More cuts to public health

In an act that is becoming far too familiar, the Snohomish Health District again made cuts to programs, with more reductions slated for later in the year.

The board of health cut 17 positions. Ten of those employees will come from the Environmental Health division's Waste and Wastewater program, which deals with wells and septic systems. Their jobs will end July 15.

Permitting activity has decreased, said Dianne White, Stanwood mayor and board of health member.

The Child Care Health program, which provides services to child care providers, will be eliminated on Aug. 1, impacting seven staff members.

The health district has an estimated $1.5 million shortfall.

When the board of health passed the 2009 budget last year, new revenue from the state was projected, said Rick Mockler, health district deputy director. That revenue did not materialize.

In fact, state revenue actually decreased. Funding from SB 5930, the 2007 health reform bill, was cut by 20 percent, which meant a $156,000 annual reduction for the district, he said.

The state is also phasing out the universal vaccine program, which means the district's ability to provide vaccines to children in the county will decrease considerably, Mockler said. Only children on Medicaid and from low-income families will still be able to receive vaccines through the district. The district will also no longer provide vaccines to community providers.

In addition, the economic downturn has decreased the health district's local revenue, he said. The district permits septic systems and new water systems, but with construction at 50 percent of historic levels, the normal increase of permitting in spring did not occur.

Employees are also not taking as much leave, which increases the health district's costs, he said.

The board of health did not do what it needed to at its meeting last Tuesday, White said.

Whereas they were supposed to agree on $150,000 per month in cuts, only two of the four programs on the table were cut, she said. The board approved about $100,000 per month in cuts.

The other two programs on the table were child home visits and the sexually transmitted diseases program, White said. The first program includes home visits during a pregnancy and until the child is age 1 for those who qualify.

The health district is the only one that offers the home visit service, White said. To her, it seems like a luxury.

The sense of the board was that there wasn't enough information to make cuts to either program, White said. She didn't agree.

"Now, it's crisis time," she explained.

The board of health did not cut enough yet to overcome the shortfall, Mockler said. The suggestion was to cut $150,000 a month starting in August, and an additional $100,000 a month starting in November.

Together, those cuts would amount to about $850,000, Mockler said. A $700,000 liquidity loan from the county would make up the additional revenue needed for payroll.

The liquidity loan is a line of credit that doesn't have to be used unless it is needed, White said. The interest rate is only .65 percent.

According to projections, the district will need it, she said.

Mockler said the suggestion is to have an annual reduction of $3 million, which will take care of the projected deficit and allow the district to repay the loan, due at the end of March 2010. It will also help absorb cost increases from inflation that take place annually.

That should allow the district to balance its budget for 2010 and 2011, as well as provide program stability, Mockler said. It is hard on both the public and employees when the continuation of district programs is up in the air.

On average, district employees have worked there for 12 years, White said.

About 80 percent of the district's budget is personnel costs, and the other 20 percent are costs related to personnel.

"We're in the business of delivering services, and that takes people," Mockler said.

The furlough discussion with employee unions in April didn't go anywhere, Mockler said. At the time, the health district was unable to articulate what would happen if furloughs did not occur.

The district's employees belong to American Federation of State, County and Municipal Employees, Washington State Nurses Association and Local 17 International Federation of Professional and Technical Engineers.

Mockler said he will begin discussions with the unions about furloughs again. Now, the district has a dollar amount of the cuts it needs to make.

The district needs to explore the services only it can offer, White said. The whole organization needs to be looked at.

It should explore becoming part of the county, rather than a stand-alone organization, she said. That would allow the district to cut down on administrative costs.

"It's kind of the elephant in the room," she said.

The series of cuts are the result of a decade of flat funding for public health, a situation that has been exacerbated by the economic downturn, Mockler said. It isn't unique to Snohomish County.

Unfortunately, it means the district will provide fewer services, which will likely lead to higher medical bills and a less healthy population, he said.