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As County Health Departments Brace For Cuts in Vital Services, Flagler’s Makes Its Case

| February 21, 2011

The Flagler County Health Department, on what used to be South Lemon Street in Bunnell--what's now Dr. Carter Blvd, off of State Road 100--may soon feel the effects of a denuded state budget for health programs. (© FlaglerLive)

A look at Gov. Rick Scott’s budget under community health programs reveals a striking zeroing out: the $2.2 billion in this year’s public health program disappears in Scott’s proposed budget, including funding for local county health departments, environmental health services, infectious disease control and other divisions.

Much of that is a reshuffling. The same divisions and a few more reappear under a new name: Public Health Services. Along the way, however, $130 million disappears. So do 657 positions. That’s just in public health. The total number of positions being lost in the health department would be 879. Clinic care is among the services that may be eliminated. That would affect affect people with chronic diseases, pregnant women, people with HIV-AIDS and other conditions that don’t qualify for a visit to the emergency room. The uninsured don’t have the luxury of calling on a doctor in private practice.

At the Flagler County Health Department, 136 people a day use clinical services, from primary care to immunizations to dental work, and as part of the Women Infants Children program (WIC). That last program is federally funded. It would not be affected by state cuts. But other services would.

For county health departments across the state and in Flagler County, Scott’s budget, if passed, would be a serious blow to community health for those who have no other options. There’s still a lot of uncertainty over the budget, and some resistance in the Legislature over its more draconian proposals. But there’s also a nearly $4 billion deficit to close. Unlike schools, which have a powerful political constituency, county health departments have no powerful advocates other than their own employees. Poor people who use county health services are neither organized nor usually able to mount activist campaigns on their own behalf. And few people will speak for them.

Patrick Johnson, director of the Flagler County Health Department, isn’t panicking yet. “Here’s what DOH told us,” Johnson said, referring to the Department of Health, during an interview at his office. “All of this has to go through the Legislature, and until that happens we’re not going to know exactly what individual health departments are going to get cut, because the Department of Health is a big agency. One quarter of the Department of Health is headquartered in Tallahassee. Three quarters are in 67 county health departments. So if they are doing a cut proportional, those numbers have to be taken into account in the formula. DOH doesn’t know any of us. Now, the budget does say 879 DOH positions will be cut. Well, there’s 16,000 positions. Many of those are vacant. So what the proportion would come to a specific health department is completely unknown.”

There are 60 full-time positions at the Flagler health department, and five part-timers. The department has a $4 million budget. The county’s share, approved earlier this month, is $250,000. The rest is state and federal money, with Medicaid alone accounting for 44 percent of the budget. Straight state funding accounts for $445,000 a year—the same amount the department has been receiving since 1996. Johnson has been at the department since 2004. The patient load has doubled since.

The day he was being interviewed, Johnson was finishing a presentation to the Flagler County Commission—an annual report—that he was presenting this evening (Feb. 21). “Our goal right now is to point out our public health role, our safety net role,” he said.

For example, the department had 366 maternity patients in 2009. That’s more than a third of all births in the county that year.

“Historically health departments have been the place for under-insured, indigent people to go to. And in small communities, small counties, that’s still the case. In bigger counties that role has diminished. We’re the medical home for 2,700 people on Medicaid. I don’t know that there’s a bigger clinic per se in the county, so our safety net role I think is going to help us.”

Other services the department provided in 2010: 12,405 immunization shots (Flagler’s population is around 90,000), some 2,000 child health check-ups, surveillance and treatment for two cases of tuberculosis and 10 new cases of HIV. In addition, the department provides a slew of environmental services such as facilities inspections and water sampling. It’s also to the department that the county turns for coordinated responses to outbreaks of disease. In all in 2010, the department touched the lives of county residents 19,000 times.

The department isn’t into frills. Employees are stacked—two, three, four per office. “It’s clean, it’s functional, it’s light and bright,” Johnson says. “You’re not going to see wood floors and a bunch of elegance. You’re going to see practical and clean and pretty straight forward.”

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24 Responses for “As County Health Departments Brace For Cuts in Vital Services, Flagler’s Makes Its Case”

  1. lawabidingcitizen says:

    The uninsured don’t have the luxury of calling on a doctor in private practice.


    You really don’t know what you’re talking about, do you?

  2. Outsider says:

    For example, the department had 366 maternity patients in 2009. That’s more than a third of all births in the county that year.

    Gee, maybe this is part of the problem; 366 people who can’t afford to have babies are having babies. No worries; the government will just suck the money out of the people who are responsible enough not to have a baby they can’t pay for. I’m sick of this whining.

  3. ForThePeople says:

    lawabidingcitizen, you are the one who seems to be clueless. People who are uninsured can go to a private practice doctor, but the will have to pay a minimum of $100 -$200 per visit. It’s even higher if the have to see a specialist or visit the hospital. I have been in multiple situations as an employee with great benefits package provided by my employer and on unemployment with no insurance when my employer eliminated my position. When my job was eliminated I had the choice of paying for Cobra insurance plus paying a high copay overtime i went to the doctor. So with my incredibly high unemployment payment and my mortgage of $1500. I was lucky enough to find a job that payed me 8.00 an hour. Lawabidingcitizen, I bet you have a great insurance plan from what ever company you work for or have retired from. So until you can honestly say you have ever been in a position where you have no income and a mortgage and an illness that requires a prescription that cost you $100 a month and visits to a specialist that costs you $150 a visit then you need to keep your opinions to your self until you have a solution to offer.

