Over Half of States Have Rolled Back Public Health Powers in Pandemic

By Lauren Weber, Midwest correspondent, Kaiser Health News, and Anna Maria Barry-Jester. Originally published at Kaiser Health News.

Republican legislators in more than half of U.S. states, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases.

A KHN review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the covid-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.

In Arkansas, legislators banned mask mandates except in private businesses or state-run health care settings, calling them “a burden on the public peace, health, and safety of the citizens of this state.” In Idaho, county commissioners, who typically have no public health expertise, can veto countywide public health orders. And in Kansas and Tennessee, school boards, rather than health officials, have the power to close schools.

President Joe Biden last Thursday announced sweeping vaccination mandates and other covid measures, saying he was forced to act partly because of such legislation: “My plan also takes on elected officials in states that are undermining you and these lifesaving actions.”

All told:

  • In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease.
  • At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements.
  • At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.

Much of this legislation takes effect as covid hospitalizations in some areas are climbing to the highest numbers at any point in the pandemic, and children are back in school.

“We really could see more people sick, hurt, hospitalized or even die, depending on the extremity of the legislation and curtailing of the authority,” said Lori Tremmel Freeman, head of the National Association of County and City Health Officials.

Public health academics and officials are frustrated that they, instead of the virus, have become the enemy. They argue this will have consequences that last long beyond this pandemic, diminishing their ability to fight the latest covid surge and future disease outbreaks, such as being able to quarantine people during a measles outbreak.

“It’s kind of like having your hands tied in the middle of a boxing match,” said Kelley Vollmar, executive director of the Jefferson County Health Department in Missouri.

But proponents of the new limits say they are a necessary check on executive powers and give lawmakers a voice in prolonged emergencies. Arkansas state Sen. Trent Garner, a Republican who co-sponsored his state’s successful bill to ban mask mandates, said he was trying to reflect the will of the people.

“What the people of Arkansas want is the decision to be left in their hands, to them and their family,” Garner said. “It’s time to take the power away from the so-called experts, whose ideas have been woefully inadequate.”

After initially signing the bill, Republican Gov. Asa Hutchinson expressed regret, calling a special legislative session in early August to ask lawmakers to carve out an exception for schools. They declined. The law is currently blocked by an Arkansas judge who deemed it unconstitutional. Legal battles are ongoing in other states as well.

A Deluge of Bills

In Ohio, legislators gave themselves the power to overturn health orders and weakened school vaccine mandates. In Utah and Iowa, schools cannot require masks. In Alabama, state and local governments cannot issue vaccine passports and schools cannot require covid vaccinations.

Montana’s legislature passed some of the most restrictive laws of all, severely curbing public health’s quarantine and isolation powers, increasing local elected officials’ power over local health boards, preventing limits on religious gatherings and banning employers — including in health care settings — from requiring vaccinations for covid, the flu or anything else.

Legislators there also passed limits on local officials: If jurisdictions add public health rules stronger than state public health measures, they could lose 20% of some grants.

Losing the ability to order quarantines has left Karen Sullivan, health officer for Montana’s Butte-Silver Bow department, terrified about what’s to come — not only during the covid pandemic but for future measles and whooping cough outbreaks.

“In the midst of delta and other variants that are out there, we’re quite frankly a nervous wreck about it,” Sullivan said. “Relying on morality and goodwill is not a good public health practice.”

While some public health officials tried to fight the national wave of legislation, the underfunded public health workforce was consumed by trying to implement the largest vaccination campaign in U.S. history and had little time for political action.

Freeman said her city and county health officials’ group has meager influence and resources, especially in comparison with the American Legislative Exchange Council, a corporate-backed conservative group that promoted a model bill to restrict the emergency powers of governors and other officials. The draft legislation appears to have inspired dozens of state-level bills, according to the KHN review. At least 15 states passed laws limiting emergency powers. In some states, governors can no longer institute mask mandates or close businesses, and their executive orders can be overturned by legislators.

