Four years after a devastating pandemic, the state has made no major investment to repair or improve its public health defenses.

While funding for Medicaid has soared over the past four years, the non-Medicaid fraction of the Health Department’s budget has dropped back to its pre-pandemic level of $5.9 billion. Governor Hochul has proposed boosting that amount to $6.6 billion in 2025. But that would still be 8 percent less than 2020 after adjusting for inflation.

Strikingly, on-budget funding for the department’s highest-profile public health operation, the Wadsworth Center for Laboratories and Research, has been cut roughly in half since Covid hit (see first chart).

Wadsworth played a pivotal role in combating the pandemic, including by developing an alternative Covid test kit in February 2020 after the CDC’s kits were found to be contaminated and unusable.

Lawmakers have renewed and increased capital funding for a new Wadsworth facility, but that project has been on the books since 2017.

As shown in the second chart, on-budget staffing for the department’s public health-related offices has been generally flat after substantial declines in the early 2000s.

The governor’s 2025 budget proposal calls for adding 152 full-time equivalents to the Office of Primary Care and Health Systems Management, which handles such functions as hospital and nursing home inspections and physician oversight. That 78 percent increase would return that office’s staffing roughly to its level in 2011.

The full picture of the state’s public health spending is clouded by the role of Health Research Inc., a non-profit organization that effectively functions as an adjunct to the Health Department. Funded primarily by government and private grants, HRI carried about one-fifth of the department’s workforce on its payroll as of 2020. That included 57 employees associated with Wadsworth in addition to its 216 on-budget employees.

It’s possible that HRI’s payroll has to some degree offset recent declines in staffing at Wadsworth and other Health Department divisions – but not enough to make up for their longer-term downsizing.

The relative lack of investment in public health stands in stark contrast to the pattern for state Medicaid funding, which has spiked to 38 percent higher than its pre-pandemic size. Non-Medicaid programs now account for just 7 percent of the Health Department’s overall state-funded budget, down from 11 percent a decade earlier.

The events of 2020 made clear that New York was both especially vulnerable to pandemics and poorly prepared to respond. New York City lost a greater share of its population during its first wave than almost any other major population center worldwide. The lack of a significant new investment in public health suggests that the state’s leaders are failing to learn the lessons of Covid-19.