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Senate Bill 1455 – Health and Welfare, Public Health Services, Appropriations FY25

Senate Bill 1455 – Health and Welfare, Public Health Services, Appropriations FY25

Niklas Kleinworth
March 27, 2024

The Idaho Spending Index serves to provide a fiscally conservative perspective on state budgeting while providing an unbiased measurement of how Idaho lawmakers apply these values to their voting behavior on appropriations bills. Each bill is analyzed within the context of the metrics below. They receive one (+1) point for each metric that is satisfied by freedom-focused policymaking and lose one (-1) point for each instance in which the inverse is true. The sum of these points composes the score for the bill.

Analyst: Niklas Kleinworth

Rating: 0

Bill Description: Senate Bill 1455 appropriates $162,795,300 and 256.52 full-time positions to the Department of Health and Welfare, Division of Public Health Services for fiscal year 2025.

Does this budget enact powers and activities that extend beyond the proper role of government? Conversely, does this budget fulfill the proper role of government?

Senate Bill 1455 provides for several concerning programs, both in the base budget and in new line items, that serve purposes that exist outside the proper role of government.

As just one example, is the Maternal, Infant, and Early Child Home Visiting (MIECHV) program. This budget would appropriate an additional $482,800 for this item. This program funds government officials to enter people's homes, monitor their children, and instruct them how to parent. The program oversteps the role of government by instructing parents on "positive parenting practices." This is part of a larger federal program that is built on Social Emotional Learning (SEL), which in turn, is used as the basis for diversity, equity, inclusion, and other woke initiatives.

One additional example of government overreach and mission creep within the division is the line item for “Disease Investigation and Control.” This program subjects minorities to special studies on obesity, vaccination, and smoking. This program even expands public transportation services and “outdoor activities,” promotes vaccination, and intervenes with private businesses’ policies regarding tobacco use. Similar projects already completed by the division under the banner, Get Healthy Idaho, even spent funds to renovate parks and trails — a function currently occupied by other state agencies.

The Division of Public Health Services has an extensive history of overstepping the proper role of government in its activities. This budget continues this trend.


Does this budget incur any wasteful spending among discretionary funds, including new line items? Conversely, does this budget contain any provisions that serve to reduce spending where possible (i.e. base reductions, debt reconciliation, etc.)? 

This legislation addresses several programs that fall outside the proper role of government. The legislation includes cuts to the COVID Behavioral Risk Factor Surveillance System and two grants funding sex education.

The COVID Behavioral Risk Factor Surveillance System was a program that subjected those Idahoans who chose not to get the COVID-19 vaccine to special study. The data is recorded in a federal database. The sex education programs are funded by two grants that will be permanently removed from this budget. The first is the Personal Responsibility Education Program — known as PREP — and the second is the Sexual Risk Avoidance Education program — or SRAE. These programs purport to teach abstinence but actually teach minors how to perform sexual acts and how to view pornography.

This legislation also makes eight ongoing programs within the Division of Public Health one-time programs. This allows for the Legislature to review the function and purpose of these programs as they set the budget for the 2026 fiscal year. Some of these programs include those in the Bureau of Equity and Strategic Partnerships and several other programs that could be used to subsidize harm reduction programs.

Providing more legislative scrutiny of existing programs with questionable purposes and cutting funds that are an overreach of government reduces waste and is a positive point in this budget.


Is the maintenance budget inappropriate for the needs of the state, the size of the agency, or the inflationary environment of the economy? Conversely, is the maintenance budget appropriate given the needs of the state and economic pressures?

This legislation confirms the program maintenance budget for the Division of Public Health Services of $136,673,200, growing it from the base by 8.4% over the last three years. This rate is slower than the rate of inflation over the same period.


Does this budget create permanent programs or Full-Time Positions (FTPs) using temporary funding?

It is estimated that this budget adds 6.8 new full-time equivalent positions, using $3 million of temporary funding for the projects those staff would support. These temporary funds are from the American Rescue Plan Act. 

Using ARPA dollars to create new programs is especially egregious because those funds were intended  to mitigate the COVID-19 pandemic and were borrowed from our grandchildren. With the pandemic long gone and millions in printed federal money about to expire in 2026, agencies like this one are seeking new ways of spending it all. In the process, they call for allocating millions to programs and staff that could become permanent facets of the agency in the future.

One example of this is that the agency is requesting $187,900 to add staff to the women, infants, and children (WIC) program. This is a permanent program within the agency. However, the Division of Public Health Services must add these two new positions to qualify for $400,000 in ARPA funding to support the program. This ARPA funding is temporary while the staff and the program will remain.


Does this budget perpetuate or expand state dependence on federal dollars, thereby violating principles of federalism? Conversely, does this budget actively reduce the amount of federal dollars used to balance this budget?

Senate Bill 1455 appropriates $98,721,400 in federal funds to support the Division of Public Health Services. This funding constitutes 61% of the division’s total appropriations for the 2025 fiscal year. What is additionally concerning is that the division relies on these funds to support the cost of most of its staff members. Two-thirds of the 256.52 full-time equivalent positions in the Division of Public Health are federally supported.

This legislation would substantially increase this federal dependency within the division. The line items proposed in this budget would increase federal funds for the division by $23.6 million, or 31.5%. About $12.3 million of these funds would come from ARPA. 


Does the budget grow government through the addition of new permanent FTPs or through funding unlegislated efforts to create new or expanded entitlement programs? Conversely, does this budget reduce the size of government staff and programs except where compelled by new legislation?

This legislation removes 2.5 full-time positions funded through the ARPA Public Health Infrastructure Grant. This line item was not continuously appropriated from fiscal year 2024. This program is designed for workforce development, training, and assessments to bolster the public health workforce. Though this request still funds $3.2 million for the program, it cuts some of the limited service positions currently supported with this funding.

Some would argue that cutting limited-service positions is fruitless because they were only temporary anyway. However, it is rare that new staff added on a temporary basis are removed at the conclusion of a program. More often, temporary positions lead to permanent growth. Cutting limited-service positions through this legislation helps reduce the number of temporary positions that may become permanent later.


Does this budget contain hidden fund transfers or supplemental expenditures that work to enact new policy or are not valid emergency expenditures? Conversely, are fund transfers only made to stabilization funds or are supplemental requests only made in the interest of resolving valid fiscal emergencies?

This legislation provides for three supplemental requests.

The first is for $1.5 million in receipt authority for HIV drug rebates. These funds come from drug manufacturers as part of federal requirements under the 340B program. The state pays the asking price for these medications, then receives discounts in the form of rebates later. The receipt of these funds were delayed, requiring a supplemental appropriation to make them available to the agency.

Though this legislation contains a valid use of a supplemental, this program is concerning. The rebates received on these drugs are used by the state to purchase more HIV medications. This is one way to subsidize the HIV drug market and their use. This activity distorts the market, artificially creating demand for very costly drugs. This negatively impacts the free market because it disincentivizes innovation for cheaper medication to treat HIV and AIDS.

The remaining supplemental requests are for net-zero fund transfers between programs. First, the division is requesting to move $115,900 in personnel costs to operating expenditures, with the funds supporting its  laboratory services program. Funding for vacant positions was historically used to support the program, but language included in the division’s appropriation last year ended the practice. The agency did not expect this and did not have time to respond.

The final item is a $240,000 transfer from trustee and benefits payments to operating expenditures. The purpose is to correct an error in an appropriation for the Cancer Data Registry program. Both of these transfers are proper uses of a supplemental request.


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