There\u2019s a good chance that local taxes will jump if Connecticut Health Commissioner Raul Pino\u2019s proposal to consolidate the state\u2019s 73 health departments into county or council of government-sized health districts is approved, Nancy Brault, the director of Monroe\u2019s health department, said. Trumbull and Monroe shared a health district until 2015. Health directors and politicians have voiced concerns about the proposal and whether the plan would be beneficial to residents. Plan Pino\u2019s plan is summarized as \u201cintegrating 73 local health departments and districts into regional health districts. The proposal will incorporate changes to the municipal payment structure along with standardizing the operations of the departments and services they provide to members of the community.\u201d The state currently offers three different models of public health service providers. There are full-time local health departments, part-time local health departments, and local health districts. Pino\u2019s plan calls for one regionalized model that would merge local departments into a regional health district. \u201cLocal health department and district staffing also varies across the state and ranges from less than one full-time employee to 60 full-time employees. Regionalization of local health departments and districts will pool resources, therefore improving staffing numbers, the delivery of public health services and the capacity to respond to public health threats in the event of an emergency,\u201d the proposal states. \u201cRegionalization will also provide governmental efficiencies. The Department of Public Health (DPH) will be able to provide better oversight and technical assistance to fewer local health departments and districts. The DPH will be able to save time and money, reducing the number of contracts and payments to local health departments and districts.\u201d Pino\u2019s plan intends to ensure that every municipality receives uniform health services. However, many health directors across the state are less than supportive of his proposal, as it would require each town and city to put aside 1.5% of the previous year\u2019s operating budget to fund the potential health districts. Monroe designated $153,365 for the Monroe Health Department in last year\u2019s budget. Under Pino\u2019s plan the town would be required to kick in an estimated $1.27 million to the health district, which would be used to provide health services throughout Fairfield County. \u201cThat\u2019s a tremendous amount of money,\u201d Brault said. If the proposal is approved, the state health department will determine the map of the health districts on July 1. At that point the departments will begin the three-year transition from local departments to the larger health districts. Concerns Brault said Pino\u2019s plan is \u201ctricky\u201d because, while the state should certainly work to ensure that everyone receives health services, consolidating the districts is not the best way to go about it. Having with one system, Brault said, would make it easier to assess the services being provided, but it would no longer allow health departments to focus on what is important to their individual towns. Stratford Health Director Andrea Boissevain said her department would have \u201ca lot to lose\u201d if the proposal is approved. Last March, Stratford\u2019s health department was one of three in the state to receive national accreditation. If the departments are merged into Pino\u2019s proposed districts, her department would no longer have the accreditation. \u201cThe proposal needed to come after having a more robust conversation about what the structure of public health should look like in Connecticut,\u201d Boissevain said. Cost Brault said that if Pino\u2019s proposal came to fruition, towns like Monroe would no longer have a health director, and that if Brault was still in Monroe, she would most likely have a different title. She also said that under Pino\u2019s plan, residents would still receive the same basic health services, but the town would have to pay for those services through a tax. \u00a0 So far, the proposal does not include information about whether the state would provide any funding to the potential health districts. David Knauf, the director of health in Darien, said that Pino\u2019s plan calls for towns to pay considerably more for health services than they currently do. \u201cI can tell you it\u2019s 10 times more in Darien than what they currently pay for a health director here.\u201d He also said the only state funding that has been mentioned is the pre-existing grants the state gives to health departments that would continue to be available to the potential health districts. \u201cWith the budget cuts we\u2019re all facing, that money might not be there in the future,\u201d Knauf said. As the districts are intended to be self-sufficient, it places the heightened public health costs on the residents of Connecticut. \u201cIt\u2019s an outrageous burden on the towns, especially as more and more state funding for different town services is being cut or held back,\u201d Trumbull Health Director Shonda Capuano said. She also said that Pino\u2019s proposal would likely cost Trumbull residents an estimated $2 million for the consolidated health district. Boissevain said the Stratford Health Department currently uses .28% of of the town\u2019s budget. Details Health directors have also voiced their concerns about the absence of details in Pino\u2019s proposal. Boissevain said \u201cthere\u2019s a lot of logistic stuff that needs to be worked out.\u201d Knauf said the proposal is more of a \u201cconcept\u201d then a plan, and that it fails to address how the consolidation would work and does not explain what would happen to infrastructure like vehicles currently used by the local departments. \u201cThere\u2019s a lot of detail work that [the commissioner] said we\u2019ll have to work out,\u201d Knauf said. \u201cFor the life of me I can\u2019t figure out how you can not have details worked out before you ask for appropriations.