OLYMPIA — A sweeping bill that aims to restructure Washington's public health system has passed its first hurdle in the state House of Representatives despite concerns from some county officials about the timing and some specifics of the bill.
The bill, proposed by Democratic Spokane Rep. Marcus Riccelli, would create new regional service centers to support local public health jurisdictions, change the makeup of local public health boards and establish an advisory board to oversee the state's public health system. It passed 56-41 with mixed reactions.
"We need to come together for predictable, stable public health that we've woefully underfunded," Riccelli told the Spokesman-Review. "This helps us leverage new resources so we can make our way toward fully funded public health services."
The bill began as an idea from Gov. Jay Inslee to regionalize the state's public health system, but it has changed drastically since its first introduction.
The new version of the bill is the outcome of a bipartisan compromise between Riccelli, Republican Rep. Joe Schmick of Colfax, and others, after Republicans and local public health officials raised concerns that a total regionalization could take away local control and funding.
As passed Monday, the bill would establish four regional comprehensive public health district centers to coordinate shared services across local health jurisdictions and the state. Counties have until Jan. 1, 2023, to choose which district they plan to join, with two forming on each side of the state.
These districts would provide shared services to all local health jurisdictions. For example, a small local health jurisdiction that does not have an epidemiologist or a poison expert could use one through the shared service center.
Schmick said public health officials have had conversations about how to address the lack of shared services for years, and this idea builds upon that.
Each regional district center will also have two newly created positions: a regional health coordinator who will coordinate services and a regional health officer who will provide support for local health officers. A regional health officer may also step in locally if a local health officer is fired or leaves.
This plan will expand what many health jurisdictions are already doing with shared services, but it would require all counties to join, Riccelli said.
The bill leaves much of the function of the regional centers up to the Foundational Public Health Services Steering Committee, which would now be tasked with determining standards and practices for the regional centers. It would also recommend how funding is allocated for shared services.
In the floor debate Monday, Republicans had concerns that even the new regional approach was taking away local control. Rep. Jim Walsh, R-Aberdeen, said this bill could be a "slippery slope" that could lead to less control at a local level.
Schmick said the new version keeps autonomy at the local level. The regional districts are meant to be "a supporting role," he said.
"The goal is trying to leave as much authority with local counties as possible," he said.
Some at the county level have similar concerns.
The state association of county commissioners as well as the Spokane County commissioners still oppose the legislation even in its current form. Commissioner Mary Kuney, who also is the chair of the Spokane Regional Health District Board of Health, said the proposal should wait.
"This isn't the time to do this — let's get through this (pandemic), and let's take a look to see how things went," Kuney said.
All of the new regional services are dependent on the state allocating more funding to public health in the next biennium. The creation of the regional centers will only happen if the state provides foundational public health services with at least $60 million for 2021-2023, slightly more than half of what it currently receives.
Many local health officials were concerned these new services would split the current funding, which they say is already less than what is needed. Riccelli said this proposal wouldn't do that.
"We put the null-and-void clause in to say we're serious about the need to be funding," Riccelli said. "This would be a significant investment."
If that $60 million is met, the funding breakdown would still prioritize local health jurisdictions. The first $30 million would be used how it always has been, allocated by the state to local jurisdictions. About 65% of funds above that first $30 million would be allocated toward shared services in the next biennium. The remaining funds would be allocated locally by the Department of Health.
Schmick said there are still some legitimate concerns from counties about the funding piece of this proposal.
Public health has been underfunded for years, and currently on the SRHD Board of Health, the county, not the cities with representatives sitting on the board, are paying for public health. This discussion of local funding sources has cropped up multiple times in the last year during SRHD board meetings, and House Bill 1152 brings it to the surface, as well.
"If you're trying to get cost efficiencies then doing some regional things makes sense for counties that can't afford it versus those that can," Kuney said.
However, she noted the bill goes beyond that with additional positions, including four regional health officers and coordinators that will need to be paid.
Beginning in 2024, the bill authorizes the Department of Health to allocate all funding based on recommendations from the Foundational Public Health Services Steering Committee.
Throughout this session, the Legislature has been looking at different ways to increase funding to public health, including a tax on sugary drinks and a "covered lives assessment" where health insurers are charged $1.54 per member per month.
Neither proposal made it out of committee on its own, but both could make their way into a final budget proposal at the end of the session.
Another portion of the bill involves changing the composition of local public health boards, a proposal Riccelli has worked on since last fall after the SRHD fired former Health Officer Dr. Bob Lutz.
Riccelli expressed disappointment in the firing of Lutz, which he called an example of how politics has infiltrated public health. If Riccelli's bill passes, it would require each local health board to include an equal number of city and county elected officials and nonelected officials. Nonelected officials are chosen from three categories: public health, health care facilities and providers; consumers of public health; and other community stakeholders, such as nonprofits or business communities. It must also include a tribal representative if the county is home to tribal land.
An amendment passed Monday that would limit the requirements for local boards of health to apply only to counties with a population under 800,000, specifically to address concerns from Snohomish County where the board is currently composed of 15 county and city officials.
The proposal as it is currently written would increase the number of board members on the SRHD Board of Health, however, broadening out membership to local stakeholders and medical professionals in the community. Koney registered concern that Spokane County would have to comply, while Snohomish, King and Pierce Counties would not have to comply with the new board member requirements .
"It's concerning to me that ... if this is really good policy, that they're choosing to not make it uniform across all counties," Kuney said.
The bill also creates a public health advisory board that will determine the use of the state's public health funding, provide feedback on public health, monitor the performance of the public health system, and develop long-term goals for public health in Washington.
Its most immediate task will be analyzing the state's COVID-19 public health response, Riccelli said.
Kuney, like some House members on Monday, said she is perplexed at what the bill is trying to accomplish. Kuney said she wants to have these conversations and work toward solutions. S he is hopeful the Legislature will let the proposal die in order to work on other solutions.
"What are we trying to fix here?" she asked. "That's what I still don't know."
Some Republicans expressed concern Monday the bill was moving too fast. Riccelli and other Democrats have argued the pandemic has shown the importance of adequately funding public health and creating shared services across the state.
Inslee first proposed the idea in December and made public health a priority in his budget proposal. While the bill looks different than his idea, it will likely still have his support. When asked about the bill's changes last month, Inslee said he hadn't looked at the full proposal but he would be supportive of a plan that puts science at the forefront of public health decisions.
"If that would advance that cause, I support it," Inslee said in a news conference.
The bill now heads to the Senate for further consideration where it will likely face even more changes. It's a work in progress, which was always meant to be a sessionlong discussion, Riccelli said.