King County executive to seek property tax hike to aid health clinics

KENT — Tam Nguyen is a nurse, but she’s often confused for someone else.

She does home visits with families about to have a baby and those with a newborn, often working with recent immigrants who speak little to no English.

“I will come to the home and she’ll only speak one word of English,” Nguyen said. “Doctor, doctor.”

Nguyen works in King County’s First Steps program, which provides pregnant women and parents of newborns a team — nurse, nutritionist, social worker, community health worker — to help usher babies through a healthy first year of life.

But King County has been warning for nearly a year that Nguyen’s workplace — the Kent Public Health Center — and all 10 public health clinics the county runs, are in danger of closing amid a $35 million budget crunch. Now, after some help from Olympia, King County Executive Dow Constantine will seek a property tax increase that he says the clinics need to remain open.

The amounts and exact mechanics of Constantine’s proposal are not yet clear, but the proposal involves a County Council vote (and not a vote of the people) to raise funds for county-owned Harborview Medical Center, and then shifting the public health clinics or their services under Harborview’s umbrella.

About 70,000 people a year get health care, dental care, nutrition aid or personalized services like those Nguyen provides, from the county’s public health clinics. Almost all are low income, many are new to the country, many are homeless.

At Constantine’s urging, the state Legislature this year gave counties the authority to raise property taxes to fund county-owned hospitals. Harborview, which is operated by UW Medicine, is the only county-owned hospital in the state.

“I will propose to the County Council that we work with our partners at UW Medicine to use this authority to preserve the critical services that our public health clinics provide to residents across King County,” Constantine said Tuesday in a prepared statement.

Constantine said he would seek the council’s approval this fall for a plan to go into effect early next year. The plan would require require “significant restructuring of governance,” a county official said earlier this year.

A decade ago, the county also warned about imminent closures of public health centers, but maneuvered budget dollars to save them.

With King County in the midst of a near-decadelong homelessness emergency, the need since then has not waned.

Nguyen’s team, and others like it, aims to provide new families with not just health care, but with what they need to be healthy — food, bus passes, mental health counseling, baby clothes.

“Just those little things make a huge difference,” she said.

One family Nguyen worked with last year, recent refugees from Afghanistan, had taken their 2-month old baby to the emergency room eight times before they met Nguyen.

They didn’t have a primary care doctor and didn’t know where else to go or whom to call. Nguyen helped them find a family doctor, signed them up for Apple Health (as Medicaid is called in Washington), taught them how to take the baby’s temperature and gave them a number to call for a cough, fever or minor concern. She set up dental appointments for the whole family.

‘A safety net to the safety net’

The county’s 10 clinics offer an array of services at centers ranging from Kirkland in the north to Federal Way and Auburn in the south.

Each site hosts the First Steps program that Nguyen works in and the federally funded Women, Infants and Children nutrition program, which provides healthy food to families with young children.

Beyond that, each site offers slightly different services. They all serve an overwhelmingly low-income population, people without insurance or on Apple Health, people who don’t speak English or are unhoused, people who can pay little or can’t pay at all.

“We take care of a population that a number of other entities don’t or won’t,” said Kevin Proctor, a regional administrator for the public health centers. “We are a safety net to the safety net.”

Downtown Seattle and Bellevue centers offer primary care clinics. Downtown’s primary care clinic has about 2,500 regular patients. About 30% are homeless.

Five centers offer dental care. At the downtown Seattle dental clinic, which sees about 50 patients a day, 85% of patients are homeless.

“Dental care is not on the top of their list,” Zoraida Pruneda, a dental supervisor, said of their patients. “By the time they get here, they’re in so much pain.”

Four health centers offer sexual and reproductive health care.

The downtown Seattle clinic has a unit that screens every refugee who arrives in the county, doing blood draws, providing immunizations and linking them with other providers.

The downtown location also hosts a buprenorphine clinic, where people battling opioid use disorder can get prescriptions for medication that blunts the effects of withdrawal from drugs like heroin and fentanyl. They get referrals from the county jail, where people can receive buprenorphine, but then often get cut off when they’re released. They get referrals from needle exchange programs and word of mouth.

And they accept walk-ins, usually seeing a dozen or so patients a day seeking medication to help stay off other opioids.

“The same day they show up, they get medications,” said Jorge Chang-Bocanegra, a nurse and supervisor of the program. “We want the patients to actually start taking the medication right away.”

There are, of course, other providers, treatment centers, facilities that offer medication-assisted treatment for opioid use disorder. The downtown clinic prides itself as being low-barrier, making it easier, cheaper, quicker to get treatment.

Funding: ‘A woven fabric’

The county says its budget hole — about $35 million in its $750 million annual general fund — puts the health centers at risk even though they get three-quarters of their funding from the federal and state governments.

The majority of the general fund goes to state-mandated services of the criminal legal system — the sheriff’s department, courts and jails. The biggest chunk of the remaining general fund budget goes toward public health, which is why officials say the county’s health clinics are in danger.

Most of the health centers’ funding, about $66 million a year, comes from billing Medicaid, federal and state grants and other outside sources. That funding doesn’t cover the full cost of running the centers, so King County’s general fund fills in the gaps, about $20 million a year.

But, the county says, it can’t just trim a little here and there to help fill the budget hole, while still preserving most of the programs the health centers offer.

The county’s public health centers, as a group, are one of about a half-dozen federally qualified health centers in the Seattle region, health care sites that provide primary care regardless of a patient’s ability to pay. They are the only one that’s federally designated as treating a large homeless population.

These designations bring both benefits and requirements. They bring millions of dollars in federal grants, reduced drug pricing, and higher Medicaid reimbursement rates, all things that help the public health centers fund more programs and serve more patients.

The designations are “absolutely essential to the financial viability,” a public health spokesperson said.

But to retain the designations, and the financial benefits they bestow, the centers must continue to provide a long list of services, including primary care, immunizations, prenatal and postpartum care, pharmacy services, substance use treatment, dental care and mental health care.

If the county were to cut any of the required services to fill its budget gap, it would be placing its designations, and millions of federal tax dollars at risk.

“I think of it as a woven fabric,” said Keith Seinfeld, deputy director for the  division that oversees the public health centers. “You start pulling out one of those threads like, OK, we’re going to close our primary care site, that’s really expensive to operate. Well guess what? The fabric starts to fall apart.”