State governments are digging deep into their own pockets to prevent an outbreak of the novel coronavirus disease and prepare to address any health crisis that does occur — and they expect to be reimbursed by Uncle Sam.

As Congress debates how to fund a federal response, the seven states with confirmed cases have taken extra measures to limit the virus’s spread and states across the country are preparing testing equipment and taking other actions to prepare for a possible emergency.

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The absence in President Donald Trump’s request for supplemental funding to reimburse state and local governments worried some, but many are expecting federal money to eventually flow. 

“I’m not worried about money,” California Gov. Gavin Newsom said at a Thursday news conference. “I’m not worried about resourcing this response. It’s just not even a concern.”

Congress is negotiating a supplemental package between about $6 billion and $8 billion. The Trump administration’s request was for a package of $2.5 billion.

[Trump administration sees swift action on coronavirus package]

Newsom, a Democrat who has conflicted often with the Trump administration over immigration, environmental regulations, health care and other issues, said he had “great confidence” the administration and Congress would provide more than enough resources. Until then, the state is running record surpluses and able to meet its immediate response needs, he said.

With 11 COVID-19 cases, California has seen more cases than any other and was the site of the first case in the U.S. of person-to-person transmission in the general public. In all other reported U.S. cases, the infected person either spent time overseas recently or had close contact with someone who did.

Departments ‘activated’

Not all state and local health departments have the Golden State’s resources, though. Adriane Caslotti, chief of government and public affairs with the National Association of County and City Health Officials said even departments without a case have been “activated” to address the virus. 

“In far too many localities, that means diverting staff and limited resources from other projects — strategies that are not sustainable and which run the risk of compromising other critical work,” she wrote in an email.

Janet Hamilton, director of science and policy for the Council of State and Territorial Epidemiologists, said states depend on Centers for Disease Control and Prevention, or CDC, funding for regular programs. The additional needs from the coronavirus- caused disease demand additional resources, not just shifted from other accounts. Doing so would negatively affect people’s health, she said. 

“The concept of robbing Peter to pay Paul is not something that public health can afford,” she said. 

In New Mexico, which hasn’t seen a COVID-19 case yet, state epidemiologist Dr. Michael Landen said he expects the federal government to provide necessary funding as it did during the swine flu, Ebola and Zika public health emergencies.

But some state advocates found the administration’s proposal alarming.

‘Really concerned’

“At the end of the day, we’re really, really concerned about the administration’s request to Congress, which didn’t include any new money for state and local reimbursement,” said Casey Katims, the director of federal and interstate affairs for Washington Gov. Jay Inslee, a Democrat.

As of Feb. 19, one month after the first U.S. case was reported in Washington state, it had spent about $1.6 million on prevention and treatment.

Inslee is also concerned the administration would move money from other programs rather than rely on new spending. The governor tweeted Thursday that states need federal money but it shouldn’t come from cuts elsewhere, including programs to treat substance abuse and mental health.

Democratic leaders in Congress seemed to hold the same point of view. Senate Minority Leader Charles E. Schumer and House Speaker Nancy Pelosi said Thursday that a supplemental package must include reimbursements for state and local governments and that funding must be new, “not stolen from other accounts.”

Schumer released his own proposal this week that included $2 billion for reimbursements to state and local governments.

On the ground

The CDC said this week that the disease would eventually spread within the U.S. and its disruption would be “severe.”

States also need help from the federal government to provide accurate and sufficient testing. Early testing kits provided by the CDC were faulty, but officials are hoping to have all state health labs equipped with working tests by the end of this week and early next.

Landen, the New Mexico health official, said he thought the state would have tests up and running next week. Such tests are crucial for states to address the virus, especially in the current preparation stage.

In addition to setting up its testing regimen, Landen said New Mexico is monitoring travelers returning from China, where the virus broke out, and South Korea, which now carries the same State Department warning about the virus as China.

The state and others are also working to educate health officials and the public on the virus, asking them to report new cases and providing directions to health care providers, schools and other institutions who ask for planning help.

States have taken basic measures to educate the public. Ohio Gov. Mike DeWine tweeted Thursday that he directed the state Transportation Department to put signs in rest stop bathrooms about how to properly wash hands.

States are also preparing now for the possibility that the virus could spread within their borders, setting up crisis hotlines, checking on hospital capacity and establishing alternate care sites in case hospitals are overwhelmed. Governors in California, Michigan and New Jersey activated crisis centers or established a task force to deal with the virus.

Eric Wohlschlegel, communications director for the National Governors Association, said state responses have gone beyond state health agencies to include public safety and other departments.

“It’s an all-hands-on-deck process,” he said.

Andrew Siddons contributed to this report.