The Public Health Cost Crisis No One Is Talking About: Why Delaying Your Plan Is Costing More Than You Think
- JoAnn Andrews
- Nov 18
- 4 min read
Across the country, counties are facing a financial reality most have never seen before. Preventable disease rates are rising, homelessness and housing instability are reshaping local budgets, federal oversight is tightening, and local governments are bracing for another year of fiscal uncertainty.
Yet in the middle of all this, one issue remains unaddressed:
Most counties still cannot quantify the true annual financial burden of preventable health and social conditions — and that gap is costing millions.
This is no longer a mild administrative inconvenience. It has become a fiscal liability.
As one county administrator recently shared, “Our board keeps asking what our preventable conditions cost us each year — and we don’t have the numbers.”
And they aren’t alone.
What is happening in 2025 is not a single crisis. It is a convergence of four accelerating pressures hitting counties at the exact same time:
1. Rising costs of preventable disease
2. Housing instability straining local systems
3. Audit scrutiny unlike anything counties have experienced in a decade
4. Local government fiscal uncertainty — with another shutdown threat looming
Together, these pressures create a perfect storm for public health leaders. And delaying your CHNA, CHIP, or Cost to the Community™ analysis is no longer neutral — it is both financially and politically costly.
The Rising Price of Preventable Disease — And Why Counties Are Being Asked to Prove the Numbers
Preventable chronic disease is now one of the largest hidden financial drains on county budgets.
According to the CDC, chronic diseases account for 90% of the nation’s $4.1 trillion in annual healthcare spending. Much of that cost is downstream — EMS calls, avoidable emergency visits, uncompensated care, and county-funded services.
The reality at the county level is sobering:
EMS systems are responding to avoidable diabetic crises
Hospitals are boarding behavioral health and substance-use patients
Jail health systems are overwhelmed with chronic disease management
Local clinics are seeing surges in unmanaged hypertension and COPD
But here’s the critical shift:
Boards, auditors, and commissioners now expect counties to show the documented, dollar-based impact of these conditions.
Not trends.
Not assumptions.Actual financial burden.
This is where the Cost to the Community™ analysis becomes essential — because it translates preventable conditions into fiscal terms counties can defend:
Estimated annual cases
Cost-per-case from validated national sources
Total county burden
ZIP code hotspots
ROI modeling for targeted interventions
In a fiscal climate this volatile, having these numbers is no longer optional — it’s your shield.
Housing Instability Is Becoming a County Budget Crisis — And It’s Accelerating
Housing instability is now one of the fastest-growing prevention and cost drivers for local governments.
Counties are absorbing the financial fallout through:
Jail health costs
Emergency room boarding
EMS repeat transports
Crisis services
Behavioral health emergencies
Child welfare involvement
Court and administrative burden
A recent HUD report showed that homelessness increased by 12% in a single year, the largest increase since tracking began.
But the fiscal impact on counties is far greater than the federal numbers show.
County leaders report:
“Our homelessness numbers went up 9%, but our costs tripled.” “Housing instability is the root cause of everything we’re dealing with.”
Counties across the U.S. report that one person experiencing chronic homelessness can cost $30,000–$50,000 per year in EMS, emergency care, crisis stabilization, and jail services.
Yet counties often cannot quantify:
The true annual cost of housing instability
Which ZIP codes are driving the cost
Which interventions reduce the cost
How to effectively present the issue to commissioners
This is where your CHNA and Cost to the Community™ analysis provide clarity county leaders cannot get anywhere else.
Audit Readiness Is Tightening Nationwide — And Unprepared Counties Are Being Exposed
2025 has brought a wave of intensified accountability.
Between federal grant restructuring, OMB tightening, and DOGE oversight, counties are facing:
More grant reconciliation requirements
More reporting demands
More fiscal scrutiny
More pressure to quantify outcomes
The counties most at risk of audit findings share three characteristics:
They cannot quantify the annual cost of preventable conditions
They cannot demonstrate fiscal impact of interventions
They cannot align spending to PHAB or state planning standards
This leads to commissioner pressure, auditor frustration, delayed funding, and weakened budget negotiations.
If counties don’t have a defensible fiscal narrative, others will create one for them — and it will not be favorable.
Local Government Fiscal Uncertainty Means Every Delay Costs More
States across the U.S. are facing projected shortfalls, Medicaid unwinding, workforce strain, and unpredictable appropriations cycles.
County governments feel this first.
Add the real possibility of another federal shutdown, and administrators are navigating:
Funding unpredictability
Delayed reimbursements
Rising operational costs
Legislative pressures
Shrinking workforce capacity
In environments like these, boards want:
Clear, defensible reports
Documented ROI
Prioritized action
Efficient use of limited funds
Your CHNA Express™ (45 days) and Cost to the Community™ (10 days) deliver exactly that.
This is why delaying planning is now the single most expensive mistake counties are making.
The Real Consequence of Delayed Planning: Your County Loses Leverage
When counties delay their CHNA, CHIP, or fiscal analysis, four outcomes occur:
1. The cost of preventable conditions increases faster than expected.
2. Housing instability spreads across systems.
3. Audit exposure increases.
4. Fiscal planning becomes reactive.
Delaying your CHNA or fiscal analysis does not maintain the status quo —it accelerates the financial and political exposure your county is already feeling.
A Standardized, Fast, Audit-Ready Solution for Counties
Ascendant Healthcare Partners™ designed two solutions specifically for this moment in local government:
✔ Cost to the Community™ — Delivered in 10 Days
A proprietary, county-specific financial impact analysis that documents:
Annual cases
Cost-per-case
Total county burden
Geographic hotspots
ROI scenarios
Counties use this in:
Budget presentations
Board meetings
Audit responses
Legislative requests
There is no competitor nationally offering this analysis.
✔ CHNA Express™ — PHAB-Standard in 45 Days
AHP’s CHNA Express™ is the nation’s only 45-day, PHAB-standard CHNA, designed for counties facing:
Fiscal deadlines
Auditor pressure
State compliance standards
Tight staff capacity
It is audit-ready, board-ready, and built to protect funding.
You Cannot Enter 2026 Without Your Numbers
County budgets no longer bend — they break.
Administrators with numbers can protect funding.Administrators without them lose leverage.
You have a short window to prepare for the next budget cycle, audit request, or crisis.
This is the moment to act.
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