Oh, I love that smell. Right? But I don't think
it smells like that. I think it smells like Lucky
Charms. Okay. That's what I'm going with. It
tastes like Lucky Charms. It does. I mean, if
you went out and licked a rainbow. You don't
think it would taste like pennies or like gold?
I don't know. Welcome to County Connection. the
official podcast of the Washington State Association
of Counties, where we dive into the legislative
issues shaping the future of our communities.
From budgets to public safety, infrastructure
to elections, we'll break down what's happening
in Olympia and how it impacts counties from across
the Evergreen State. Stay informed, stay engaged,
and join us as we amplify the voice of Washington's
39 counties. All right, welcome everybody to
the County Connection podcast. I'm Paul Jewell,
the Washington State Association of Counties
Government Relations Director and your host on
the County Connection podcast. We're back in
the studio and we're here again with Jamie Bodden,
the Washington State Association of Local Public
Health Officials Managing Director. Jamie, it's
Wednesday and more importantly, it's cutoff day.
Happy Cutoff Day. Happy Cutoff Day, or as I like
to call it, Happy Bill Death Day. Oh, in memoriam.
In memoriam. You know, I was thinking, do you
remember the LSC meeting we had a couple of weeks
ago? Commissioner Rolfes was talking about how
part of what we were talking about felt like
the Hunger Games. I kind of felt like we could
do that with legislative districts. Like, this
was a good bill from, you know, so -and -so with
legislative district number 15. Kind of do a
whole Hunger Games theme. A tribute to those
that have fallen. Yeah, exactly. It is a fun
day. It's a stressful week because you want certain
things to survive, but it's also really great
when your plate gets a little bit less chaotic.
There are certain things that we want to survive,
but there are other things that we want to say
goodbye to as well. And today is definitely a
big day for that. And we're going to get a chance
to talk about that maybe in... future podcasts
because we still don't know what the results
are because it's still early on cutoff day. But
you just got back from Washington, D .C. I had
a podcast just a couple of days ago with a couple
of county commissioners that also just got back
from Washington, D .C. But they were there for
a different purpose than you. Why were you back
there? Yeah, so Wasilvo goes to D .C. every year
as... part of NACCHO, which is the National Association
of City and County Health Officials. Not to be
confused with the delicious nachos that we might
eat. They missed an opportunity with that acronym.
I know, they did. But NACCHO is our national
association, so WSALFO is our state affiliate
for that. And every year they do a leadership
week with my counterparts from across the country.
We meet and discuss on different public health
issues. going on in our states, what's going
on federally, just a chance to network, share
best practices, learn from each other. And then
the culmination of that meeting is Hill Days.
So we actually get to meet with our congressional
and Senate delegations from our states as well.
So taking advantage of our time in D .C. So this
is something that you do every year. Yes. And
it's basically your counterparts from across
the country. Yes, we have of the 50. states i
think we have like 32 um what are called sachos
or state associations okay um and so they'll
be um i'll get to sit with utah i'll get to sit
with minnesota nebraska oh north carolina you
say minnesota nebraska that that uh wisconsin
accent my midwest comes out a little bit yeah
yeah um and it's it's always interesting because
public health particularly local public health
is implemented so differently across our country
and so you talk to somebody like Massachusetts
that has over 300 local health departments in
their state. And then you talk to somebody like
Arizona and they have six. So it's really interesting
to get kind of that. glimpse of just the differences,
but also a lot of the similarities that we share.
