Clark County Public Health Director Alan Melnick speaks to the media during the first day of a mass vaccination site at Tower Mall March 6.
A bill to create four regional public health districts across Washington and pump significant funding into foundational public health services is making progress in the state Legislature. And after several revisions, what opponents critiqued as a swipe at local control is now gaining more support.
“What originally felt like a hand slap to public health departments who have been struggling so hard to keep Washingtonians healthy this year now feels like a bill I can live with, but with some refinements,” said Jefferson County Commissioner Kate Dean, who also chairs the county’s board of health.
While HB 1152 still aims to insulate public health from local politics, the proposal no longer looks to dissolve local boards of health, which are usually dominated by elected officials. Instead, local boards of health would be required to balance elected officials with health experts and other stakeholders, and four regional offices would help coordinate shared services. The goal is to address inequities across the state.
At a public hearing last week, Pierce County Councilmember Derek Young, who also chairs the Tacoma-Pierce County Board of Health, cited “significant improvements” in the new bill.
Meanwhile, Senate Majority Leader Andy Billig, D-Spokane, told reporters last week that he’s hopeful the bill will make it onto the Senate floor, where, if passed, it would head to the governor’s desk to be signed into law.
Majority floor leader Sen. Marko Liias, D-Lynwood, also weighed in on the proposal, saying it would help depoliticize public health, pointing to the 2019 dismissal of two public health officials in his district’s Snohomish County.
“It’s been over a year. I still have no idea why our chief health officers were let go,” he said. “They went into some sort of confidential settlement and provided no transparency to the public. I think that kind of decision making just is not sound when it comes to important issues of public health.”
Lawmakers have also pointed to public health officials who have left the job during the pandemic. During public testimony for HB 1152, state Secretary of Health Dr. Umair Shah — a supporter of the governor-requested bill — told lawmakers that the pandemic has put public health officials at the center of political squabbles.
“We’ve had, at times, those health officers not being able to do their jobs or being asked not to continue in their jobs,” he said. “I’m very concerned about the public health workforce, not just across the state of Washington but across the country. There are many people that are tired.”
Across the country, public health officials have been dropping out of the field during the pandemic. Locally, when Lewis County sought to replace its retiring health officer last year, officials cited high demand — and not much supply — in their search. Ultimately, Dr. Alan Melnick and Steven Krager stepped in, taking on Lewis County in addition to several others in Southwest Washington.
Shah added that public health officials have been “vilified for making decisions that are in the best interest of protecting Washingtonians.”
Challenges
Despite some stakeholders coming around to the bill, many opponents still have their heels dug in. Clark County’s Sen. Ann Rivers, R-La Center, told lawmakers during public testimony that she had been “stewing over this bill.”
“This bill makes it seem like it’s all the local health departments, but without examining what were the failures at the state level that may have contributed to the local health departments having greater difficulties,” she said.
Shah shot back, citing the state’s favorable metrics in comparison to the rest of the country. In total COVID-19 cases per capita, Washington falls among the bottom few states, according to analyses by The New York Times and Statista.
Rivers also argued that the bill would add another layer of bureaucracy, funding for which would not reach ground-level efforts, and would diminish local control.
When funding is connected, Rivers argued, counties could be “forced into doing something that may not fit their local culture.”
Rep. Marcus Riccelli, a Spokane Democrat who sponsored the bill, agreed that there would be “accountability” with increased funding. He also pointed to the null and void clause of the bill, which ensures that the restructuring would not go into effect unless the state approved the funding to support it.
The way Riccelli sees it, the new regional centers would serve to decentralize public health, since in the current system, officials from the state — rather than a certain region — must step in when counties are struggling. The plan is for public health to be “state supported, regionally coordinated and locally implemented.”
As lawmakers work to get the bill on the Senate floor, the question of timeliness remains. While supporters say the pandemic should be the catalyst for change and that the restructuring and funding boost is long overdue, others are still wary of undergoing major restructuring before the pandemic is over.
HB 1152 moved quickly from public hearing to executive session late last month, and heads to the Senate floor next.
