 came from federal sources.

But in some places, the pandemic cash did little more than keep small health departments afloat. The Central Montana Health District, a public health agency serving five rural counties, received enough money to retain a staff member to help handle testing, contact tracing and rolling out the coronavirus vaccines. It wasn't enough to hire extra workers, but it allowed officials to fill a position left empty when a staffer left the department, said Susan Woods, the district's public health director.

Now, five full-time employees work for the health district — enough to scrape by, Woods said.

"Any kind of crisis, any kind of, God forbid, another pandemic, would probably send us crashing," she said.

Adriane Casalotti, chief of government and public affairs for the national health officials' group, said she expects layoffs and health department budget cuts to intensify. Those cuts come as health officials work to address issues that took a back seat in the pandemic, such as increases in rates of sexually transmitted infections , suicide and substance misuse .

And rural health departments deserve more attention, Casalotti said, as they are likely to be the most vulnerable and face compounding factors such as hospital closures and the loss of services including maternity and other women's care .

Why cancer among younger Americans is on the rise

On tap today: Yale School of MedicineVeda Giri, the American Cancer SocietyRebecca Siegel and the National Cancer InstituteSteven Rosenberg will join Washington Post Live for a conversation on the factors driving the rise in cancer cases among young people, strategies to reduce risk and the latest advances in immunotherapy treatments for the disease.

Tune in here at 2 p.m. Eastern time to catch the event.

Election watchHarris, Walz aim to win over rural voters with health-care initiatives

With less than three weeks until Election Day, the Harris-Walz campaign is racing to shore up support among rural voters in battleground states with new promises to improve and expand their access to affordable health care.

The plan was announced by Minnesota Gov. Tim Walz, the Democratic vice-presidential nominee, during a campaign stop in rural Lawrence County, Pa., on Tuesday. Key proposals include:

Recruiting 10,000 health-care professionals in rural and tribal areas through scholarships, loan forgiveness and new grant programs.Permanently extending Medicare coverage for telemedicine, a pandemic-era policy set to expire at the end of the year.Strengthening emergency services by increasing financial and technical support for training, equipping and employing first responders, along with providing new grants for small volunteer ambulance and EMS programs. Other proposals are aimed at supporting independent pharmacies and rural hospitals, lowering prescription drug and health insurance costs, and restoring reproductive rights. The plan also reiterates Democratic nominee Kamala Harris's push to expand Medicare coverage for long-term care at home .

Reality check: Even if they win the White House in November, many proposals in the Harris-Walz plan would still need congressional approval to move forward. As the election nears, Republicans appear poised to win the Senate, while Democrats seem to have a slight edge in the House race, per The Post's Marianna SotomayorLiz GoodwinPaul Kane.

In other news from the campaign trail ...

Former president Donald Trump's recent medical report in Truth Social posts, falsely claiming her seasonal allergies are a "a very messy and dangerous situation" while asserting that his own health report, which he has not released, "IS PERFECT," The Post's Justine McDaniel reports.

Key context: In a letter Saturday, Harris's doctor said the vice president is in "excellent health" and noted that she has seasonal allergies and urticaria (hives), which have been effectively managed through allergy immunotherapy.

Medical experts who reviewed the letter for The Post said those conditions aren't serious and that Harris appears healthy. In posts online, however, Trump inaccurately labeled them "deeply serious conditions that clearly impact her functioning."

"I am far healthier than Clinton, Bush, Obama, Biden, but especially, Kamala," Trump wrote.

Yes, but: Trump hasn't released his medical reports since the presidential race began, sharing only a brief letter from his doctor and another after the assassination attempt against him. On Tuesday, he claimed he had provided reports "many times."

Reproductive warsNebraska voters to choose between dueling abortion questions

Nebraskans will vote on competing abortion-related ballot initiatives next month, a historic event that is expected to boost turnout in an election and that features a crucial House race with high stakes for the presidential contest, The Post's Annie Gowen reports.

Key context: One measure would amend the state constitution to recognize the right to abortion until "fetal viability," typically around 24 weeks. The other would codify the state's existing 12-week ban, with limited exceptions. If both pass, the one with the most votes wins.

The dueling measures have sown widespread confusion and drawn intense attention and money to the state. The abortion rights question has garnered support from national groups like Planned Parenthood, with records showing the effort has raised over $6 million.

On the antiabortion side, virtually all of the $7.14 million raised has come from two wealthy Nebraska families, the Peed family and the family of Sen. Pete Ricketts (Neb.), a Republican whose billionaire father founded online brokerage firm TD Ameritrade, according to campaign finance records.

"My gut feeling is that the abortion issue is going to play a significant role in this election," said Democratic activist Patty Zieg, a board member of the Nebraska Appleseed Action Fund, which backs the abortion rights proposal.

There are implications for the presidential race because of Nebraska's unusual way of awarding its five electoral votes: Two go to the statewide winner, and each of its three congressional districts awards one. Democrats are looking to hold on to the district covering the Omaha metro area , which went blue in 2008 and 2020, and they're counting on the abortion question to help them do it.

In other health newsThe Biden administration has invoked the Defense Production Act to expedite repairs at a major IV fluid manufacturing plant that was shut down this month due to damage from Hurricane Helene, leading to a nationwide shortage , Alexander Tin reports for CBS News.plans to close. The move marks the latest turnaround attempt by a retail pharmacy giant as the industry faces new competition, shifting consumer behavior and a sharp drop in vaccine demand post-pandemic, The Post's Aaron Gregg reports.On our radar: Joe Biden plans to appoint Kimberly Stegmaier to the National Cancer Advisory Board. Stegmaier is a professor of pediatrics at Harvard Medical School and vice chair of pediatric oncology research at the Dana-Farber Cancer Institute, among other positions. Health reads Abortion could decide control of state supreme courts (By Michael Wines | The New York Times)

Lawmakers calls for extending telemedicine flexibilities, object to proposed DEA rule (By Joseph Choi | The Hill)

Meta can't escape states' claims it hooked kids on platforms (By Isaiah Poritz and Rachel Graf | Bloomberg Law)

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