  4. DLF says:

    No one wants to cut anything, teachers pay,police retirement, speed trains to nowhere, or health care for the people who cannot afford it. The state is going broke and where do people expect the money to come from, maybe the state could win its own lottery. I wish someone at Flagler Live would come up with some suggestions to find the money so we can continue to have all the things we think we deserve or entitled to, or maybe we don’t deserve some of them. maybe we are not entitled to everything. Flagler Live seems to be quick to point out all the things that we need but are not getting, maybe they can come up with some suggestions on how to achieve all our wants with the current income the state has.

  5. Liana G says:

    The state is growing broke because of the greed and thievery of people like Scott /elites. Who got the bailouts and tax breaks? And who stole from the public services and exploited the naive (compliments of public education)? Now who is getting shafted?

    FYO, the poor pays taxes which fatten the coffers of the elites especially when the poor do not get a return on their investment. What is this? Population culling because government don’t want to pay out.

    Then the government needs to stop taxing me and taking out for ss and medicare etc if I am not going to be able to collect. Why the heck should I keep paying for services NOT BEING RENDERED!!!!!

    So let me get this straight, these poor people will continue to pay into the system but will die out from lack of services, while the ones who can afford it are living way tooooo long and collecting more than they paid in. Watch out. Your day has arrived even if you havn’t figured it out yet.

  6. Justice for All says:

    The King’s, err, the Governor’s proposed budget is on line. The budget projects revenues from documentary stamp taxes (real estate sales) will increase, along with sales tax revenue, by 2013. Problems solved – cue the music……….

  7. DLF says:

    Liana G I don’t know where you got your facts that the state is going broke because of people stealing, the bail outs were approved by people you voted in office. The government is going broke because we pay our government workers an average of $26.25 per hour compared to private industry worker $19.68. the government is going broke because the government worker gets 11 paid holiday compared to 8 for the rest of us. The government is going broke because 98% of the government worker get paid sick leave while only 74% of private industry worker has paid sick leave. These figures were part of the Labor Dept. latest report, another government agency that is wasting our money.The government is going broke because we have become a nation of entitlement, we think the world owes us a living and you have helped place people in office who think the same thing. You better wake up and see that the gravy train is coming to a halt and we all will need to tighten our belts, all of us, poor, rich, crooks, even our elected officials, oops they are not in the same boat as the rest of us, are they are in the group you make reference to. Oh, by the way most of the poor do not pay tax, federal, in fact about 48-52% of Americans do not pay federal tax and some big number hide what they do make, lets look at that group.

  8. John Boy says:

    Of course Scott wnts to reduce competition for his Solantic Clinic’s. The FRAUDster needs to be run out of the State. The upprising in the Mid East is coming to the US and the rich and powerful better start hiriing private security forces, ie Blackwater, etc. because what’s left of the middle class has about had.

  9. DLF says:

    Liana: forgot to mention that the IRS refunded over $12 million to Florida prisoners who in part had no right to the refund, that was in 2009. Florida led the states in most refunded money, the total for all the states was $39 million. Another great job by our government work force. The same workforce we are paying higher wages better health care and more vacations than any other group of workers, Even the workers that add something to the GNP, which the government does not.

  10. DLF says:

    John Boy: just remember that the rich will be the only ones who can afford to arm them selves. I believe the Mid East up raising is against the government or lack of, maybe that’s who we should be going after, the crew of crooks in Washington, makes sense to me.

  11. PC Dad says:

    DLF said: “The government is going broke because we pay our government workers an average of $26.25 per hour compared to private industry worker $19.68.”

    You quoted a Department of Labor report. Which report?

  12. DLF says:

    PC Dad: the numbers I made reference to came from an article in the Wall Street Journal dated 2-19-20-2011. the chart they used makes reference to source: Labor Dept. The chart was titled “Head to Head/How wages and benefits compare.” The government workers were State and local government workers, if we factor in the Federal worker i would bet the number is higher.

  13. Outsider says:

    Umm, everyone’s blaming the rich here…..did “the rich” father all 366 of those babies born on welfare? Will their demands for free social services and food stop when they leave the maternity ward? Again, a big part of the problem is all the leaches that are sucking the financial blood out of our society. One third of all births are to people who are incapable or unwilling to care for their own children? THAT couldn’t be an issue; let’s just blame it all on someone other than those responsible (or irresponsible.)

  14. David Frank says:

    Outsider:well said but you are preaching on the wrong site, you know that the liberal cross section wants to take care of everyone as long as they are not paying. Since most liberals are not smart enough to be rich they want to punish the people who are rich and smart.

  15. Dad33 says:

    Also according to my math that is over $80.00 per visit. Wouldn’t it be better to just send them to a doctor in the area?

