Shrinking Safeguards

What happens when public protection becomes expendable.

I recently returned to Toledo, Ohio for a very brief visit. I have spent half my life there, and the majority of my adult life. Being back reminded me of things I once took for granted, both about the city and about modern life in America.

One memory stands out in my mind.

Several months into the pandemic, I was working in the dispatch office. The virus running amok across the country, and Toledo was no different. Lucas County was surprisingly flush with 8 hospitals for a population of around 430K, but there were limits to what the system could absorb.  

When a hospital could no longer safely take in and provide a full standard of care for ambulance patients, it could request a status called "EMS Bypass". It was asking ambulances to take patience elsewhere. One or two hospitals might spend time in this status on a typical evening as car accidents, misadventures, and various maladies brought patients through their doors

That evening, one at a time, I heard each hospital report over the radio that it needed to go on bypass.

There was no more capacity for business as usual.

For a few hours, we turned to a protocol reserved for extraordinary circumstances. Except for patients whose conditions required particular destinations, hospital assignments rotated to distribute the overflow. Inside the hospitals, staff worked to free resources, find alternatives, and triage scarce options.

It was a frightening moment when something easily taken for granted vanished. Thanks to work done outside public attention, there were plans for managing that convergence of circumstances. Those plans gave people a coordinated way to act when ordinary capacity failed.

I had previously interned with and worked alongside the Hospital Council of Northwest Ohio, now the Health Council of Northwest Ohio. Through that experience and similar work elsewhere, I understood something of what stood behind those procedures: long conversations, bargaining, analysis, exercises, and difficult decisions made before anyone needed the answers urgently.

Hospitals are separate organizations with their own resources, responsibilities, and constraints. A shared emergency requires them to work together. Healthcare coalitions bring healthcare providers, emergency responders, public health, and other partners into that preparation. Federal support, particularly the Hospital Preparedness Program, helps sustain that work.

Someone has to maintain the agreements, test the procedures, identify the gaps, and update the plans as personnel and capabilities change. A plan left in a binder cannot do that work for us.

Yet the funding that supports these safeguards is repeatedly treated as expendable.

The Trump administration’s FY2026 budget proposed eliminating HPP’s $240 million in funding. The program survived: ASPR announced $240 million for the funding period beginning July 2026. But the administration’s FY2027 request again proposes eliminating it. These are elimination proposals, not evidence that the program has already disappeared. They are evidence that people responsible for maintaining preparedness must repeatedly defend the means to do so.

Other reductions have already reached communities. In February congressional testimony, Maryland officials reported that the National Capital Region’s Urban Area Security Initiative grant had been cut by 44%, more than $21 million, between federal fiscal years 2024 and 2025. UASI supports regional security and preparedness. The testimony described reductions in personnel and capabilities following losses across federal preparedness grants.

Then there is the use of protective funding as leverage. On September 28, a federal judge blocked the administration’s attempt to withhold 20% of counterterrorism grant funding unless state and local governments changed election procedures. The court found that those conditions exceeded FEMA’s authority.

Public protection had become a bargaining chip in a dispute over how another public function should operate.

A cut, an elimination proposal, and a threat to withhold funding are different actions. Each weakens the ability to plan and sustain protection. Organizations cannot confidently retain people, maintain partnerships, or make long-term commitments when the resources beneath them are repeatedly put in question.

The needs do not disappear with the money. They move. Local governments must find replacement funds. Hospitals absorb more strain. Responders cover the gaps. Families wait longer, travel farther, or discover that the help they assumed existed is no longer available on the terms they expected.

We should be suspicious of any accounting that records the savings while leaving those consequences off the page. A public expense can be reduced by transferring its cost to someone with less power to refuse it. That does not establish that we have become more efficient, or safer.

Stewardship requires an honest account of what we are responsible for preserving. Preparedness programs should be evaluated, corrected, and held accountable. Anyone proposing to cut or dismantle one should also explain what protection will be lost, what will replace it, and who will carry the risk in the meantime. Political disagreement does not release officials from their obligation to protect the people affected by it.

I remember those hospitals calling in, one after another. The people answering the radios and caring for patients could not postpone the emergency until a more convenient budget year. They had to work with the capacity and preparation already available.

When the next call comes, that will be true again. What they have to work with is being decided now.