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State Representative Mike Sturla speaks during a press conference held by Governor Tom Wolf at the former Bon Ton site at Park City where Lancaster County's mass vaccination site is set up for Covid-19 shots starting tomorrow on Wednesday, March 10, 2021.

A bill being drafted by Lancaster city’s representative to the state House would require each county to form a public health department to deal with problems like the COVID-19 pandemic. 

Rep. Mike Sturla, D-Lancaster city, said his bill would mandate that any county with a population of 500,000 or more create its own health department. Smaller counties would be required to create their own as well, but would have the option of forming regional departments, likely in conjunction with health systems, Sturla said.

The bill would require counties to fund public health departments on their own. The six counties that already have health departments pay approximately 50% of the total cost each year, with the other half subsidized by state funds.

“This is something that’s a responsibility of local government, as far as I’m concerned,” Sturla said.

With Delaware County projected to open its own department by January 2022, Lancaster is set to become the largest county in the state to lack its own health department. Officials here have long argued that the state Department of Health already fulfills duties that would be assigned to a local agency. And they have generally cited the traditional arguments against creating a new layer of bureaucracy paid for by local taxpayers.

“I approach this as a conservative who is somewhat skeptical of growing government, especially when there’s a state department that’s supposed to be doing this,” said Josh Parsons, the county commissioners chair during a live-streamed interview with LNP | LancasterOnline reporters last month.

But the COVID-19 pandemic brought the issue back to the forefront, with several municipal governments in the county passing resolutions urging the county commissioners to create a health department. Manheim Township’s commissioners were the first to make such a call, and the township’s Democratic and Republican Party area committees there have endorsed the idea as well.

In March, Sturla sent a memo to his colleagues asking them to co-sponsor his legislation. He said he began working on the legislation prior to the release of a United Way-funded poll conducted by Franklin and Marshall College’s Center for Opinion Research which found an “overwhelming” percentage of Lancaster County residents are willing to pay more in taxes to fund a local health department.

Costs

The six Pennsylvania counties that currently have health departments are Philadelphia, Allegheny, Montgomery, Bucks, Chester and Erie. Chester and Erie counties both have smaller populations than Lancaster County’s more than 545,000 residents. 

Sturla said he did not know how much it would cost the remaining 60 counties to establish health departments under his proposal, noting that the costs would depend on what responsibilities they are required to fulfill. He said he plans to introduce the bill within the next month, where he expects it will be referred to the House Health Committee for further consideration.

While his legislation would place an unfunded mandate on counties, he said he thinks public health departments would lead to greater savings in the long run for the counties. 

Counties and municipalities currently can create health departments under a 1951 law that funds local agencies as long as they meet specific requirements, such as providing a range of administrative, support and personal health services according to the Department of Health website. The law was expanded in 1976 to include environmental health services, including water pollution controls, food and water supply protection and building inspections.

Under current law, a department in Lancaster would initially operate with a $2 million annual budget, of which only $160,000, or 8%, would come directly from county taxpayers, according to projections by the county’s Partnership for Public Health. State funding and grants would likely cover most of the department’s operations, the group said.

Taxpayers in Chester and Allegheny counties pay less than an estimated $10 a year per person for their health departments, according to an analysis by Jennifer Meyer, a professor at Franklin & Marshall who worked on the United Way poll. 

Local movement?

Given that Sturla’s party is a minority in the legislature, a local effort is the most likely path to creating a public health department in Lancaster County, at least in the short term.

The county government will soon begin an after-action review of its community response to the COVID-19 pandemic, which will include discussion about whether it should create a county health department, Parsons said last month.

Lisa Schaefer, the executive director of the County Commissioners Association of Pennsylvania, said her organization was not consulted by Sturla on his legislation. She echoed a point made by Parsons that many counties are already well-served by the state health agency. 

“It’s a very significant decision for a county,” Schaefer said. “We’ve learned a lot from this pandemic, how we can better prepare for and plan for public health emergencies going forward and one of those key things is the flexibility to respond to local conditions.”

County Commissioner Ray D’Agostino said in an email that Sturla’s proposal is another bureaucratic approach, and he added that he has not heard from Sturla at all during the COVID-19 pandemic, and had not been approached by him about this proposal. 

“We are not even entirely out of the throes of the current pandemic crisis and there is already a call for the forced expansion of government bureaucracy without having all the facts, let alone a discussion,” D’Agostino added.

The current state law governing local health departments includes regulatory requirements counties must meet to receive state funding -- rules that Schaefer said make it hard for counties to comply.

Sturla said he plans to meet with the Department of Health while finalizing his legislation to possibly change this language to make it easier for counties.

“If the government is always going to be reactionary, instead of preventative, then man, we’ve got a crazy role to play in life,” he said.

And Sturla said his bill embraces the conservative value of local control.

“The way you stop a pandemic, an epidemic or an outbreak in your community is to have a department where somebody is paying attention to that at a micro level, as well as a macro level,” Sturla added. “That only happens if you have a local health department.”

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