The same is true with county commissioners. When
you compare, say, Western county commissioners,
meaning the Western states versus kind of Midwestern
or Eastern, they're very different. Their roles
are really different. In fact, not all of them
are called county commissioners. Some are county
judges or county supervisors, and they have a
few other names. And some states don't even have
counties, they have boroughs, right? So it's
really interesting to kind of compare. and contrast
the roles, think about what it might be like
to have that role. There are many roles that
some county commissioners have in other parts
of the country that I'm so glad that our county
commissioners don't have. I would have never
wanted to have that role as a county commissioner,
but there are others that you go, oh, that's
kind of interesting. I wish we had the opportunity
to work in that area as well. I'm sure you find
the same thing. Yeah, that was one of my local
government culture shocks when I moved out to
Washington State coming from. wisconsin and working
in county government in wisconsin i had 27 county
commissioners or county supervisors as we called
them um in my county that i worked with just
in your county just in my county 27 um and so
coming to washington and there's three um was
like but But what about, you know, they do all
the job of 27. And it was really interesting
to kind of learn that difference and understand
that nuance a little bit more. Well, and the
counties in this part of the country are really
big, too, compared to other parts of the country.
I don't know how big they are in Wisconsin, but
you certainly get into the eastern parts of the
country and, you know, like Ohio and Pennsylvania,
even though they're smaller states, they'll have.
you know, 150 counties versus our 39, something
like that. So there's, they, they break them
up into smaller jurisdictions. What were the
big issues that you guys talked about when you
were back in D .C.? Yeah. I mean, there's a lot
going on there. A lot going on. I just had Commissioner
Osias and Commissioner Eisenhower in here kind
of reflecting on their experience. And obviously
they had some major issues, but they weren't
really focused on public health other than maybe
Medicaid. Was that something you guys talked
about a lot as well? Yeah. So when we did our
federal visits, we kind of focused on three big
topics when we met with our congressional delegation
and then also our two – federal senators. We
talked about public health funding kind of at
large. One of the things that public health does
is we get about, on average, about 40 % of local
health department budgets come from the federal
government. That fluctuates depending on the
LHJ. But on average, about 40 % of local health
department budgets are comprised of federal grants.
So that could be something like the Maternal
Child Health Block Grant. which obviously funds
maternal child health programming. It could be.
Something that's more categorical, like the Ryan
White HIV grant, which funds local HIV prevention
case management treatment work in our state,
which is really, really critical. It could be
something like our prevention preparedness grant,
which funds our readiness and public health preparedness
and response activities around flooding, wildfire,
smoke, disease outbreaks, that kind of thing.
So just maintaining that public health funding,
which is really important. really, really critical.
It's a lot of what anchors and we build a lot
of our other programs around. Maternal Child
Health Block Grant has been around for decades,
for example. Our WIC program, another really
critical federal grant that serves our families,
that's longstanding. So one of our talking points
was just... you know, showcasing the many grants
that we might receive at the local level, describing
their importance and really advocating to maintain
that critical funding that we get. There's been
a lot of talk about cuts, both here at the state
level and at the federal level. I think the federal
level, they were looking to cut about $3 trillion
out of the federal budget. There's been all kinds
of... kind of rhetoric and rumors going around
with the new administration. How has that affected
this federal funding? Are you worried about that?
I can remember during the Great Recession, federal
funding for public health was just gutted as
part of those cuts, right? That was really devastating
to the public health system back then. I know
a lot of that has changed. A lot of that has
turned around. With this new kind of... budget
era that we're looking at and possibly another
recession kind of facing us both nationally and
locally. How concerned are you about these programs
and about these funding levels? I think overall,
very concerned. Now there's, you know, a local
health jurisdiction might get. 10 to 20, 30 plus
different types of federal grants. And all of
those are important in different ways. But there's
definitely certain grants where they have been
around for such a long time. They're essentially
the backbones of a lot of our programs. Yeah,
like WIC. I mean, how long has WIC been around,
right? More than 50 years. And so if those programs
go away, they're gone. They're not coming back.
They're really, really critical kind of centerpieces
for a lot of that work. Maternal child block
grants is another good one. We've built home
visiting on that, nurse family partnerships on
that. We might do things around safe sleep. or
car seat checks and car seat programs. We might
build other injury prevention programs around
that. We might expand that into early childhood
development work. All of that needs that core
funding to help stabilize it. So we are really
concerned. We know that kind of everything's
at the table and everything's in the shuffle.