When North Dakota’s legislative session began in January, a long slate of bills sought to rein in public health powers, including one with language similar to ALEC’s. The state didn’t have a health director to argue against the new limits because three had resigned in 2020.

Fighting the bills not only took time, but also seemed dangerous, said Renae Moch, public health director for Bismarck, who testified against a measure prohibiting mask mandates. She then received an onslaught of hate mail and demands for her to be fired.

Lawmakers overrode the governor’s veto to pass the bill into law. The North Dakota legislature also banned businesses from asking whether patrons are vaccinated against or infected with the coronavirus and curbed the governor’s emergency powers.

The new laws are meant to reduce the power of governors and restore the balance of power between states’ executive branches and legislatures, said Jonathon Hauenschild, director of the ALEC task force on communications and technology. “Governors are elected, but they were delegating a lot of authority to the public health official, often that they had appointed,” Hauenschild said.

‘Like Turning Off a Light Switch’

When the Indiana legislature overrode the governor’s veto to pass a bill that gave county commissioners the power to review public health orders, it was devastating for Dr. David Welsh, the public health officer in rural Ripley County.

People immediately stopped calling him to report covid violations, because they knew the county commissioners could overturn his authority. It was “like turning off a light switch,” Welsh said.

Another county in Indiana has already seen its health department’s mask mandate overridden by the local commissioners, Welsh said.

He’s considering stepping down after more than a quarter century in the role. If he does, he’ll join at least 303 public health leaders who have retired, resigned or been fired since the pandemic began, according to an ongoing KHN and AP analysis. That means 1 in 5 Americans have lost a local health leader during the pandemic.

“This is a deathblow,” said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. He called the legislative assault the last straw for many seasoned public health officials who have battled the pandemic without sufficient resources, while also being vilified.

Public health groups expect further combative legislation. ALEC’s Hauenschild said the group is looking into a Michigan law that allowed the legislature to limit the governor’s emergency powers without Democratic Gov. Gretchen Whitmer’s signature.

Curbing the authority of public health officials has also become campaign fodder, particularly among Republican candidates running further on the right. While Republican Idaho Gov. Brad Little was traveling out of state, Lt. Gov. Janice McGeachin signed a surprise executive order banning mask mandates that she later promoted for her upcoming campaign against him. He later reversed the ban, tweeting, “I do not like petty politics. I do not like political stunts over the rule of law.”

At least one former lawmaker — former Oregon Democratic state Sen. Wayne Fawbush — said some of today’s politicians may come to regret these laws.

Fawbush was a sponsor of 1989 legislation during the AIDS crisis. It banned employers from requiring health care workers, as a condition of employment, to get an HIV vaccine, if one became available.

But 32 years later, that means Oregon cannot require health care workers to be vaccinated against covid. Calling lawmaking a “messy business,” Fawbush said he certainly wouldn’t have pushed the bill through if he had known then what he does now.

“Legislators need to obviously deal with immediate situations,” Fawbush said. “But we have to look over the horizon. It’s part of the job responsibility to look at consequences.

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  1. ambrit

    It’s looking like diseased turtles all the way down.
    The exposure of the Federal level “Noble Lie” to limit public use of masks, supposedly in order to reserve supplies of said masks for medical personnel, basically was the straw that broke the camel’s back. Insofar as the State level politicos respond to local power blocs, this spate of anti-“expert” legislation is a clear indication of the public’s repudiation of the “official” narrative concerning the Pandemic.
    These localized political actions do not happen in a vacuum. They are responses to a real failure by the top ‘Authorities’ to adequately deal with the health crisis.
    It may be all well and good to say; “Follow the science.” However, the top level politicos forgot that Public Health is all about the Public. Dealing with the Public is not science; that is the Art of Politics.
    This is not going to end well.
    I fear that ‘this’ is not going to ever end. There is no “Back to Normal” possible now. It is basic evolutionary theory; “Adapt or die.”

    1. voteforno6

      Yes, this is about politics, so maybe we should look at where the politics is coming from – the Republican Party. Why is the Republican Party so hell-bent on pursuing policies so destructive to the public? I think that is a much more interesting question.

