Health officials say Nebraska’s public health budget cuts will lead to layoffs, service gaps

Governor Jim Pillen is aiming to veto more funding from Nebraska’s 19 public health districts in one of the line-item budget vetoes he detailed late Wednesday night. The vetoes were never filed with the clerk of the Legislature’s office before the deadline, so it’s unclear if the vetoes will be accepted.

In the budget bill sent to the governor’s desk, state senators recommended cutting $3.5 million from statewide public health – down from the governor’s initial recommendation of $4.5 million.

If Pillen’s veto stands and cuts the extra million, public health departments will revert back to losing $4.5 million. State senators have until the end of the session in early June to override Pillen’s veto. But even if the additional cut doesn’t hold up, public health departments would still stand to lose $3.5 million.

“The purpose of this line-item veto is simple: the COVID-19 pandemic is over, and the government public health apparatus that grew to address it must be shrunk to its pre-pandemic size,” Pillen explained in his veto letter.

But several public health directors argue that Nebraska’s public health districts are better equipped now to respond to health emergencies and provide consistent, preventative health services because of lessons learned and added funding during the pandemic.

Health districts are looking down the barrel of cuts while the threat of a measles outbreak creeps closer to Nebraska, summertime’s severe weather and dangerous heat ramp up, and the federal government’s funding cuts continue to pause and resume.

Dr. Lindsay Huse, the public health director for the Douglas County Health Department that encompasses much of the Omaha metro, said the budget cut is a decrease in the protection of critical infrastructure.

“This isn’t an extra benefit that the communities have,” Huse said. “This is basic infrastructure to assure that the health of the community is something that’s being addressed. We address a lot more than just giving people vaccinations.”

Huse spoke to Nebraska Public Media News Thursday afternoon, shortly after an executive meeting with other Douglas County Health Department leaders to discuss budget changes. Her district could lose $600,000, or 34% of its state funding. The first cuts in service could be to programs for childhood immunizations and clinics that help treat and prevent sexually transmitted infections. The department has recently stepped up its STI clinics after levels in its communities skyrocketed 450% since 2020.

As of Thursday, Huse said several of the department’s staff positions will need to be moved to be funded through different means in order for those positions to be saved.

“We are lucky in that we have a very large population that we support here, which makes us eligible for some more grants than those rural ones are able to get,” Huse said. “Luckily, my people are okay right now, but that’s not necessarily true across the state."

Terra Uhing, the public health director for the Three Rivers Public Health Department that serves mostly rural communities in the counties of Dodge, Saunders and Washington, said her district is now considering scaling back some community response, including service hours and staffing.

“I’ve been transparent with all of my employees, trying to let them know what’s happening,” Uhing said. “These are the types of things that we’re looking at.”

She’s had several contingency budget plans mapped out, depending on how much state money her district would lose. If the budget cut stands at $4.5 million, her district, which serves around 80,000 people, would lose $228,081, which Uhing said is a 37% reduction in state funding.

“I understand having to balance budgets,” Uhing said. “Even taking a bit of a cut, I can understand. This is a significant cut.”

Uhing said general funds help the health department be more active in the communities in its district. The Three Rivers Public Health Department was able to lean on its general funds to be part of the Arbor Day tornado response team in 2024, for example. It provided health resources, mental health assistance and immunizations.

“We were in the Emergency Operations Center. We were part of the meetings with all the county officials,” Uhing said. “We wanted to hear exactly what was happening, what the immediate needs were, what the health impacts were related to that tornado.”

Uhing said the tug and pull of state and federal funding could halt important work that was established with pandemic-era funding, such as staffing satellite public health offices in Blair and Wahoo. In addition to the district’s main office in Fremont, the new, smaller offices put a presence in each of the district’s three counties.

“Public health has been underfunded for decades,” Uhing said. “We were able to build some capacity and do some really good things that help with the overall wellness, health and safety of the individuals that live in our counties.”

Both Uhing and Huse said it’s hard to see the benefits of public health when it’s working and well-funded. Huse argued to senators earlier this year that for every dollar spent on public health at the local level, the district is averting around $4, conservatively, in reactive health care costs.

“Public health is invisible when it works,” Uhing said. “I’ve always told people that if I don’t make the news, I’ve done my job. Nobody hears about it because we’re taking care of all the things, and we’re preventing a lot of issues. It’s only when we become under-resourced and underfunded that we’re going to have a big problem.”