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Local public health officials, responsible for steering the state鈥檚 covid-19 response, had asked the Democratic governor for $200 million per year for the nuts and bolts of public health, starting in the 2021-22 budget year, which kicks off July 1.

But Newsom did not grant their request in his $268 billion budget proposal released Friday, despite a projected budget surplus of $76 billion. If Newsom does not change his mind before the budget is finalized, this would mark the third consecutive year he has denied funding requests to help rebuild California鈥檚 devastated public health infrastructure and workforce, threatening the state鈥檚 ability to control covid and prepare for future threats, public health experts say.

鈥淲e鈥檙e extremely dismayed and disappointed,鈥� said Michelle Gibbons, executive director of the County Health Executives Association of California. 鈥淲e can鈥檛 wait until the next pandemic or public health crisis to start thinking about funding public health. We have to do it now.鈥�

California鈥檚 61 local public health departments are responsible for keeping their communities safe but, throughout the pandemic, city and county public health leaders had to functions, such as , communicable disease testing and because they do not have enough staffing or resources.

Last year, in the thick of the crisis, Newsom the state couldn鈥檛 afford to boost local public health budgets. California was staring down a that required the governor to retreat on his biggest health care ambitions.

But the unexpected surplus projected by the Newsom administration this year 鈥� fueled primarily by 鈥� is allowing the first-term Democrat to dream big again. Newsom wants to expand the state鈥檚 Medicaid program for low-income people, called Medi-Cal, to income-eligible unauthorized immigrants age 60 and up, at a cost of $1 billion in the first year. He proposes to spend $7 billion to convert hotel rooms into permanent housing for homeless people. He鈥檚 calling for new mental health and substance misuse services for kids and teens in schools. And he is spearheading a major transformation of Medi-Cal to expand behavioral health treatment and social services, such as food and housing assistance, for homeless, formerly incarcerated and other medically vulnerable people.

The federal government provides the lion鈥檚 share of public health funding in California, and Newsom鈥檚 budget would use tens of billions in additional federal covid relief money to support state and local public health agencies. But health care leaders say federal spending does not sufficiently support ongoing public health infrastructure needs such as staff compensation and data collection systems.

鈥淵ou need strong public health and you need a strong health care system, and to think that you can invest in one to the exclusion of the other is just foolhardy,鈥� said , chair of the department of epidemiology and biostatistics at the University of California-San Francisco.

Public health leaders say an infusion of $200 million annually could help fund long-term staff positions including nurses and epidemiologists, pay for new public health laboratories 鈥� the state has lost 11 since 1999 鈥� and rebuild obsolete data systems that , a problem that officials say has cost lives during the pandemic.

Asked why he did not provide the funding in his budget blueprint, Newsom pointed to proposed investments in other health care programs, such as his transformation of Medi-Cal, expected to cost $1.5 billion per year, and $300 million for public hospitals.

鈥淚 hope folks celebrate that,鈥� said Newsom, who will likely face a Republican-driven recall election this year. He added that his budget proposal is simply a starting point for negotiations with state lawmakers that will continue over the coming weeks. The legislature has until June 15 to send a revised budget proposal to him for approval.

But state Democratic lawmakers, who control both houses of the legislature, don鈥檛 think Newsom鈥檚 proposed investments in Medi-Cal and public hospitals are enough. For the first time, the leaders of the Senate and Assembly and the chairs of the health committees in both houses are publicly calling on the governor to invest in local public health departments, too.

鈥淲e know how difficult the past year has been for public health officers and our county public health staff,鈥� said Senate President Pro Tempore Toni Atkins. 鈥淭heir commitment is tireless, and they鈥檝e gone above and beyond in their efforts to protect our health and safety during the pandemic.鈥�

Assembly member Jim Wood, who chairs the Assembly Health Committee, said he would personally lobby Newsom.

鈥淯nknown to the average Californian, there has been an ongoing erosion of funding for local public health departments,鈥� Wood said. 鈥淐alifornia has let its guard down and made us all susceptible and vulnerable to future health threats.鈥�

Without additional money, lawmakers fear, the state will fall further behind on controlling communicable diseases like measles and tuberculosis, and chronic diseases like heart disease and diabetes.

鈥淲e can do more,鈥� said state Sen. Sydney Kamlager (D-Los Angeles), who is calling for a 鈥渓ong-overdue reckoning.鈥�

鈥淎n ongoing $200 million investment will not only help heal and restore a public health system left shaken from the devastating covid-19 pandemic but is essential in preparing for the crises that are already here, like the sexually transmitted infections epidemic and the ones to come,鈥� she said.

State Health and Human Services Secretary Dr. Mark Ghaly said the Newsom administration is eyeing 鈥渙ngoing funding鈥� for local health departments, but not until next year. He pointed to $3 million in the governor鈥檚 current spending plan that would identify the public health system鈥檚 long-term needs and assess 鈥渓essons learned鈥� from the coronavirus pandemic.

Assembly member Phil Ting (D-San Francisco), who chairs the Assembly Budget Committee, agreed that a detailed inventory of the state鈥檚 public health needs is critical.

鈥淲e definitely need to make an investment in public health infrastructure,鈥� Ting said. 鈥淏ut what counties seem to want is a blank check.鈥�

Newsom is expected to face intense lobbying on public health and other health care proposals. Some lawmakers expand Medi-Cal eligibility to all unauthorized immigrants in California, an expensive proposition that the nonpartisan Legislative Analyst鈥檚 Office says could . Newsom also faces pressure to go bigger on mental health and homelessness, and to increase state-based financial assistance for people purchasing health coverage through the Covered California health insurance exchange.

鈥淭his is not just about providing some justice to public health and essential workers who have struggled throughout the pandemic, but about making a health care system that is stronger with everyone included,鈥� said Anthony Wright, executive director of the nonprofit advocacy group Health Access California.

This story was produced by , which publishes , an editorially independent service of the .