Maybe Clark County Public Health Officer Dr. Alan Melnick needs to advocate for public health in a cuter way? If only he could fit orcas into his advocacy.
From 2003 to 2018, Clark County Public Health’s biennial revenue has dropped by close to $7 million, while the county’s population has risen by about 80,000 people. State foundational support has mostly flatlined at around $3.5 million over the last decade, and total funding from the state, which can include grants and other funding streams, has fallen by more than $3 million.
Local revenue to Public Health has increased by more than $3 million during that time period.
Gov. Jay Inslee’s 2019-2021 budget allotted up to $22 million to public health foundational services across the state, but the actual dollars will fall short of that pledge, Melnick said. There are new bills this session that could help increase funding, but if those bills don’t pass, health agencies across the state will have to cope with another decrease.
“We’ve been dealing with declining funding and revenue streams for many years,” Melnick said.
Public Health’s revenue is made up of fees, state, county and federal funding, and grants. State funding has seen the most drastic cuts, Melnick said, which stems from the fact that if Public Health does good work, its efforts go unnoticed.
Clark County Councilors Temple Lentz and John Blom said it’s difficult to procure funding for Public Health, because it’s not flashy. They compared it to the advocacy last year that led to bills being passed to help protect orcas in Washington. Blom said those environmental bills were important, but mentioned there’s not thousands of people showing up in Olympia to stump for better immunization records, like there are for orcas.
“I don’t know if an orca is cute, but it’s not as cute as an orca,” Lentz said of Public Health. “And it’s not as dire as a wildfire. So it’s easy to continue to push it off. We see that in a lot of our legislation. It’s so easy to pay attention to the shiniest, fastest, most pressing thing when really we should be paying more attention to the underlying layers, because we need them to make sure we have fewer crises.”
Lentz and Blom acknowledged that legislators have many issues competing for dollars. They said there are many Clark County departments having to do more work or the same amount of work with fewer resources.
But given how health costs pile up in the long run, it seems like more foundational health funding would be a good return on investment, Melnick said.
Foundational public health services fund different work depending on the health jurisdictions. Clark County Public Health uses those dollars heavily for work on communicable disease control and epidemiology (relevant after the county’s measles outbreak last year), tuberculosis case management and developing new protocols for investigating hepatitis C, according to an email from Clark County Public Health spokeswoman Marissa Armstrong.
“It’s somewhat invisible,” Lentz said. “That’s part of the reason it doesn’t get as much attention. When things are going well, the community at large doesn’t necessarily know it’s there. And when something like a measles outbreak gets a lot of attention, it’s because something went wrong. Typically, that’s because we’ve systematically underfunded the systems that keep us safe and healthy.”
Coming up short
When Inslee made his budget last year, health jurisdictions and tribes across the state collected data to come up with their budget request. It initially came close to $400 million, Melnick said. That was then reduced to $296 million, but after receiving requests to lower it even more, it ended up at $100 million.
Inslee’s final budget included funding for only up to $22 million for foundational public health services for the county health departments, the Washington Department of Health and local tribes. The amount was $80 million short of their final request.
In the governor’s budget, the $22 million was split between $10 million from the state’s general fund and $12 million generated from the state’s new vaping tax. In July, Melnick told the Clark County Board of Health the vaping tax was likely to fall short of that $12 million. Given the string of lung injuries and bans around vaping products, Melnick said the tax will definitely fall short of the $12 million.
Lentz said the vaping tax is not a sustainable funding solution for Public Health.
“Last year, when we talked about the vape tax, our ideal is that people don’t vape,” Lentz said. “We certainly don’t want to be in a position, where in order to pay for your public health, you need to go out and start vaping. That’s ridiculous. Anywhere we are taxing a sin to help the prevention of it, that’s counter-intuitive.”
Lentz, Blom and Melnick are in favor of House Bill 2679 and Senate Bill 6451, which would significantly increase funding for foundational health services. The proposed bills would take a percentage of excess surplus dollars from nonprofit health insurers in Washington such as Kaiser Permanente and Premera Blue Cross. Some money from the bill would also help Washingtonians purchase health insurance coverage.
According to the Kitsap Sun, nonprofit surplus levels from nonprofit health insurance companies in Washington have risen to $4.4 billion. Surplus is supposed to be carried in case of emergencies, but the excess has grown too high, Blom and Lentz said.
HB 2679 and SB 6451 propose to take a small percentage of that surplus and use that money to provide an estimated $162 million a biennium for foundational public health services, or $81 million a year, Blom said. That’s almost eight times more than the proposed amount coming from the vape tax.
Blom and Lentz said nonprofit insurance companies shouldn’t be sitting on dollar amounts that large, especially while insurance premiums rise. They feel those nonprofits should either reinvest in their organizations to help the community, or give back to the communities they operate in.
“They are sitting on money that got there from ratepayers in Washington,” Blom said. “That’s money that we have paid to them, and now they’re just sitting on it. This is an opportunity for that money to come back, and really help the ratepayers.”