How State Health Departments Are Banding Together in the New Federal Policy Environment
Wrenching shifts in federal health policy are being felt across the public health system. In response, several states are working together in new ways to support the health of their residents.
In a recent panel discussion, Robbie Goldstein, Health Commissioner of Massachusetts, and James V. McDonald, Health Commissioner of New York State, spoke about how states are collaborating on issues ranging from vaccines to reproductive and gender-affirming care. The discussion was organized by the Center for Public Health Systems at Columbia Mailman School and moderated by Magda Schaler-Haynes, professor of Health Policy and Management and Population and Family Health. (Watch a video of the event below.)
The biggest challenge of the current health policy environment is its uncertainty and unpredictability, Goldstein said. He offered the example of the Advisory Committee on Immunization Practices meeting about the hepatitis B vaccine. “You can put thirty really smart people in a room together and ask them how this is going to play out, and you will get thirty different answers,” he said. Adding his own perspective, McDonald said the federal government isn’t making his job harder. “It was already hard. It is making my job more important.”
State health departments have always collaborated, but this year some of those relationships became more structured with the creation of the West Coast Health Alliance, which is made up of California, Oregon, and Washington, and the Northeast Public Health Collaborative, which counts six states as its members, including Massachusetts and New York. Goldstein explained that the Collaborative grew out of conversations about how to handle the loss of federal grant funding. While member states include elected officials from both parties, they all share a common ethos: “We’re a group of folks who have collectively decided that public health is important,” Goldstein said. McDonald concurred, adding, “[The Collaborative] is not a political entity. It’s not meant to necessarily push back against the federal government. Its [goal is] to put out objective honest information, like every health department should do.”
State health departments vary significantly in the scope of their responsibilities. For example, New York State’s Health Department oversees Medicaid; in Massachusetts, it does not. Massachusetts has a universal vaccine program that pays for vaccines for all children; New York does not (vaccines are required for school entry in both states). “If you’ve seen one state health department, you’ve seen one state health department,” McDonald quipped. Even so, most of their responsibilities overlap. Both states are committed to the health of all their residents—including those threatened by new federal policies restricting access to reproductive and gender-affirming care. “There are policy decisions out of Washington that will make the delivery of care really challenging to do, and so we are actively planning for that future,” Goldstein noted.
The U.S. Constitution reserves significant authority for states, particularly in the public health arena. The federal-state relationship is complex, and many states long ago incorporated federal roles into their own statutes. One fraught example is vaccine guidelines, a priority area for Northeast Collaborative member states. “It’s not to say that the federal government shouldn’t come back and have power, and that [they] shouldn’t be able to advise and recommend and put out guidance and use money and policy decisions to drive action, but that we need an off ramp, too, in the states, in case it swings in a bad way and in a way that doesn’t comport to the values of our jurisdictions,” said Goldstein.