  16. palm coaster says:

    Looks like we got the whole oligarch bunch banding here now. We are broke because the thievery of the wealthy in Wall Street, the mighty banks and the collusion of the Federal Reserve and their in timely manipulation of the interest rates after 2005 when after all loaded in variable rates loans advised by Greenspan, he raised the interest rates 19 times in one year alone.
    Also we are broke because the wealthy mammoth corporations pay zero to 17% taxes only when us middle society pay 39% plus. Raise those elites taxes to the same level as ours and our budget deficit will disappear. Also end these useless wars that also only benefit the Halliburtons style thieves and cost us more than 8 billions/month. Get your tainted paws of our workers and unions.

  17. ForThePeople says:

    So according to you David only the rich are smart? Wow how arrogant can you be. You are the exact reason this county is in trouble.

  18. dlf says:

    For the people Are you the attorney who does the ads on TV for the money, oops for the people No, I said only the liberals, are not smart nor rich So not being smart or rich they want to spend all the money that belong to others.If you are smart the chances are you are not poor, cannot help what is true , I did not make up the rules or the facts, just look around and figure it out. Did not say I agree with the brains =money but it is the way things are. Do you need me to give you some examples?

  19. Liana G says:

    DFL –
    “Liana G I don’t know where you got your facts that the state is going broke because of people stealing, the bail outs were approved by people you voted in office.”

    Bottomline – the bailouts were approved by our corporate controlled government to benefit the rich corporations. However, there’s a difference between the conscientious rich and the sleeze ball greedy ones.

    “The government is going broke because we pay our government workers an average of $26.25 per hour compared to private industry worker $19.68″

    And you begrudge these people making a piddly $6.00 more per hr while the rich are getting millions for free from their screw ups and thievery. Clue to you, you are not one of them – you are a prole just like the rest of us. Yet you would rather give that $6.00 more to the rich than to your fellow citizen struggling to make it in hard times brought on by the rich you are defending.

    Yep I agree with you that only the rich are smart because they, unlike you and me, can afford the expensive education that shows them the countless ways they can steal and rob from the dumb down wanna bes, and the poor, using double speak and brain washing.

    Yes that would explain why these private companys are outsourcing even the $19.00 per hr jobs to countries where they can pay 10 cents for every dress/top/sneakers a worker sews for companys such as Disney, Nike, Aerocrombie etc. So the next time you bash those made in China products, remember many of them are American corporations you so patriotically support.

    Let’s not forget those other workers getting paid diddly squat for IT and tech support jobs also being outsourced.

    And the IRS FL refund – I bet if you dig around some you’ll find out it was some corporate scam, you know similar to the judge who was taking money from these private prisons in exchange for sending people to jail for the smallest infractions.

    The poor don’t pay taxes? Think again

    ” Claims that the richest one percent are paying far more than their fair share usually focus only
    on one type of federal tax paid (the federal income tax) while ignoring other regressive federal
    taxes, like the payroll tax, which is more significant for most taxpayers. They also ignore state
    and local taxes, which tend to tax low- and middle-income families more heavily than well-off
    families. As these figures make clear, the richest Americans are not being “overtaxed” relative
    to other Americans or relative to their share of national income.”

    Feel free to check out the following link for the full report.

  20. dlf says:

    Liana G: you need to stop blaming the rich ,the big corporations for all the problems that the government has in fact been the cause of. Who has allowed the rich to become rich, who has allowed all the big business to become big, who forced banks to loan money to people who could not afford $350,000 homes? Who is spending money we don’t have on things that do nothing to help the jobless rate. If you voted you are and were part of the problem for voting the current crew of crooks we have in Washington, wake up and take the blame instead of trying to blame every thing else. I stand by the facts that the rich pay more then their fair share, while a majority of the American people pay next to nothing or nothing in the way of FEDERAL TAX, not sales, not state but FEDERAL TAX. I would like to know the last time you got a job from a poor person or from the government?

  21. dlf says:

    Liana G the IRS refunded over $12 million to people in prison,by mistake, by not doing their job. It was a scam by the convicts not anyone else but the convict and the great employees of the iRS. That $12 million would go a long way to help the needy in Florida. Again another great job by the government, the same people who have screwed up Social Security, health care, the post office. Hell they could not get the right bodies of our fallen heroes in the right graves at the National Cemetery.

  22. Jack says:

    DLF: Did you cut and paste talking points from every conservative news outlet you could find? There seems to be not one original thought that hasn’t been parroted by every other Republiturd out there. Defrauding the government is nothing new (Gov. Rick Scott knows) and it’s not because government can’t do it’s job, but because conservative politicians who you support continue to deregulate and defund departments that are responsible for the oversight of such scams you speak of, thus making it that much more difficult to do their jobs properly.

    The only folks laughing are the big corporations running away with your tax dollars, but your too blind from the golden shower that’s raining down on you.

  23. dlf says:

    Jack:: after everything you said , which was fact-less, senseless and a little on the stupid side, what is your point or his your hat covering it?

  24. Jack says:

    DLF: Okay, a golden shower was a stretch, a santorum would’ve been a more appropriate term in your case. LOL!

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