\u201d He also said he found himself with more questions than answers from the proposal. \u201cIt boggles my mind how we can have a bill go in front of the legislature without details of how it\u2019s going to work and supporting documents on why we need it,\u201d Knauf said. \u00a0 Capuano said the proposal \u201cdoesn\u2019t make sense,\u201d as the state doesn\u2019t have county-wide infrastructure. She also said Pino\u2019s plan doesn\u2019t outline how the health districts would improve public health. \u201c[The] proposal has never really clearly explained how it\u2019s going to improve public health service delivery,\u201d she said. She said she\u2019s curious as to why the local health directors weren\u2019t invited to be more involved with the planning on Pino\u2019s proposal. Staff The newly consolidated districts would each be maintained by a regional health director appointed by Pino. As for employees of local health departments, many part-time employees might find themselves without a job if the consolidation plan were approved. Knauf said Pino claims there wouldn\u2019t be any layoffs and that state law requires all full-time staff to be permitted to stay on when government agencies merge. However, it doesn\u2019t offer the same protection to part-time staff, Knauf said. Capuano said nothing has been mentioned about what would happen to the part-time staff. \u201cIt makes me believe that they won\u2019t be included in the transition,\u201d she said. Need? Capuano said she thinks the plan is \u201cdrastic,\u201d especially since Connecticut has been rated high on the national health scale the past few years. In December 2016, Pino announced that the United Health Foundation\u2019s 2016 America\u2019s Health Rankings placed Connecticut as the third healthiest state in the nation. In 2015 the United Health Foundation ranked Connecticut as the sixth healthiest state in America. Taking that ranking into consideration, Capuano said, \u201cwe\u2019re all scratching our heads trying to figure out why such a drastic measure has been taken.\u201d If Connecticut was lower on the list, Knauf said, he could understand why the commissioner would want to revamp the system, but it doesn\u2019t make sense to recreate the health system when the state is ranked that high. Capuano said she understands some of the state\u2019s reasoning but \u201cit seems that this one-size-fits-all approach is like throwing the baby out with the bath water.\u201d The Courier was unable to get a comment from Connecticut\u2019s department of health or the health commissioner\u2019s office. Benefits The health directors agree that all residents should have access to public health, and they support Pino\u2019s effort to ensure that the services are being carried out, but say it could be done without consolidating the departments. \u201cThe way I see it, every health department should be delivering the 10 essential public health services and there needs to be some sort of assessment to ensure that we\u2019re doing that,\u201d Brault said. The 10 essential public health services are: Monitoring health status to identify and solve community health problems. Diagnosing and investigating health problems and health hazards in the community. Informing, educating and empowering people about health issues. Mobilizing community partnerships and action to identify and solve health problems. Developing policies and plans that support individual and community health efforts. Enforcing laws and regulations that protect health and ensure safety. Linking people to needed personal health services and assuring the provision of health care when otherwise unavailable. Assuring a competent public and personal health care workforce. Evaluating effectiveness, accessibility, and quality of personal and population-based health services. Researching for new insights and innovative solutions to health problems. \u00a0 Boissevain said because the towns would be paying more for public health services, more funds would be available to provide public health services for residents. She also said that Connecticut\u2019s public health \u201ccould stand to be updated.\u201d Boissevain noted that the health districts would be able to bill residents for public health services. Not all health departments are currently able to do. The only benefit Brault and Capuano could see in Pino\u2019s plan was that it intends to provide equity assurance. Knauf, however, said he \u201cdoesn\u2019t know\u201d if there are any benefits to the plan. \u201cIf there was to be a proposal that would enhance the public health in Connecticut, certainly I would be supportive of it,\u201d Knauf said. \u201cI don\u2019t see anything in this proposal that really tells me or other health directors how this proposal is going to improve the health of Connecticut residents.\u201d Knauf recognizes that Pino\u2019s plan intends to ensure that health services are provided to all residents, but he said local health directors have asked what gaps currently exist in the system and where they are located, because that way they could be fixed without overhauling the current public health system. He said a targeted approach might provide a better solution than consolidating the districts. Boissevain said, however, that Pino had informed the state\u2019s health directors that approximately 174,000 residents are not currently receiving public health services. Resistance In addition to concerns surrounding the cost of Pino\u2019s plan, Knauf voiced worries over a loss of autonomy. \u201cThis proposal takes away local decision-making abilities from our local governments, from boards of selectmen and mayors,\u201d Knauf said. \u201cThe larger you get, the more you lose track with the local communities.\u201d Brault said many people are concerned about the loss of local focus that accompanies Pino\u2019s proposal. \u201cIt\u2019s very difficult, because in Connecticut we\u2019re all about home rule. There are costs and benefits \u2014 the benefit is that you could have better public health services but there are a lot of unknowns,\u201d Brault said. \u201cThey want their own control of their town or their district. They want to be able to focus on the type of programs that are important to them.\u201d Government response State Rep. Holly Cheeseman of East Lyme and Salem proposed a bill to prevent Pino\u2019s proposal from coming to fruition. She put forth a bill that would prevent health departments from being consolidated into health districts. Her bill is brief and concise, arguing that \u201cthe existing health district structure [should] be maintained.\u201d Capuano and Knauf both said they were pleased with Cheeseman\u2019s efforts to block the consolidation. Boissevain said there needs to be a conversation about public health at the state level and that Cheeseman\u2019s bill is more of a statement than a bill. The Courier was unable to get a comment from Cheeseman about her bill. \u00a0 State Rep. J.P. Sredzinski of Monroe said he opposes Pino\u2019s plan. \u201cThe proposed plan to consolidate all health department services into county-sized districts will not serve Monroe or Newtown well \u2014 it will cost our taxpayers more and reduce their level of service,\u201d Sredzinski said. \u201cThis proposal is not something I would support in its current form and will do what I can to stop this from becoming law.\u201d At the local level, Monroe First Selectman Steve Vavrek said he is \u201c100% against any state mandate that forces any additional tax burden to individual towns\u2019 or cities\u2019 taxpayers.\u201d Vavrek said he hopes other legislators will work to block consolidation. Brault said the town\u2019s Board of Health is opposed to the commissioner\u2019s plan. \u201cWe need more details before we commit. We need to make well-informed decisions, and it [the plan] is very open-ended right now,\u201d she said. The health commissioner will be holding an informational session about the proposed health districts at the Office of Emergency Management in Bridgeport on Jan. 24 at 10 a.m.