Budget woes put public-health agencies on critical list

When voters revolted against the state's motor-vehicle excise tax in 1999, chances are that few people made the link between their ballots and immunizations, dental care or birth control.

Yet the taxpayer rebellion that ushered in the flat $30 car-tab fee also eliminated dedicated funding for public-health agencies, which oversee virtually every aspect of a community's well-being, ranging from restaurant inspections to preparing for a bird-flu pandemic.

Since then, Public Health — Seattle & King County has managed to avoid deep cuts in services thanks only to backfill money from state and county coffers.

But now, as governments at every level in Washington are anticipating budget deficits in 2009, those financial crutches themselves are about to snap, imperiling what already was a shaky funding system for public health.

In King County, which is grappling with an expected $90.6 million shortfall in its general fund next year, Executive Ron Sims has proposed slashing its discretionary support for public health by $12.6 million — a 44 percent drop.

That likely would force the closure of some public-health clinics and curtail a host of services, including vaccinations, interpreter services and communicable-disease control.

One program that could be at risk is the Nurse-Family Partnership, which puts vulnerable young pregnant women under the tutelage of public-health nurses until their child's second birthday.

When Laurice Slaughter was first teamed up with a nurse, she was hardly a model of maternal promise: an unemployed teen who more often slept on other people's couches than in her own bed. But for two years, public-health nurse Erika Boyd has visited her every two weeks without fail, guiding her through an emergency C-section, postpartum depression, single parenthood and homelessness — not to mention a neophyte mother's general inexperience.

Today mother and daughter live in a subsidized apartment in Pioneer Square, and Slaughter, at 20, is hoping to enroll in community college next year. She wouldn't be the mother she is without the help she's received, she said. "I wouldn't be here right now." The funding crisis has added urgency to calls by community advocates and public-health officials for a stable revenue source to replace the lost car-tax money once and for all.

The King County Board of Health is weighing possible solutions, including asking Olympia to grant it authority to levy local taxes.

Without a permanent funding fix, warns Dr. David Fleming, public-health director for King County, vital health services will face "death by thousand cuts."

Cuts, layoffs loom

The money for county health agencies is evaporating even as their responsibilities and demand for their services are growing

In 2007, 143,000 people relied on King County's public-health centers for primary care and other services. Almost a third had no insurance, more than half needed interpreter help, and 60 percent were people of color.

But unless the county finds a way to shore up the threatened funding, significant cuts and layoffs loom for public health, according to Fleming.

The nurse-partnership program is vulnerable despite having been proved nationally to reduce child abuse, prevent subsequent unwanted pregnancies, help mothers get jobs and prepare their children for school. But it's also costly and labor-intensive, and yielding benefits that may not be apparent for years.

For Slaughter, it was nothing short of a lifeline. The fruits of her time spent with Boyd show in daughter Quashia, a healthy and inquisitive toddler with soft corkscrew curls, already able to recite numbers and alphabets. When the child turns 2 later this month, Slaughter will graduate from the program, and mother and nurse must part.

Slaughter said it distresses her to imagine leaving vulnerable first-time mothers — and their babies — to fend by themselves.

Boyd "kept telling me how far I'd made it and how far I could go," Slaughter said. "She just got me in the right mindset."

Closing health centers

Though the beleaguered county general fund provided King County's public-health agency with only 15 percent of its $193 million budget this year, the money is pivotal — parlayed by officials into getting matching grants from the federal government and other sources.

The state also has kicked in $9.5 million each year to King County public health ever since the car-tab tax went away. But that largesse is voluntary — hardly reassuring at a time when Olympia is expecting a $3.2 billion shortfall of its own during the next two years.

On top of service reductions, King County is considering closing some of its 10 public-health centers.

Two — one in Northgate and one in Bothell — were threatened with closure two years ago before getting a reprieve. Like some of the other clinics, those two operated in the red last year, exceeding their allotted budget by a combined $4.9 million.

Fleming lays part of the blame on state voters.

Not only did they do away with the motor-vehicle tax, they passed strict limits on property-tax increases, barring counties from raising total existing property-tax levies by more than 1 percent annually without explicit voter approval.

While Fleming said the best solution may be for state lawmakers to authorize health departments to collect their own taxes, Snohomish County is looking for money elsewhere.

Snohomish County Executive Aaron Reardon has proposed returning to having cities chip in directly to pay for public health. But with most of Snohomish County's 20 cities braced for red ink next year, Reardon's plan so far has been a nonstarter.

Dr. Gary Goldbaum, head of Snohomish Health District, argued that leaving public health without fixed funding is no longer tenable. "We can't look to the cities. We can't look to the state. And we know the federal government isn't going to kick in anything," he said.

"Only the county can give us money, [and only] by shifting away from someplace else. It's a zero-sum game."

Kyung Song: 206-464-2423 or ksong@seattletimes.com