We have identified kind of what are our high,
priority most critical grants are, and then what
are kind of medium priority, medium need, and
then what are some other kind of federal grants
that might enhance or expand upon other existing
grants. A good example of that is there's a federal
grant to support WIC programs and farmers markets.
So it's not the core WIC program funding, but
it's an enhancement to tie WIC participants to
farmers markets. So what were you hearing from
the delegation as part? of your presentation
and your concern. I mean, I assume you were communicating
your concern about potential cuts. Did they give
you any hints on what the administration was
thinking or where they thought things might be
going? I think recognition of just the challenges
of a budget that continues to be. kind of punted
down the line with continuing resolution after
continuing resolution. Right. They're trying
to get another one in place right now. Right
now. And this week, I think the 14th is their
deadline for that. And we've heard, you know,
most likely a continuing resolution instead of
any sort of shutdown. But, you know, there's
challenges around that, of that, you know, we
can be pretty. you know, pretty predictable in
terms of funding amounts, but those funding amounts
are also very stagnant. And so they're not necessarily
responsive. And so, you know. They acknowledged
that budgets are tight. It's a challenge. I think
we got good feedback of being able to prioritize
and identify like these are the core ones that
we are most concerned about. And then, you know,
some some lower risk or lower need or lower of
concern. But those that really support a lot
of our infrastructure, we were able to highlight.
And I think they were responsive to that. OK,
OK. Let's talk Medicaid for a minute. That was
a big issue for the county commissioner. at the
legislative conference. That's what I was talking
with Commissioner Ozias and Commissioner Eisenhower
about. And I was there and it was really highlighted
by the National Association of Counties as a
major area to discuss with our delegation because
they felt like it was at risk of major cuts.
And different states are obviously dependent
on Medicaid at different levels. Washington has
a fairly significant population, especially in
different regions that really... penned on Medicaid.
One of our county commissioners was talking about
half of the births in their county over the last
year were Medicaid -supported births, and those
children are going to be born regardless of whether
or not the benefits continue to be provided.
I know Medicaid is a big issue for clinics that
your members oversee and run. What are you guys
thinking as far as Medicaid and what did you
hear? I think what we heard was a lot of from
our congressional delegation and senators who
are more familiar with Medicaid, very, very tuned
into. what cuts mean and very concerned. You
know, 50, I think it is an average of 50 % of
our babies in Washington state are born on Medicaid.
Really half. And there are certain counties and
certain regions where that goes to 60 and if,
and even higher to 70%. Wow. Which is significant.
And we know health outcomes are absolutely dependent
on whether or not you can access care. So, you
know, Pregnant moms who aren't getting prenatal
care are more at risk for maternal mortality,
poor birth outcomes that impacts infants potentially
for life, depending on what some of those birth
outcomes are. So it has a very big cascading
effect. Our delegates that are more familiar
with the Medicaid space are very much aware of
what that could mean and the impacts that could
have. And not all of our delegation was. And
so being able to share some of those stories
right away of, you know, hey, did you know? 70
% of your babies born in this county or this
jurisdiction or region are on Medicaid. That
was news to them. And that made them kind of
pause and think a little bit of, oh, this has
a bigger impact than they maybe have realized.
