Public Health budget update
Updated Thursday, June 19, 2014 at 05:16 PM
Public Health pursuing solutions to federal, state budget cuts
Health reform enables transition for some services, but serious reductions loom
A decade of dwindling financial support has taken its toll on King County's public health services and now a $15 million annual shortfall is forcing difficult choices. A strategic proposal calls for transitioning some services to community organizations, while making regrettable reductions in services where federal and state funds have been cut.
Finances for Public HealthSeattle & King County have been precarious ever since voters repealed the major source of funding for Public Health 14 years ago, and a voter-approved cap on property taxes restricted the remaining source of local, flexible funding.
This gap was partially patched in recent years by creating efficiencies, spending one-time reserves, securing outside grants and special funding, and reducing staff including a major round of layoffs in 2009. Now, however, reductions to federal payments for administering Medicaid and other cuts have pushed the agency past a tipping point.
"We’ve run out of rabbits we can pull from our hat," said Dr. David Fleming, Director and Health Officer for Public HealthSeattle & King County. "To operate with a balanced budget, we may be compelled to reduce staffing and services."
If adopted by the King County Council in November, the proposed reductions could lead to major changes at six Public Health Centers.
Two of those centers in Columbia City and North Seattle would transfer primary care services to other healthcare organizations, as health reform has made it more feasible for providers to take on more patients. The department is in discussions with NeighborCare and Harborview/UW Medicine to make those transitions in 2015.
Unfortunately, inadequate funding means four other Public Health Centers may have to close: in Auburn, Federal Way, Northshore in Bothell, and Greenbridge in White Center. While the Northshore Center would close, one of its satellite clinics would remain open.
Site-closure proposals were made with the goal of maximizing services to as many clients as possible. While support services for pregnant women and children and for family planning will be lost at these locations, they will continue to be offered at six other locations in King County, including Kent, Renton and Eastgate.
Prevention services also face reductions
More broadly, reductions would impact a range of core public services such as reducing the capacity for disease investigations, and curtailing Public Health work on tobacco and obesity prevention. (For more examples and details, see additional links above.)
"This is painful and, like you, I’m concerned about our clients," wrote Dr. Fleming in a message to staff. "We’ll work with our communities to try to find ways to mitigate some of these cuts, but at the end of the day, this is likely to result in a loss of services for some of our clients."
Altogether, the proposed reductions could potentially lead to more than 200 layoffs.
EMS and restaurant inspections not impacted
The department's top priority is preserving the core, irreplaceable functions that only Public Health is able to provide.
Most Public Health funds come from grants, levies or fees that are dedicated for specific purposes, and cannot be shifted to other services. For example, emergency medical services (EMS) are funded by levy dollars that can only be used for EMS. Restaurant inspections are paid for by fees.
The proposed cuts would not impact all areas of Public Health. Most will occur in three areas that rely on more general funding: Public Health Centers, Prevention Services, and services provided through the Director's Office/Administration.
- No final decisions have been made
- Budget proposals will be forwarded to the King County Executive, who will balance competing County needs and limited revenues, and work to preserve the most essential services
- King County Council will adopt a final budget in November
- All current services will be maintained at Public Health Centers while decisions about the budget are in process
The health department has been providing crucial services to the community for 125 years, protecting health, preventing injuries and chronic diseases, and providing access to quality care. That mission will continue in a changing funding environment.