Rep. Mitch Greenlick, D-Portland, put forth legislation designed to modernize the state’s public health system, with a pair of bills that he stated at the onset would require a number of amendments but that in the end will likely pass, requiring the Oregon Health Authority to develop a 10-year plan for the delivery of essential public health services across the state.
“We’re changing essentially the structure of public health, but we won’t be changing until we’re ready to move forward so we must make sure to keep the system in place that has to be in place to do the business while we’re trying to create the future,” Greenlick said.
The new focus lays a principled framework for the public health services that each Oregonian should have -- including protection against communicable diseases, environmental health and chronic disease prevention programs.
“We really have seen with ebola and measles and chicken pox and mumps that we just aren’t able to deal with the foundational elements,” Greenlick said.
Rep. Alissa Keny-Guyer, D-Portland, noted the importance of an epidemiologist working in each county, a critical position that can examine the data and diagnose local public health problems.
“We’re in agreement that the current structure of public health does not serve our communities well,” said Lillian Shirley, the director of the state Public Health Division. She said the state division often runs from one federal grant opportunity to the next, basing its programming on these fickle awards.
It’s unclear who would pick up the tab for these public health services, but inevitably the shift appears to move funding away from the counties and toward the state general fund. Both public health bills -- Senate Bill 663 and House Bill 3100 -- are light on such details.
The coordinated care organizations may be able to take on the clinical services side of public health, but it’s unclear how they could count on Medicaid dollars for environmental health or other public health concerns that don’t boil down to an individual, or provide services for non-Medicaid members.
Supporters of the reform note that Oregon is an embarrassing 46th in the nation on the amount of state money it dedicates to the public health system -- but this statistic is misleading as it ignores the money spent by Oregon’s counties, which the state has traditionally delegated responsibility for much of the public health system.
“Counties put in more general fund money than the overall state investment in public health,” said Tammy Baney, a Deschutes County commissioner who led the task force on public health.
Clear Cut Trees for Public Health
At one time, rich timber harvests from massive Douglas firs and Sitka spruce trees on federal lands provided a cash cow for Southern Oregon timber counties to be liberal with their public services, and provide robust public health systems at the county level.
But those old-growth forests have been all but cut and harvests on the remaining big trees and second-growth timber are fewer and nowhere near as profitable. Several counties in Ssouthern Oregon have attempted to scrap their public health departments entirely.
Josephine County voters have responded to the loss of timber revenues by refusing repeatedly to pay property taxes in return for county services. This comes despite a public safety crisis that has left the county sheriff operating roughly during business hours. Property tax rates in Josephine County are the lowest in the state and a fraction of those outside Southern Oregon. The rest of the state had never been able to rely so heavily on timber harvests to provide their county services as these counties, all of which have tax rates less than half the state average.
Shifting the funding stream for public health services to the state could allow these Southern Oregon counties to keep their artificially low tax rates while counting on the overall state to provide the services they once were expected to deliver locally.
Greenlick said it was clear that not everything can be done by the state or county governments. He wants to see real public-private partnerships with the Medicaid system’s Coordinated Care Organizations, as well as schools, nonprofits and hospitals.
Lane County did raise its taxes to make up for the loss of timber revenue -- but in a four-year time span that saw its rate of sexually transmitted diseases like chlamydia, gonorrhea and syphilis rise during the time span that its STD screening clinic was closed. Dr. Pat Luedtke, the chief health officer of Lane County, said residents have long come to see the county as the place to go for such a service, and without it, they hadn’t known where to turn.
(Ironically, Washington County plans to close its clinics, not because of the loss of timber revenues but because of the assumption that the Affordable Care Act has rendered such clinics obsolete.)
Central Oregon Points to Regional Solutions
The crisis may have come to a head because of the collapse of a funding source in Southern Oregon, but county-led services would still lead to uneven funding for public health across the state.
Urbanized counties have a property tax base they can leverage for public health; but Oregon has plenty of county governments, particularly in eastern Oregon, that have never had either the luxury of a rich property tax base or a windfall of timber receipts. Wheeler and Sherman counties have the highest property tax rates, twice what’s paid in Multnomah County, despite Portland’s liberal public service offerings.
Baney said that her county, Deschutes, has worked with neighboring Crook and Jefferson counties to collaborate for region-wide policy and to pool resources so they are more attractive for grant opportunities.
“We work regionally,” she told The Lund Report. “We don’t spend general fund dollars outside Deschutes County.”
A regional system is something Greenlick initially proposed in 2013 before agreeing to participate in a public health task force, and it’s also something Rep. Knute Buehler, R-Bend, said he would like to see more of.
Crook and Jefferson actually pay higher taxes than Deschutes, but because they have fewer businesses to tax, they have less money.
Baney highlighted a one-time funding situation to describe a success that central Oregon has had from collaborating regionally.
Jefferson County -- north of Bend -- has a problem with a high teen pregnancy rate in its burgeoning Hispanic community, which is significantly higher per capita than Deschutes or Crook counties. Jefferson County would not have been an attractive candidate for federal grant funding because of its small overall population, but by teaming with its neighbors, it was approved for the grant.
