Anthrax, swine flu and Ebola all threatened population centers in the United States during the past 20 years, and with each potential menace came heaps of funding for the public health officials charged with keeping them at bay.
Those crises passed, and so, too, did the stream of money needed to hire epidemiologists and establish data systems that would be ready for the next public health threat, which arrived this March in the form of COVID-19.
In 2018, the Washington Department of Health identified a $30.8 million funding gap for assessment and surveillance of such public health threats, part of a $227 million shortfall for all public health needs in the state.
Public health workers past and present are hoping history doesn’t repeat itself with the novel coronavirus, and that emergency funding is replaced with a more reliable stream of support to prepare for future pandemics.
During the current crisis, the state’s 36 local health districts and departments have largely been forced to appeal to politicians for federal emergency funds to cover the costs of managing it. The Spokane Regional Health District needed $6 million from county commissioners earlier this year to make up its deficit.
Instead, health officials argue the state needs to institute a new funding system that’s been necessary for decades, hastened by the defeat in the late 1990s of a motor vehicle excise tax that gave local jurisdictions the flexibility and certainty needed to beef up their public health systems.
“During my 10-year tenure, we never recovered from that. Every year we’d go through this cut exercise,” said Dr. Kim Thorburn, health officer for the Spokane Regional Health District from 1997 to 2006.
The first $30 car tab initiative pitched chiefly by Tim Eyman, who has continued the crusade against the fees, successfully repealed a tax that had given local health districts a consistent source of cash. The immediate effect in Spokane was the proposal to eliminate public health nursing positions in 1999, an idea that received immediate condemnation. But other cuts have followed in the years since, with a lack of funding identified as a key factor. That included ending the district’s public health clinic in 2012.
The motor vehicle excise tax revenue freed officials from what former Spokane Regional Health District Administrator Torney Smith called a yearly exercise where he and others would go hat-in-hand to the state and county looking for general fund dollars. Smith retired in 2019 after serving as administrator at the district for close to two decades.
In good times, such requests for more money were often seen as a low priority, Smith said.
“When your car is running perfectly well, do you take it to the dealer? When your health is good, do you spend money to make your health better?” he said.
Some government bodies, including the Spokane County Commission, have cut their local funding to a health district when faced with potential budget shortfalls. In 2018, facing the prospect of reducing criminal justice services, the commission cut its funds to the Spokane Regional Health District by $400,000.
Counties are tasked with protecting public health under Washington state law, but without a dedicated stream of funding from the state each county must come up with its own source of money to support the efforts of the health districts. That’s led to widely different levels of funding across Eastern Washington, according to a 2018 review by the state’s Health Department. The local contribution in Spokane was a little more than $2 million that year, while Whitman County provided no money.
Health districts have also become more reliant on grant dollars from the state and federal government, which are given for very specific tasks, such as treatment for opioid addiction or the WIC program that provides low-income families with nutritional assistance. One example of the limitations of those targeted funds, Smith said, is that money the Spokane Regional Health District received from the federal government to fight HIV infections could not be used for the treatment of other sexually transmitted diseases.
With that money dedicated to specific tasks, and federal funding for responses to emergency health outbreaks usually arriving only after a pandemic-level threat has been identified, there is little room in the budget for preparation, said Mary Selecky, former Washington state secretary of health and head of the Northeast Tri-County Health District, which encompasses Stevens, Pend Oreille and Ferry counties.
“There are still are some flexible dollars, but when you get hit with something like this, it’s not enough,” Selecky said. “There’s not a strength of core funding, that lets you get the message out as to how you’re going to prevent it from spreading, and distribute medications and vaccines to bring it to the end.”
Another source of funds for health departments are fees, paid by restaurants to open their doors and by private home owners hoping to install a septic system in rural areas. Those fees cover the costs of inspecting the food served in restaurants and protecting the water table from contamination by a leaky septic system.
But there isn’t a clear fee that could be charged to fund pandemic readiness, Selecky said, and voters rejected the idea that motor vehicle taxes should be used to fund public health.
The latest proposal from health officials identifies specific offerings that local health districts must provide, called foundational public health services. Among those is the prevention of communicable disease and setting up data systems to track outbreaks. Those services would be funded by a new, dedicated fund that would receive money from a tax on both nonprofit and for-profit health insurers in the state, based on a determination of their surplus funds made by the state’s Office of the Insurance Commissioner. Some of the money would also go toward subsidies to help lower-income Washington residents buy health coverage.
The bill, proposed in both the state House of Representatives and Senate in the past legislative session, did not leave committee. Insurance companies across the board opposed the bill, saying it would reduce their ability to build up reserves and noting the millions of dollars in state taxes they already pay.
Jeff Ketchel, executive director of the Washington State Public Health Association, said the bill is the best proposal he’s seen in a decade to provide local districts the funds necessary for long-term planning to prepare for disease outbreaks, such as the coronavirus.
“A lot of these jobs require a good amount of training, and you need to be embedded in your community,” he said. “You can’t launch them at just a moment’s notice.”
Ketchel said he had hoped the measles outbreak last year, which infected 87 people in Washington, would be a wake-up call to legislators that more preventive money is needed to ensure systems are in place when a disease starts to spread. Now, he hopes the coronavirus, which has infected more than 60,000 Washington residents and killed more than 1,600, will serve that purpose.
That’s the same message Smith, the former administrator at Spokane Regional Health District, hopes lawmakers and taxpayers take from the current pandemic.
“We need to put the money out now, or it’s going to cost us way more later,” Smith said. “It’s not just dollars, it’s lives.”
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