Bill to restructure public health gets big changes in Legislature after passing state Senate

Spokane County’s local board of health may soon have to change if a bill sponsored by area Rep. Marcus Riccelli gets final approval from the Legislature.

The bill, which passed the state Senate on Sunday , looks a lot different than it did in January when lawmakers hoped to create a more regional approach to the state’s public health system.

The newest version would require the composition of local boards of health to include an equal number of elected officials and nonelected citizens. It also would create a public health advisory board to oversee public health across the state.

Riccelli, a Democrat from Spokane who had worked on the proposal since December, called the version that passed Sunday “a mixed bag.”

An amendment added in the Senate rejected the bill’s original intent of creating comprehensive public health districts to share services and better coordinate public health across the state. The idea had received criticism from some lawmakers, local health officials and county leaders across the state who said now was not the time to be restructuring the public health system.

There was significant pushback, Riccelli said, from local health officers who wanted to “protect the status quo.”

“I’m disappointed about that,” he said. “I think this was a good opportunity for good public health.”

The current version keeps the provision that would change local boards of health, something Riccelli first proposed after the firing of former Spokane Health Officer Dr. Bob Lutz last year.

It requires an equal number of elected officials and nonelected members on the boards, according to the bill. In Spokane, the board of county commissioners would approve the nonelected members by a majority vote.

The Spokane Regional Health District Board of Health currently 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.

Beginning July 1, 2022, each local board of health must include nonelected members from three categories:

Those with experience in public health or health care.

Consumers of public health, such as residents in communities that face health inequities.

Other stakeholders, such as military personnel or representatives from the business community.

If the county contains tribal land, the local board of health must include a tribal representative.

Supporters say the composition change could be the first step in depoliticizing public health, something with which public health officials have had concerns throughout the COVID-19 pandemic.

“When politics infects public health, it’s very concerning,” Riccelli said.

Opponents of the bill argued Sunday it was attempting to fix a problem that doesn’t exist.

Sen. Mark Schoesler, R-Ritzville, called the bill “an answer in search of a problem.” The public health jurisdictions in his district work well, he said.

“Because some people didn’t like the outcome of a personnel decision in Spokane is no reason to overhaul the entire state,” Schoesler said on the floor.

Spokane Valley Republican Mike Padden made similar remarks, saying the bill is the result of the Spokane Regional Health District board making a personnel decision, and that shouldn’t lead to rewriting the makeup of local boards of health.

The bill also creates a public health advisory board, which would be charged with advising the public health system, providing feedback on public health, monitoring the performance of the public health system and evaluating the use of public health funding. It would report to the secretary of health and work with local health jurisdictions, the governor, the Department of Health and the state Board of Health.

Its first task would be to analyze the state’s COVID-19 public health response.

The board would be made up of representatives from the governor’s office, the state Board of Health, the Department of Health, the tribal government public health sector and multiple statewide associations.

It also must include four representatives from local health jurisdictions, including one large and one small from each side of the Cascades. The large jurisdiction must have a population between 200,000 and 600,000, and the small jurisdiction must have a population under 200,000.

Perhaps the biggest change for public health this year will be a boost in funding.

Both the House and Senate Democrats’ proposed budgets have a significant amount of funding for foundational public health. The Senate’s proposal sets aside $150 million over the next two years, while the House’s proposal sets aside $100 million.

House and Senate budget leaders are currently in negotiations for a final budget, which likely won’t be passed until the last day of session, April 25.

Sen. Emily Randall, D-Kitsap Peninsula, said the state needs to work “hand-in-hand” to support local public health jurisdictions and ensure they are representative of their communities.

“We have learned over the last year that public health is essential to the health and survival and well-being of our communities,” she said on the Senate floor.

The proposal to create comprehensive regional health districts originated from Gov. Jay Inslee who shared the idea in December. While the topic of regional health districts or coordinating shared services could come up again in the future, Riccelli said he isn’t giving up yet this session.

“I stand strong by the policy goal that everyone everywhere should be able to rely on a public health system,” Riccelli said.

The bill now heads back to the House of Representatives for final concurrence. If the House agrees to accept the changes, it will head to the governor’s desk. If not, both chambers could work together to come to an agreement in a conference committee.

The Legislature has less than two weeks before it is scheduled to adjourn on April 25.