And if you think of other populations that might
be utilizing Medicaid, that can have really far
-reaching impacts. We also know that providers
are struggling for Medicaid reimbursement. It's
not sufficient to cover the cost of health care
in some regions. And so providers are either
pulling out of the Medicaid program, so not taking
patients on Medicaid, or pulling out of services
altogether. Well, that's been a problem for a
while. That's not something that's new. No, but
could absolutely be exacerbated. Right. So if
you cut Medicaid beyond where it is now, and
it's not sufficient in many cases, it's just
going to make the problem worse. Exactly. And
so concerns about that, particularly for our
areas that are already driving long distances,
if telehealth is impacted by potential cuts,
because depending, I guess, again, on what gets
cut or what changes happen in terms of what's,
you know, reimbursable or what's allowed under
Medicaid, if things like telehealth change, now
you're not able to, you know, see a provider
more on demand. like telehealth can sometimes
provide, now you're traveling. And if you don't
have reliable transportation, or if it's the
one provider who's going to see a population
of 200 ,000, good luck. And that has some significant
impacts for our communities. Distance, convenience,
access, reasonable access to healthcare services
is a big indicator of outcome, right? For many,
many people, especially those who need the support
of... programs like Medicaid, because if they
need Medicaid, like you said, they probably don't
have reliable transportation or are less likely
to. They may not have other family supports that
could assist them in getting to that care, et
cetera, et cetera. It could be a real challenge.
Yeah. The cascading impacts are big. It also
impacts what Medicaid policies we pass at the
state level. So we often will pass state enhancements
or expansions, get that approved at the federal
government. So if whatever changes at the federal
government might impact what we're able to pass
in terms of expansion or additional Medicaid
benefits at the state level. So it does have
a cascading effect. And so I think it's something
that, you know, public health is very much tuned
into that access to care issue and concept. Yeah.
You know, it's interesting that you bring that
up. And I wanted to talk about federal issues
today and what you were hearing at the federal
level. But this is one of those that really does
spill in a major way over to the work that we're
doing also at the state level. During the legislative
session that's going on now, you know, we are
facing a 10 to 14 billion dollar deficit. It's
likely, in my opinion, to actually it's not going
to get better with the next. revenue outlook,
and it may get worse. Some are already calling
it a $15 or $16 billion deficit or trying to
plan for that. If there's a major cut in Medicaid
at the federal level, you know, the state uses
a lot of that money in its budget for Apple Health
and other services. Have you guys started talking
about what that might look like and how the impacts
would be felt locally from that cut at the federal
level? Yeah, so there's a concept around that's
being tossed at federally around block grants.
So instead of being a reimbursable program like
Washington State utilizes, some states utilize
Medicaid as block grants. So here, instead of
reimbursing for every service, here is X million
dollars to do preventative care. In Washington
State, you figure out how you want to use that
block grant to do that work. Most often, block
grants are not the same amount of money, right?
And so now you're figuring out, okay, do we cut
eligibility? do we cut types of services? Block
grants are kind of their way of saying, we're
not going to tell you, we're not going to give
you money with a bunch of strings attached, right?
We're going to make it more flexible and easier
for you to use, but it's probably less. Yeah.
And so that's going to be a real challenge of
how does Washington State in a budget deficit
year, do they prioritize that over things like
public safety or housing or other things that
they have already identified as big ticket items?
That they want to fund. Behavioral health is
a big one where. Right. Right. It's a big one.
Yeah. Medicaid. There's a lot of Medicaid dollars
to go into behavioral health services. And so
it does have a trickle effect into the state
conversation. And so one of the things that local
government and counties can do is we can be a
voice of elevating local stories to our federal
delegations. Like we have examples of this is
what's going on right now in your communities
that we're hearing from the constituents who
elected both of us into office. It could also
be a way of being. communicator to the state
of, you know, here's what we're hearing going
on in our federal visits and the concerns that
we have and coming to the table to help provide
some solutions or just being aware of what those
potential changes are and helping navigate them.
Yeah. No, I appreciate that. I wanted to try
to make the tie between some of what we're hearing
at the federal level and how that's going to,
you know, could have reverberating impacts and
significant ones at the local level. You mentioned
there were three, three big items. We talked
about public health funds. funding, Medicaid,
I assume that was one of the big items. What's
the last one? The last one was just being able
to strengthen that federal to local connection.
