What’s at stake?
-- More on public health impacts
Public health programs in Colorado have suffered
under TABOR, Colorado's version of CI-97. Between Fiscal Year
(FY) 1992 and FY 2004, state funding for the Department of
Public Health and Environment declined by one-third as a share
of personal income, even as Colorado's population grew rapidly.i
Between 1995 and 2003, Colorado declined from
24th to 50th in the nation in the share of children who receive
their full vaccinations. Unvaccinated children are at much
greater risk of getting measles and whooping cough. Moreover,
medical research shows that vaccinated children are much more
likely to get these diseases when they live in areas with
unvaccinated children.
While several factors determine a state's immunization
rate, a recent Colorado Health Institute study concluded that
"spending restrictions" are a factor in Colorado's low ranking,
since TABOR does not give Colorado the same flexibility as
other states to meet changing needs.ii
From April 2001 to October 2002 the state was
forced to suspend its requirement that students be fully vaccinated
against diphtheria, tetanus, and pertussis (whooping cough)
because Colorado, unlike other states, could not afford to
buy the vaccine.iii
Between 1992 and 2002, Colorado declined from
23rd to 48th in the nation in access to prenatal care, a sign
of funding shortages in local health clinics. In an effort
to increase access to prenatal care for low-income women,
the state launched the Prenatal Plus Program in 1996, but
financial pressures have forced the closing of a number of
local sites.iv
Among the casualties of the decline in public
health funding was a state program that provided local public
health agencies with vital revenues. The canceling of this
program in 2002 forced many counties to eliminate a range
of services, from immunization clinics to car-seat safety
education.
While plummeting state revenues during the
economic downturn were the immediate cause of the program's
cancellation, TABOR has cemented this cut in place and prevented
the restoration of funding.v
Funding cuts like these have forced public
health agencies to make difficult tradeoffs. "Because per
capita and county dollars fund our core public health services,
there were no good choices to be made," said Dr. Adrienne
LeBailly, director of the Larimer County Department of Health
and Environment.vi
Larimer County responded to the shortfall by,
among other things, eliminating hazardous waste inspections
and inspections of leaking underground storage tanks; reducing
health inspections of restaurants, school cafeterias, and
grocery stores; closing a clinic designed to help at-risk
children thrive in their home environment; scaling back health-care
programs for special-needs children and prenatal risk reduction;
and reducing public-information and tobacco-prevention services.vii
While some funding was later restored, these cuts in services
seriously hindered the department's ability to provide health
services to the county.
"It really is a travesty that a state as wealthy
as Colorado and with as high an educational level has more
restrictive health policies than Mississippi, Alabama, Texas,
Wyoming, [and] New Mexico. It's just inexcusable"; -- Dr.
Stephen Berman, Professor of Pediatrics at the University
of Colorado School of Medicine and former President of the
American Academy of Pediatrics ("Bad policies aid and abet
a killer: flu," The Denver Post, December 7, 2003)
Read
about SOS/TABOR and its impact on Medicaid.
i
It is important to note that as a share of income, state own-source
appropriations for the Department of Public Health remained
at a constant 0.9 in the decade prior to TABOR's passage.
Thus, the state's investment in public health programs was
growing with the state's income but began to shrink after
TABOR passed.
ii
Ranking is for the 4:3:1:3 series. By investing additional
funds to immunize children, Colorado was able to improve their
ranking to 43rd in 2004. Information on medical research from
D. Feikin et al., "Individual and community risks of measles
and pertussis associated with personal exemptions to immunizations,"
Journal of the American Medical Association (Dec. 27, 2000):
p.3145-3150. For study, see Colorado Health Institute, "Colorado
Childhood Immunization Rates: Policy and Practice," May 2005,
www.coloradohealthinstitute.org/Documents/Q&A_final.pdf.
iii
There was a national shortage of the Diphtheria, Tetanus,
Pertussis (DTAP) vaccine in 2000 and 2001. The Colorado Department
of Public Health and Environment suspended the school entry
requirement for the 4th and 5th doses of DTAP. Most other
states only deferred the 5th dose DTAP requirement and used
state funds to purchase existing vaccine at a higher price.
Colorado, however, could not choose this option due to a lack
of state funding. See Colorado Health Institute, "Colorado
Childhood Immunization Rates: Policy and Practice," May 2005,
www.coloradohealthinstitute.org/Documents/Q&A_final.pdf.
iv
Ranking data from National Center for Health Statistics, Centers
for Disease Control and Prevention. Information on program
participation from Colorado Department of Public Health and
Environment, "Prenatal Plus Program Annual Report," various
years, www.cdphe.state.co.us/pp/womens/PrenatalPlus.asp#AnnualReports.
v
The state program is known as "per capita funding." Colorado
General Assembly, Joint Budget Committee, "FY 2005-06 Staff
Briefing: Department of Public Health and Environment," November
10, 2003, www.state.co.us/gov_dir/leg_dir/jbc/pubheabrf1.pdf.
vi
Larimer County Department of Health and Environment, "Proposed
Service Reductions to Mitigate Deficits Larimer County Dept.
of Health and Environment-Summary of Cuts," June 27, 2002,
www.co.larimer.co.us/depts/health/admin/cuts.asp.
vii
Robin Baker, e-mail message to author, July 10, 2005.
Source: Center on Budget and
Policy Priorities A Formula for Decline, Lssons from Colorado
for States considering TABOR, By Dvid Bradley and Karen Lyons,
October 19, 2005
What's At
Stake:
Senior citizens
Public
health and safety
Local
communities
Jobs and economic
development
K-12 schools
Higher
education
Montana's
most vulnerable citizens
Agriculture |
