Jackson Baures, the public health division manager for Jackson County Health and Human Services, told a legislative panel Wednesday how a presumptive case of tuberculosis became an all “hands on deck situation.”
With 17 vacant positions in his office, including nearly a third of its public health positions and no full-time case investigators, Baures explained how staff scrambled to prevent the potentially deadly bacterial infection from spreading. Employees who answer phones and check people in, nurses who provide immunizations, communicable disease staff and an epidemiologist were all pulled off their regular jobs, he said.
“Many of our positions have been vacant for more than a year and that really increases the workload of other managers and staff, and requires a constant triage of priorities to deal with only the most urgent needs,” he said.
The House Behavioral Health and Health Care Committee heard from dozens of local health care officials, including Baures, and others who urged passage of four bills intended to boost the behavioral health and local public health care workforces.
During the hearing, lawmakers heard stories from across the state of how health care systems are on the verge of collapse due to a lack of workers. They also heard how despite high demand for behavioral and public health workers, low pay and high training costs prevent vacancies from being filled.
Addressing Oregon’s health care workforce shortages, which have been worsened by the pandemic, is one of the central issues of the legislative session. Bolstering the behavioral health workforce is also a priority of Gov. Tina Kotek. Lawmakers are considering other requests to increase the state’s health care workforce as state economic forecasters have warned of potentially declining revenues.
The bills drew overwhelming support. But state Rep. Rob Nosse, a Portland Democrat who chairs the committee, alluded to potentially difficult discussions when another panel determines whether to fund the legislation’s hefty price tag.
“I’m sure we’re all hearing about how difficult it’s going to be in Ways and Means,” he said, referring to the legislature’s budget-writing committee where many bills go to die.
‘Rebuild, repair and prepare for the next emergency’
One of the bills, House Bill 2773, would direct the Oregon Health Authority to implement an incentive program to recruit and retain local public health workers. The incentives would come in the form of grants to local public health agencies from $40 million appropriated to the health authority. The grants would be used to keep public health workers in their jobs and entice new ones with offers of student loan forgiveness or repayments.
Sarah Lochner, executive director of the Coalition of Local Health Officials, told the committee that the “local public health workforce in Oregon is in crisis.” She blamed the situation on chronic underinvestment of public health, as well as stressful working conditions under the COVID-19 pandemic and its “politicization.”
She pointed to a report from her organization showing high turnover among public health workers who are being required to do multiple jobs for relatively low pay while experiencing increased scrutiny.
The coalition’s report, based on interviews with local authorities, indicated that in 2021, the average starting wage for a public health nurse across all local public health agencies in Oregon was $29.36 per hour. But the range was wide, with the lowest starting pay being $24.57 per hour and the highest starting pay being $39.18 per hour.
Local public health workers, Lochner said, have an important role in testing for and treating sexually transmitted infections and other illnesses, providing immunizations, reproductive health services and home visits for new babies and their parents.
“We want to home-grow our workforce, creating career pathways for folks who may otherwise not have access to the necessary education, folks who can then become the trusted messengers in their communities to help rebuild, repair and prepare for the next emergency,” she told the committee.
Jessica Pratt, Association of Oregon Counties legislative affairs manager, told the committee her organization supported the bill with the understanding it would be amended to take out language directing the incentives go toward increasing public health workers who are specifically “people of color, tribal members or residents of rural areas in this state.”
She said an earlier bill that contained similar language was taken out because it was deemed unconstitutional. But she said the current bill remains aimed at serving these populations.
Two Republican members of the committee expressed skepticism about the bill. State Rep. Charlie Conrad, of Dexter, questioned why the bill was needed when research shows employees are likely to stay in a job when they have good relationships with their supervisors and feel valued. State Rep. Ed Diehl, who represents East Salem through the Santiam Canyon, suggested that the bill was moving forward with provisions deemed unconstitutional.
Behavioral health bills
The committee also heard testimony on a trio of bills intended to increase the number of behavioral health workers in Oregon.
House Bill 2977 directs the health authority and the Higher Education Coordinating Commission to develop behavioral health workforce training programs. The bill appropriates $1 million for a higher education grant program to recruit and provide scholarships for students going into behavioral health. It directs another $5 million for grants to local workforce development boards to increase behavioral health workers.
House Bill 2652 allows counties to access grants after declaring shortages of health and human services personnel that are putting the public’s health at risk. The Oregon Health Authority must agree with each county’s declaration. The bill appropriates $58 million for counties with shortages that can be used for scholarships and loan forgiveness for students entering health care and human services. The money can also be used for bonuses and to help workers pay for housing and child care, among other sweeteners.
The bill also sets aside $31 million for school programs on healthy eating, physical activity and mental health.
House Bill 2651 appropriates another $81 million to the health authority to expand the state’s behavioral health workforce.
Much of the money would be used to support existing programs that fund scholarships and provide other financial support for behavioral health workers, particularly those serving marginalized communities. It would also include more grant money to cover costs for students completing the clinical supervision required for their license, as well as their supervisor.
The legislation would build on the $1.35 billion the Legislature approved in 2021 on the state’s behavioral health system and to support the implementation of Measure 110, a voter-approved ballot measure that decriminalized drugs and directed more funding for addictions treatment.
State Rep. Janelle Bynum, D-Happy Valley, told the committee that when the Legislature approved a bill she sponsored in 2021 providing financial incentives to increase the state’s mental health workforce, it was understood it was a “down payment” to make up for some of the damage caused by the COVID-19 pandemic.
She said H.B. 2651, which she is the chief sponsor of, would provide needed additional resources for the state’s behavioral health workforce.
Mary Monnat, CEO of Portland-based addictions and mental health services provider LifeWorks NW, thanked the Legislature for the previous investment, and that this month, for the first time in over a year, her organization hired more people than it lost. But she said more needs to be done and that her organization has over 100 vacant positions.
“If we have that kind of vacancy, the people out there are just — they’re in crisis,” she said.
Washington County Commission Chair Kathryn Harrington urged support for all three of the bills. She said the Legislature in 2021 passed the largest incentive program to retain behavioral health care workers. However, she said applications seeking loan relief totaled $78 million, five times more than the $15.5 million allocated for the program.
Harrington said underinvestment in Oregon’s behavioral health workforce has meant limited hours and services and a lack of staff able to provide culturally appropriate care. That’s left vulnerable populations even more marginalized and clinicians overwhelmed, she said. The legislation would send a message to newer practitioners, she said.
“We’re not just investing in them,” she said. “We’re reinvesting in Oregon and building Oregon, and all of our communities will benefit as a result.”
The committee also heard from Anjabeen Ashraf, a licensed professional counselor, who described financial barriers to entering the profession that keep communities with less wealth out.
She said graduate mental health programs often cost more than graduates make during their first year out of school, and that’s after being expected to work for free to gain experience as part of their licensing requirements.
“The embedded classist expectations within our mental health professions lead to the self-selection of certain backgrounds into the field,” she said. “From the cost of these programs, to unpaid internships, and underpaid post-graduate positions, these barriers to entry are easier for some to overcome than others.”
Correction: An earlier version of this article misstated the amount of relief sought for a loan relief program. The Lund Report regrets the error.