Mar 23, 2020 - Politics & Policy

U.S. counties expect coronavirus response to cost billions

Health care workers from Virginia Hospital Center put on their personal protective equipment in Arlington County, Virginia. on March 20, 2020.

Health care workers from Virginia Hospital Center, Arlington, Virginia. Photo: Andrew Caballero-Reynolds/AFP via Getty Images

County officials are urging Congress to make their governments eligible to directly receive coronavirus relief funds to offset the ballooning costs of responding to the crisis.

Why it matters: The country's 1,900 public health departments are run by counties, which also manage roughly 1,000 U.S. hospitals. More than 500 counties have already declared a state of emergency to trigger additional funding and resources.

Driving the news: Senators failed to move a third stimulus package forward in Congress Sunday, and it's unclear what the package will include for state and local efforts, and whether counties will be required to apply for funds from state governments.

The big picture: State and local governments have cut public health staffs by over 25% — or about 60,000 workers — since 2008 due to federal funding cuts. Since then, funding has been restored to handle a specific health crisis, such as ebola or the opioid epidemic.

  • "What we're seeing now is the result of those cuts in federal funding," said Matthew Chase, executive director of the National Association of Counties. "You can’t ramp up in a public health epidemic. You need a baseline capacity."

By the numbers: Los Angeles County, the most populous in the country, is estimating $290 million in costs over six months, and 50 of the 88 cities in the county will face additional expenses of $145 million.

  • Harris County, Texas, which includes Houston, has already spent almost $43 million in coronavirus response costs and expects to spend an additional $11 million every month.
  • Contra Costa County, California, estimates its health department alone will have incurred $46 million through May.
  • San Diego County, California, is spending about $7 million each month for emergency response, including temporary housing for people who need to be quarantined.
  • Clark County, Nevada, which includes Las Vegas, is projecting $1.08 billion in expenses, which includes lost revenue for the fiscal year.
  • Hamilton County, Ohio, estimates the crisis has cost $1 million so far, but it is also causing a loss of about $12 million each month in revenue — more than 10% of the county's total monthly revenue.

Between the lines: Costs are only part of the picture. Adding to the budgetary pressure is the anticipated lost tax revenue due to businesses shutting down for weeks if not months, which makes it even more challenging to absorb the extra costs.

  • Smaller counties will likely see larger percentages of impact on their budget. Over six months, a small county may see deficits of 10% or higher. And that's before projected revenue loss is factored in, said Teryn Zmuda, chief economist for the National Association of Counties.
  • Larger counties may run deficits of 2%. That may sound small, but 2% of a populous county's budget can mean $80 million–$100 million. In addition to that, large counties face a potential loss of 7%–8% within a six-month time frame.

Context: Some services, such as homeless programs, may be joint efforts provided by the city and the county, and some counties operate as a consolidated city-county entity.

  • But when it comes to public health services, counties typically take the lead.
  • Even before this crisis, a little over a quarter of counties had not recovered from the Great Recession of 2007-09, while also seeing "unprecedented" demands on public health programs, Chase said.
Go deeper