We often work very, very closely with our state
agencies, Department of Health and local health
jurisdictions often work hand in hand, but we
also work with Ecology, we work with Healthcare
Authority, DCYF, but we also work with federal
partners like the CDC. And so we really wanted
to have a conversation of, hey, we work and rely
on CDC for a number of things that could be data
and linking local data sets that we might have
public facing on websites to CDC data systems.
In times of emergency, our avian flu outbreak
is a good example of that. We actually strengthen
that relationship even further where CDC will
actually send technical experts to help in the
response or will fast track testing and laboratory
diagnostics. in response to an outbreak. And
so we really wanted to emphasize that, hey, we
have a strong connection federal to local. It
isn't just, you know, federal, state, and the
state only interacts with federal government.
We have that interaction and rely on federal
government in a lot of ways too. And so really
emphasizing that relationship. Our cuts. to those
agencies affecting your ability to build those
relationships and make those connections? Did
you talk about that? And did they kind of discuss
what maybe the plans are? Yeah, one of the programs
that I think is small, but is a really interesting
program is the PHAP program that's run through
the CDC. And I'm going to get the acronym probably
wrong. It's Public Health Associates Program.
And it is a very highly technical expertise program.
So I think epidemiologists who are highly trained
in a certain area or skill set. Local health
departments actually apply to participate in
that program and they get one of those PHAP associates
to come. into their jurisdiction. So they live
in their, in their County, in their communities,
they work in their local health department. They
provide that skillset. Is it for a certain period
of time? It's for two years. Okay. But overwhelmingly,
almost like a job core program. Almost. It's
very, yeah. Similar to AmeriCorps or other job
core programs where it's specializations. Right.
They're like a project employee and they come
in and usually in jurisdictions that are smaller,
you know, cash strapped, that sort of thing.
Yeah. And we have, number of jurisdictions who
were participating in that program. It's been
cut. So that program no longer exists. Those
staff are no longer working in those local health
departments. And for a number of our local health
departments, that work is just gone. They're
not able to pick it up because it was either
highly specialized or very unique to that program.
I'm pretty sure we had that program in my county
and we had an epidemiologist that we shared with
a couple of other jurisdictions. If I'm not mistaken,
she was in our county maybe once or twice a week
and then kind of traveled around a little bit.
Yeah, we have a number of LHJs that have participated
throughout the years. I believe we had five PHAP
associates in our jurisdiction or in our LHJs
when the program was cut. LHJs are? Local health
jurisdictions. Perfect. And so that's a loss
to our communities. That work is just not being
done anymore. It's just sitting there. And epidemiologists
will do what sort of work? An epidemiologist
might do a lot of data analysis, looking, pulling
data from federal data sources or state data
sources. They might also be analyzing that data
to look at trends. Ours was very interested in
ticks, believe it or not. Yeah, or tracking different
things. So ticks is a really great one where
an epi core across the country is actually mapping
the migration of ticks across. I wish people
could see the smile on your face when you say
things like this. It's fascinating. It's the
nerdy part of me. But you can actually see how
Lyme disease is migrating across our country.
You know, 30 years ago, Lyme disease, East Coast
issue. You know, 20 years ago, Midwest issue.
Now it's slowly creeping to the West because
the environments that ticks are living in. Are
changing. Are changing. You know, we have tick
season in the Midwest. west where i came from
it used to be summer activity we have ticks now
that can live you know in sub -zero temperatures
you know you're not thinking of ticks are going
to take over the world you know it's just one
right one one very niche example they're so disgusting
you know really interesting example of of using
data to track that um and so now oh you know
you didn't need to have any sort of um program
around you know tick prevention or education
or awareness and you weren't necessarily looking
at Lyme disease or anaplasmosis or babesiosis
and all these other tick -borne diseases, now
you are. And because you have that... that resource
at the local level and state level, you're more
tuned into it. Right. And that sort of information
could be helpful to healthcare providers in the
region as time goes by and those trends change.
And without someone looking at that data, without
that resource being available, a lot of times...