      1. Basil Pesto

        maybe they’re concerned about climate change and are tacitly encouraging a bit of population die-off?

      2. Synoia

        Because the Republicans see electoral advantage in the policies it pursues, and the Public is not convinced about the honesty of the politicized public health apparatus in the US.

      3. Carolinian

        I’m with Ambrit. The poor performance of the national health agencies have given Republicans the excuse to intervene. And it’s not like the Dems themselves weren’t making political hay out of the pandemic from day one. A year ago it was yet another excuse to go after their previous obsession, Donald Trump.

      4. drumlin woodchuckles

        We are getting to the point where a studied refusal to see this by people on the Left amounts to
        Liberal Democrat Derangement Syndrome and PMC Derangement Syndrome. The Democrats are not useful the way we wish they were. The Republicans are part of a rising Cultural Fascism movement working to take over and monopolise power at all levels, step by step by step. I am just lately getting convinced of this as a real danger, and the real goal of the Republican Party.

        Some Left wing analysts and thinkers won’t understand that until they are falling through the air from the helicopters they have been thrown out of.

    2. marym

      Unless Republican state legislators are magically non-elite, this conservative response is just more openly hostile to public health than neoliberal blob attempts to cloak its response — as with other issues — in an elite veneer of “the science” and “the experts.”

      1. ambrit

        Oh, I in no way excuse the Republican Party. I’m sure that State level opportunists of both legacy parties have taken advantage of the dismal and depressing ‘response” in America to the Dreaded Pathogen. Insofar as “All Politics Are Local,” the public will sooner or later force a useful response by the local health authorities to the continued depradations of the ever mutating Covid. I say this because of my increasing encounters with positively pissed off people of all classes and socio-economic levels. People have so far given the Official Medical Establishment much leeway in the responses to the Pandemic. The “Official” response has been to promise a quick and painless “Return to Normal.” The people “on the street” are beginning to see that this doesn’t rise even to the level of a “Noble Lie.”
        The ‘Official’ Medical Establishment has managed the difficult feat of throwing away decades worth of good will in less than two years.
        From what I can see, the present attempts to “mandate” compliance with this confusing and nonsensical medical regime are the flailings of a system that is in the throes of collapse. What comes next, I fear to imagine.

  2. Tom Stone

    The destruction of Public trust has taken a bi partisan effort.
    The USA is well along the road to becoming a low trust Society, Fauci’s “Noble Lie” is but one example, “RUSSIA!” another, Warren’s call for Corporate censorshiip another…
    There are and have been many and we are beginning to experience the consequences.

  3. The Rev Kev

    When reading this article, I was wondering if the legislation against public health could be mapped to a time-line of events in America to see if there were any obvious triggers and then I suddenly realized. Whatever doubts and soul-searching that any of those legislators had about the legislation that got pushed through is now over. When Joe Biden came out the other day and told America to take a vaccine or else, that was it. To their way of thinking, I am sure that this was confirmation of all their fears about public health powers going too far. So now I am confident that we will see more roll-back of public health powers as a consequence of the Feds power grab in using it. Classic blowback.

  4. Brooklin Bridge

    Nothing going on that can’t be resolved with a nice civil war among heroes. And to help out in this all American cause, with somewhat remarkable foresight, our MIC has been giving away military grade equipment to local police forces all across the country (such as army tanks to little hamlets in New Hampshire) so they can mist their fellow Americans to resolve the upcoming little existential squabbles between States by remote killing, the very essence of American heroism, pushing a button while safely hot dogged in a metal bunker far away from the kill zone, or conversely, getting oneself killed with absolutely no idea of why they are doing so.

  5. Fritzi

    Ah, wonderful.

    No evil deity could do a better job at getting us to set ourselves up.

    Maybe there is a Nyarlathotep after all.

  6. Kengferno

    Every day it seems there’s at least one article that chills me to my increasingly weakened bones and has me contemplating the demise of humanity due to our own incompetence as a species. And this is perhaps the MOST chillingest article. Which is really saying something…

  7. Larry Y

    We’re a country of Typhoid Mary’s (Covid Karen? What’s the male equivalent? Ken for alliteration?).

