Ohio bill may force smaller city health districts to merge

COLUMBUS — After more than a year spent battling a deadly, once-in-a-lifetime global pandemic, health districts in smaller cities across Ohio — including several in the Mahoning Valley — may soon face consolidation driven by the state Legislature.

A provision in Ohio House Bill 110, the state's 2022-23 budget bill, which passed on to the Senate last month after a nearly three-to-one House vote, would require cities with fewer than 50,000 residents to conduct a study on the "efficiency and effectiveness" of merging their health departments into larger county health districts, and comparing that to keeping them independent.

Ohio has more than 100 health departments, including county-level departments in each of its 88 counties. All of the Mahoning Valley's city health districts would fall under the proposed rule, except for Youngstown's.

"I can't even imagine not being here," said Alanna Stainbrook, the City of Salem's health commissioner. "I think it would be a horrible detriment to the residents of the city of Salem to not have their own health department."

Losing access to local care

Aside from their relentless work during the COVID-19 pandemic, city health departments told Mahoning Matters they're otherwise ground-level access points to care for residents who may otherwise struggle to reach services.

Salem has a large Hispanic population — people whom Stainbrook said would likely "lose their access to care, due to the lack of transportation and the language barrier."

That means immunizations for children of uninsured or underinsured families and vital statistics services like birth certificates. The city also offers two volunteer interpreters who work closely with that population, she said.

"In my opinion, they probably would not go down to Columbiana County [General Health District], to Lisbon," Stainbrook said, which is about 10 miles away, 20 minutes by car. "They can walk here."

Carol Cowan, East Liverpool's health commissioner, was also concerned about transportation barriers facing those most likely to take advantage of city-level public health programs. There's also the city health district's familiarity in the community.

"We're a small health department. And the county — they're larger. They have some additional health screening programs," Cowan said. "But to me, I think for the community, it's better to have a small health department. We're taking care of our own community, but it doesn't mean people can't have the benefits of the county [health district]. We all know our partners.

"We're just losing another access point of care, which is really critical."

The vast majority of Alliance school children qualify for free or reduced lunch — a metric speaking to the poverty barriers in the city, Beth Canfield-Simbro of the city's health department testified before the Ohio Senate Finance Committee last week. She called the measure "unnecessarily intrusive."

"Local control of locally funded public health departments is essential to provide quality care and best use of said tax dollars," Canfield-Simbro said. "Elimination or merger of our local health department would reduce access to necessary health care for many residents in our city.

"It can take up to 2 ½ hours by bus to travel from Alliance to Canton, and frankly, many residents will forgo immunizations and WIC services if they cannot walk to the city health department to receive them."

Both Salem's and East Liverpool's health districts have fewer than 10 regular employees. According to language in the bill, "the service status" of city or general health district employees wouldn't be affected by the creation of a combined health district.

"I always felt we needed more troops on the ground," Cowan said.

One-size-fits-all?

The bill orders the state's health director and auditor to develop the criteria to determine whether a merger "is advisable." But ground-level public health workers are wary of the one-size-fits-all approach.

The criteria may include whether the city health district has received accreditation from the Public Health Accreditation Board, an independent nonprofit — for which Alliance has already spent more than $100,000, city officials said.

Such a health district efficiency study has already been done in Stark County. It found it would actually be more costly to merge Alliance's health department with the county's, city Mayor Alan Andreani told the senate Finance Committee earlier this month.

The district receives only $4,200 a year from the state's general fund for services, Health Commissioner Randall Flint also told the committee.

When the COVID-19 pandemic erupted, East Liverpool City Health District had most of its accreditation paperwork in-hand and was about a month away from applying, Cowan said.

Salem's health district is also close, Stainbrook added. It's now preparing for a site visit and a final determination by accreditation officials.

Leslie Shaffer, an Alliance public health worker who also acts as the city's liaison with Mount Union University, said the university likely avoided larger outbreaks and outright closures because of its partnership with the city health district.

"When it came to my attention that local health departments may be cut, I could not believe it," Shaffer told the finance committee earlier this month. "Each local health department and the city or town that it resides in should be able to decide if they can govern efficiently or not. I have worked with three different health departments within Stark County, and each serves their respected jurisdictions, and each community is different."

Local pushback

In the past month, some Valley legislators and city-level officials have pushed back against the consolidation plan.

Salem City Council earlier this month approved a resolution "strongly opposing" any state efforts to abolish its health department, which has been "invaluable in protecting the health, safety and welfare of the entire city," it reads.

Mayor John Berlin, who's also president of the city's health board, did not return multiple calls for comment on the House bill.

Stainbrook said Salem's hometown state lawmakers, Rep. Tim Ginter, R-5th, and Sen. Mike Rulli, R-33rd, have pledged their support.

Ginter, however, ultimately voted to move the budget bill along with the provision intact when it passed the House in mid-April, 70 to 27.

Reps. Al Cutrona of Canfield, R-59th, and Mike Loychik of Bazetta, R-63rd, were the two other Valley legislators who also voted to pass the budget bill. Mahoning Matters on Wednesday reached out to the House majority spokesperson, but did not receive a response from Loychik or Cutrona.

State Rep. Michele Lepore-Hagan, who voted against the budget bill, said local health districts are "underfunded as it is." She was also opposed to language that would put American Rescue Plan dollars toward a $380 million tax break.

When the first wave of COVID-19 cases crashed, "the whole system crashed, because we have not invested in public health infrastructure," she told Mahoning Matters Wednesday. "This takes us in completely the opposite direction."

The bill is currently before the Ohio Senate Finance Committee. City health officials said they expect to learn by early June whether the provision will stay or what form it will take. Until then, they're waiting with "a sense of silence." Stainbrook said. She's heard assurances Rulli is working behind the scenes to adjust or remove the provision.

Rulli did not respond to a request for comment Wednesday.

"I hope they're working on it in the Senate," Lepore-Hagan said. "I would hope they would be lobbying right now against it.

"The local health departments that need to be reinvested in and funded and built back up again are now just being slighted."

This story was originally published May 27, 2021 at 3:52 AM with the headline "Ohio bill may force smaller city health districts to merge."