Those providers aren't – you're not going to
have as good a care. You're not going to be as
prepared in your community. And that's just one
tiny little example, right? One tiny – literally
because ticks are small. I didn't even mean that,
but that – yeah, okay. You got me on that one.
But they can be a really big problem. They can.
Really big problem. Okay. Well, thanks, Jamie.
You had a good trip overall? Had a good trip
overall. Always fun to go to the other Washington
for a little bit and always great to come back
to. And how was the weather while you were there?
It was actually beautiful. Oh, that's great.
We had, yeah, it was like 65. No spring blossoms
yet. Sunny. Yeah, it was quite lovely. Good,
good. Got an opportunity to see a few sites,
I hope? Got to see some sites. Obviously, we
did our congressional visit, so got to see. the
Capitol and the, not Republican, but the congressional
buildings. So Rayburn, Longworth, Cannon, got
to go through the tunnels. House offices and
all that. House offices, Senate offices. Got
to see the Library of Congress. Oh, it's a beautiful
building. Which is, in my opinion, the coolest
building in DC. I absolutely agree. Have you
been on the tour? I have. I love the tour. Have
you gotten your library card? No, I want to,
and I want to sit down. I want to get in and
sit down. into the rotunda yeah it is one of
the funnest most fun souvenirs and like you know
touristy things because it is you know it is
our it is our library right it's america's library
and being able to get your library of congress
card is yeah um it's a really fun thing i've
never had as much time as i needed to actually
kind of go through that process and then sit
on the floor you know and and Do, I don't know,
some research, whatever you do in the Library
of Congress. But I just remember being awe -inspired
by the building. I really enjoyed the tour. The
interior of the building is just as magnificent
as the exterior, and I think it really is one
of the most beautiful structures in D .C., if
not almost anywhere. Yeah, and then I was able
to tick the postage museum. Tick the postage
museum? Yes, tick the postage museum off my list
of D .C. things. Oh, tick it off your list. Okay,
I thought you were referring to... our earlier
parts of the conversation. But yeah, I was able
to go to that, which I had never been yet. I
don't think anybody goes to that, Jamie. You
know, it was a little gem. It was, you know,
you don't need to spend a lot of time, but it
was interesting to learn about postage and see
some old postage stamps. Wow. So exciting. You
know, it was more exciting than I thought. And
it was one of the things I had yet to do in D
.C. So for those who don't know, the postage
museum is over by... Union Station, which is
right across from, what is the Irish pub right
there? I can't remember the name of it. It's
super old. But it is connected to a hotel. Yes.
And I have stayed in that hotel several times,
having gone to DC quite a few times. And I have
looked at the postage museum. many many times
and walked right past it and i never think i
don't think i ever saw anybody go in so you must
have been they must have woke up when you opened
the door there was a number of folks that were
there um it wasn't just me um how are you on
the age list compared to the other people that
were there uh you know there was some young little
Kids with grandparents. But, you know, if you
have an hour, hour and a half, it's fun to just
dip into. What's great about D .C. is so many
of those museums are just free to the public.
Part of the Smithsonian. Hey, I have 35 minutes.
I want to see, you know, I want to go and see
this one thing. It's a good little thing to do.
Well, I'm glad you had a good time. You are the
only person that I have ever met that's actually
been inside the postage museum at Washington,
D .C. That'll be a trivia question at some point.
in the future. Jamie, it's cutoff day. It's early.
We're going to be up late, I'm sure. And I hope
you'll come back and cut another podcast with
me to share in the good news and maybe some of
the not good news after cutoff. Sounds good.
All right. We'll see you then. Thanks for tuning
in to County Connection. Stay in the loop by
subscribing to us through your preferred podcasting
app and following us on LinkedIn, Facebook, and
Instagram. And don't forget to join The Hub,
your go -to source for the latest news and updates
from the Washington State Association of Counties.
Until next time, stay connected and stay informed.