    Or that person in a zombie movie who’s been bitten but hides it. Enough with the sequels…

    Seriously though, the lessons from 100 years ago have not been learned. Be it 1918 Flu with masks and ventilation or Typhoid Mary. With the asymptomatic/presymptomatic spread, I can see parallels with Typhoid Mary. Need to treat people with dignity – she still needs to make a living, see friends/family, etc.

  8. Pookah Harvey

    Covid was a test and only a test, and we flunked dramatically. Not only did we learn nothing, we dramatically weakened any future response when the REAL (high mortality rate) pandemic hits. All hail the corporate god of short term profits over everything, including what should be actual common-sense.

  9. Bob Blake

    The covid virus has adapted to changes in the environment as it is designed to do via nature. To date it has done a hell of good job.

    The human species has adapted to these changes by retreating to the glorious past life of freedom from (fill in whatever).

    Personally I am not one to bet against nature being considerate of human ignorance and the plunging heads into holes in the ground.

    I find it interesting and worthwhile to keep tabs on those vanquished diseases like, for instance, measles. Or the childhood respiratory diseases that rarely show up but now for some unexplained reason they are showing up more and more and earlier.

    I seem to remember hearing that the virus flu would disappear when summer came. Then I remember hearing the virus flu would mutate into the common cold. Then I remember hearing that in just a few more months down the road the virus would fade away. Then I remember hearing…..

    It’s probably fake news of course but I did read that the Chinese government is vaccinating everyone in China and wants to finish the job by October 31st. Now say what you want about the Communists but I really don’t believe the Chinese are stupid. Why the push to vaccinate over 1 billion people in 60 days?

    Nature can be a real tough taskmaster and in fact, it does not care at all what any of us think or hope or pray for.

  10. LAS

    Public health has been in decline for 40 years or more, as the profession well knows. This is just a perpetuation of trying to discredit the profession, box it in and down. Very few in the profession have authoritative powers; most of the profession is working on social/environmental distributive research, information sharing and best practice in regulation of corporate product/worker safety. As politicians increasingly cater to wealthy, influential donors, they have disinvested in the American population itself; they have disinvested in fair distributive sharing of social gains, so they are very anti-public health. To the extent they are interested, it is mostly in the public health police powers which they would like to direct for their own benefit … the lack of interest in core public health functions shows in widespread poor health, decreasing life expectancy, decaying infrastructure, and so forth.

    If you were to ask me, I’d say health and longevity are the main metrics of both good governance and good economics. Our decline as a country shows in our decline in health.

    The new Texas laws against women seeking abortion — if allowed to stand — will by itself knock a few more years off the life expectancy of all women. All women will lose health care privacy because they will all be subjected to challenge — even those not seeking an abortion. Just as vigilanties hunt down colored people they deem to be suspicious (even though they’re doing something a white person does without question), so too will they be doing to women. This will affect everyone.

    1. drumlin woodchuckles

      Ian Welsh wrote a post about the Texas anti-abortion law. Some of the comments featured actions by people designed to degrade the functionality of elements of that law’s enforcement infrastructure. Here is the link.

      Any rat fink vigilante beginning an anti-woman lawsuit action under this law will have to identify itself somewhat in the process of filing the suit. This should allow digital activists to dox every aspect of that vigilante suit-filer’s life and existence, and should help swarms of activists destroy that person’s life, perhaps visibly enough to deter other people from sueing under this law.

      If rat-fink tiplines are re-established and find somewhere to host, hackers may well try to get inside them to see and dox the rat finks who are calling in tips. That might cause the supply of rat finks to dry up.

      In a one party state situation where electoral politics offers no benefit or hope or hope of benefit to anyone not supporting the one party’s agenda, people will take these more effective forms of direct action.

  11. James Simpson

    It is, obviously, vitally important for the freedom of True Americans that government be prevented from doing anything to help or protect them, except by means of cutting taxes for the rich. That’s what makes America so great, isn’t it?

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