Public health is about to get more expensive in Adams and Arapahoe counties, as the rapid unraveling of the Tri-County Health Department forces both metro counties to figure out how to best safeguard the wellbeing of more than a million residents amid an ongoing global pandemic.
That’s the conclusion of a consultant’s report released last week, which calculated that Adams and Arapahoe counties will have to spend millions more to provide public health services whether they join forces or choose to each go it alone.
The difficult — and sudden — choice facing the two counties stems from Douglas County’s decision last month to break off from Tri-County and form its own health department following a months-long battle over COVID-19 public health orders, culminating with Tri-County’s directive that all students be masked while in school.
Douglas County had been the third member of Tri-County since 1966. The public health agency has provided services like disease surveillance, vital records and infectious disease protection to a large swath of the metro area population for more than 70 years.
The report, from the Otowi Group LLC, states that Arapahoe County’s annual tab to go solo would leap from the $4.8 million it currently pays Tri-County to $8.4 million. Meanwhile, Adams County would pay $6.5 million a year as its share to operate its own health department, well above the $3.8 million a year it contributes to Tri-County for health services.
An Adams County health department would have an overall $18.5 million budget with 158 employees, while Arapahoe County’s agency would have a budget of $22 million with nearly 200 employees, Otowi Group said. Aside from the county contributions, the agencies’ revenues would come from the Colorado Department of Public Health and Environment and from what is raised through grants and contracts for service.
Even if the counties partner in a single public health district, the report says, more than $6 million in “additional needed” funding beyond what the two counties now pay Tri-County is required. And that’s not to mention the $61 million in “transition costs” that Otowi projects the disassembly of Tri-County will generate.
“Whatever we do, we want to make sure we have a seamless health department for our residents,” Arapahoe County Commissioner Nancy Jackson said. “This is not going to be an easy decision. This will take some time.”
Concerns about cost estimates
Already there is pushback on some of the consultants’ numbers, with Adams County Commissioner Steve O’Dorisio calling them an “inflated, worst-case scenario” that needs to be “analyzed more.” His colleague, Commissioner Eva Henry, said of the report: “There are holes in it.”
Both commissioners question how much Adams and Arapahoe counties will be on the hook for separation costs, $50 million of which the report pegs as pension obligations under the Public Employees’ Retirement Association, or PERA.
“There’s no evidence that we ever signed anything as a county that we were responsible for PERA,” Henry said.
Attorneys for the county, she said, are poring over the financials of Adams County going forward with its own health department or pairing with Arapahoe County, and she expects that she and her colleagues will make a decision on what to do by Dec. 1.
Chris Henning, a spokesman for Arapahoe County, acknowledged that creating a standalone agency or partnering with Adams County “results in a cost increase to the county.” But he said final costs will likely change based on the “specific mix of programs that are needed for Arapahoe County residents.”
And that’s where the auspicious aspects to going alone on public health come through, Henry said.
“The greatest benefit is targeting our health services to the needs of Adams County residents,” she said. “This has made us really take a look at our health department and how to make it better.”
That was part of Douglas County’s philosophy when it broke away from Tri-County, saying it had a much different demographic and health picture than its two partner counties. The county, which will still contract for services from Tri-County through 2022, hasn’t yet pinpointed a cost to run its own health agency, but Commissioner Abe Laydon said he is “not interested” in paying more than the $2.5 million the county paid Tri-County a year.
Counties’ differing needs
The three counties that made up the Tri-County Health Department are significantly different from each other and different from what they once were, O’Dorisio said. Adams County, for example, had just 40,000 residents when it joined Tri-County after World War II. It now has 520,000 residents.
“Each of these communities is growing and we each have different challenges and needs,” he said. “I believe the pandemic just highlighted those differences and accelerated the inevitable.”
Adams County faces unique health and environmental challenges with the Suncor Energy oil refinery in Commerce City and the county’s extensive oil and gas production sector, both of which present air pollution and water contamination concerns. Suicide prevention and family planning, especially in communities of color, are also issues that Adams County grapples with to a greater degree.
O’Dorisio thinks a hybrid model — operating independently yet still coordinating on some services — might be a feasible middle ground that could work for both counties.
“I think we need to be open-minded to work with other jurisdictions on things that make sense; specifically, things that are not unique to individual jurisdictions,” he said. “Then we can focus on those items that we need to address in our community, such as environmental health, economic equity and other local public health issues.”
As for Tri-County itself, deputy director Jennifer Ludwig said the agency would like to remain a “district health department serving Adams and Arapahoe counties, focusing on both delivery of core public health services as well as programs uniquely targeted to the needs of each county.”
“Due to its size, history, reputation and expertise, TCHD is very competitive in receiving grant funding in order to provide needed programming in the communities we serve,” she said.
She said it’s not clear if individual county health departments would be able to access some of the grant money Tri-County is able to tap into.
“Also lost would likely be some of the expertise and specialists that TCHD has the ability to attract, recruit and retain, who themselves have played key roles in our ability to apply for competitive funding and delivering a breadth of high-quality services,” Ludwig said.
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