OLYMPIA – The state’s public health system may look a bit different by next year after Gov. Jay Inslee signed a law Monday that would require local health boards to change their membership.
The composition change for local public health boards is one proposal of many looking to better prepare the state’s public health system for its next emergency. When the session ended April 25, the Legislature had changed the makeup of local public health boards, created health equity zones and allocated a significant increase in funding to foundational public health services.
The Legislature also funded a plan to create regional health service centers and regional health officers – a policy proposal that died in the Senate but was resurrected in the final budget.
The bill signed Monday requires local public health boards to have an equal number nonelected and elected officials – an idea Spokane Democrat Rep. Marcus Riccelli carried after the firing of Dr. Bob Lutz last fall.
It also creates a public health advisory committee to oversee public health statewide with its first task being a look at the state’s COVID-19 pandemic response.
While signing it, Inslee said Monday it will “take politics out of public health” to offer better direction during public health emergencies.
“(The policy) makes sense,” Riccelli said. “We want to make sure we’re making good public health decisions.”
How Spokane’s board of health may change
The bill signed Monday only focuses on the change in local public health boards. It requires an equal number of elected officials and non-elected members on the board. The non-elected members must include an equal number from three categories:
- Those with experience in public health or health care, such as physicians, nurses or health care workers.
- Consumers of public health, such as residents in communities that face health inequities.
- Other stakeholders, such as community-based organizations or representatives from the business community.
If the county contains tribal land, the local board of health must include a tribal representative.
The board of county commissioners would approve the non-elected members, but the approval must follow a process set out by the State Board of Health.
In the coming months, the State Board of Health will set and adopt rules for local boards of health to follow when they select non-elected board members. The deadline for these rules to go into effect is July 2022.
The State Board of Health plans to invite those interested and impacted by the new law to participate in the rule-making process.
Currently, the Spokane Regional Health District Board of Health includes three Spokane County commissioners, three Spokane City Council members, two Spokane Valley City Council members, one elected official representing small cities and three citizen representatives.
The new law could vastly expand the Spokane Board of Health due to the ‘equal number’ requirement that evens out representation between elected and nonelected members.
If the Spokane County commissioners decide to keep the board’s current structure, they would need to add at least six new non-elected members. The board will also likely need to add a tribal representative to the board, who would be selected by the American Indian Health Commission.
The county commissioners will have to update Spokane County code to align with the new law, but how they do that could vary. They might decide to have fewer elected officials sit on the Board of Health to keep the board at a smaller size now that non-elected members will make up half of the board. Regardless of how the board will change, the commissioners will have the final say on appointing new non-elected members.
Commissioners are already preparing for other changes that also might affect the health board makeup.
Next year, Spokane County leadership will grow from three to five commissioners. It’s not clear how this could also effect the Board of Health makeup, but the increasing number of commissioners may affect discussions about board representation in the next year.
Regional health services close to becoming law
The bill signed Monday took a long journey to get to Inslee’s desk.
It initially passed the House of Representatives with language that would establish four regional comprehensive public health district centers to coordinate shared services. After pushback from local public health officials, the Senate removed the plan from the bill, passing a version that only focused on the makeup of local health boards.
With that version passing the Legislature, the regional health system idea looked dead – until the final budget was released. A short section in the 1,100-page final budget funds a plan to implement regional health officers and centers, despite its failure to pass in both chambers of the Legislature.
The final budget has yet to be signed by Inslee, and it’s unclear what, if anything, he’ll veto in it.
The budget allocates more than $2.2 million in the next two years to the Department of Health “to establish and operate regional shared service centers, regional health officers, and regional coordinators,” according to the budget.
Regional health officers and regional coordinators must be employees of the Department of Health but can be co-located within local jurisdictions or other government agencies, according to the budget. Regional health officers are tasked with working with local jurisdictions, the state health board, the Department of Health and tribal governments to coordinate public health across counties and providing support to local health officers.
Regional health officers should have the same qualifications as local health officers, which include someone who is an experienced physician licensed to practice medicine in the state.
The role and duties of the shared service centers is left up to the Department of Health but include coordinating shared delivery of public health services and implementing health equity zones that allow the department to identify areas in the state that experience health disparities and to develop projects that meet the needs of that zone.
Rep. Joe Schmick, R-Colfax, said the language on regional health districts is “pretty vague.”
Schmick worked with Riccelli throughout the session to find a compromise on the regional health proposal. A compromise that Schmick supported passed the House but failed in the Senate. It looked a lot like what’s now included in the budget but had more guidelines for how to create the regional health service centers, he said.
“This has nothing,” he said. “They left it to the (Department of Health) to design it with really little oversight.”
Riccelli said the regional health centers will help ensure everyone has equal access to quality public health that’s done in a “predictable and essential way.” Statewide coordination on shared services will help support that standard, he said.
“I’m glad we’ll be moving in this direction,” Riccelli said.
Schmick said regardless of how he feels about the proposal, he had concerns over how it made it through the Legislature in the end. He said it was “interesting” that a piece of policy that failed in the Senate made its way back into the budget.
“I just don’t think it’s the best way to do government,” he said.
The regional plan had received push back throughout the legislative session. Many local health officials said they had already been sharing services and didn’t want to be spending money to set up another governmental system to do so.
Riccelli said he does not think the final plan will get much pushback because of how much the budget funds public health overall.
On top of the $2.2 million set aside specifically to set up the regional services, $147 million of state funds will be allocated for public health services in the next two years. That money will be allocated by the Department of Health for local health jurisdictions.
Schmick said he is “crossing my fingers” that the increase in public health funding will reach many of the smaller counties that he represents. In the past, Schmick said many smaller counties have received little to no funding for public health.
“They frankly get left out,” he said.