States Are Forming “Health Alliances.” Can They Make a Difference for Public Health Policy?

The recent emergence of several state health alliances marks a new phase for public health in the U.S. These alliances include two that formed last month: the “West Coast Health Alliance” announced September 3 and the “Northeast Public Health Collaborative” announced September 18, and another just this week announced by fifteen governors called the “Governors Public Health Alliance”, which has some overlapping membership with the regional alliances. To date, these alliances have included Democratic-led states only, and a common thread across all three is a broad rejection of the Trump administration’s approach to public health and the policies of the Department of Health and Human Services (HHS) under its current Secretary, Robert F. Kennedy, Jr.

Thus far this year the administration has cut staff at HHS by over 20,000 (with the Centers for Disease Control and Prevention, CDC, losing about 3,000 workers – a quarter of its staff), sought to pull back funding for state and local health departments, implemented new, more restrictive recommendations for some vaccines, and questioned long-standing scientific data and public health guidance. Many state health leaders, especially Democratic-led ones, have criticized these changes, with the new alliances being one manifestation of that push back. While the federal government is charged with issuing guidance and making recommendations that can influence public health across the country, it is states that have the ultimate authority to decide whether and where to follow that guidance.

Given this, the effects of forming these alliances generally fall into two main areas. One is practical: even if each state will continue to determine its own public health policies, alliances can foster communication and cooperation and allow for sharing of resources when needed, without necessarily relying directly on the federal government. For example, the West Coast Health Alliance aims to help align immunization recommendations across member states while the Governors Public Health Alliance seeks to be a “coordinating hub” for state leaders to share data and develop complementary public health guidance, among other activities. That could prove valuable for states that no longer have faith in the public health recommendations coming from CDC or other federal agencies. It could aid in communication with the public by providing a more unified message across states rather than each state seemingly going its own way. The other effect these alliances may have is more symbolic and political in nature: states banding together as a highly visible rebuke to the Trump administration’s public health approach and policies.

Even before these alliances were announced, many states had already started to make moves to de-link their policies from the federal government (particularly relating to vaccines). So far this year, for example, 26 states have implemented policies to ensure that pharmacists can administer COVID-19 vaccines broadly and without a prescription, despite changes – actual and anticipated – in federal recommendations coming from the Trump administration. A smaller number have moved to require state-regulated health insurers to cover, at no-cost, vaccines recommended by the state, even if they are no longer recommended by the federal government.

While it may be unusual for groups of states to join together to develop their own public health recommendations, independent of federal guidance, it’s not completely unprecedented. In the early months of the COVID-19 pandemic (during the first Trump administration) groups of Western states and northeastern states set up coalitions to coordinate responses and share supplies and know-how across state lines in the face of what they perceived as federal government inaction. Later, Republican-led states joined together in opposing some of the COVID-19 policies imposed by President Biden. 

Whether more alliances will form or these new ones will grow, remains to be seen. Ultimately, however, perhaps the most significant consequence of their formation is further cementing what is a growing partisan divide in public health, reflected in both public opinion and state policy, and which is likely to lead to increasingly divergent public health policies and access across the country and uncertainty about the future of the relationship between the federal government and the states on key public health issues.