The Monroe City Council last week agreed to fund a $1 per capita payment — roughly $18,120 — to the financially strained Snohomish County Health District, which sought help from local municipalities last year.

Since 2008, staff and services have been reduced to offset stretched revenue. Councilmember Jason Gamble was one of two who voted against the disbursement.

“I am not saying the health district is not important by any stretch of the imagination,” Gamble said. “I just don't believe this is the proper way to go about funding the health district. It's a one-time shot in the arm.”

Seven other city governments have agreed to help with the one-time request, which will be satisfied through an interlocal agreement. The process has been repeated since the health district was established. The agency formed in 1959, and jurisdictions have given short-term contributions periodically since 1967.

“What makes public health particularly challenging is that we do not have any taxing authority,” said health district interim administrator Jeff Ketchel. “State law says public health cannot raise money through taxes, so we are dependent on the kindness of others. Counties have the ultimate responsibility for public health in their jurisdictions.”

Some cities have declined the most recent request, and others are still discussing their specific interlocal agreements, Ketchel said. Many previously budgeted an amount to consider this year, he said.

Last year, Monroe councilmembers set aside enough for a $2 per capita agreement. Councilmember Jim Kamp also voted against any kind of payment at last Tuesday's meeting.  He said the amount was not a productive mechanism for funding the health district, and he wants to see a long-term solution.

“We are basically doing this to feel good, I just want to make sure we all understand that. We are not getting any additional services for customers. It's all great, the stuff that they are providing — it's fantastic,” Gamble said. “They will be providing us the same services tomorrow if we approve the $0 and stay status quo, and they'll be providing Mill Creek the same services, which probably has more demand on the system. Some of these larger cities have more demand on the system, and on their (the health district) resources than we do, so just remember that.”

Ketchel said the health district is working to develop a sustainability plan at the request of multiple municipalities. It might outline how long-term financial relationships between the health district and local agencies and governments could look, he said.

The county health district is one of many public health jurisdictions working to rebuild resources after slashes were made during the economic downturn. A Public Health is Essential initiative is being led by those jurisdictions, and asks the Legislature to supply more state funding for public health this year and the next.

Ketchel said the $60 million request is a “down payment for cuts made during the Great Recession.” Gov. Jay Inslee's recently released budget includes a $20 million allocation. The House includes a $36 million allocation, while the Senate budget makes no allocation, he said.

“State funding for local public health has decreased 65.7 percent from a peak of $27.29 per capita in 2000 to $9.36 per capita in 2014,” according to agreement documents. “The health district has experienced a 22 percent decrease from its 2005 funding level while the county population has increased by 14 percent in the same 10-year period...The health district ranks 34 out of 35 local health jurisdictions in the state for public health expenditures per resident.”

The health district's more than $16 million annual budget is balanced by a combination of federal, state, county and per capita funds, plus grants, some license and permit fees and charges for services, according to the 2017 budget.

Ketchel said the federal funds are currently at risk with the proposed rescission of the Affordable Care Act, under which the Prevention and Public Health fund was established. That money covers health district programs, such as tobacco prevention, emergency preparedness, immunization promotion, and healthy eating. All affect the residents in Monroe, he said.

The per capita funds will help support other efforts, such as the health district's involved response in this year's mumps outbreak in Snohomish County, including the two confirmed and two probable cases within the Monroe School District, Ketchel said. They are also managing an above-average number of local reports of tuberculosis this year, he said.

“We have to actively make sure each person takes their medication every day, and most of those are staff driving around to their houses and watching them take their medication,” Ketchel said. “That is how important it is to make sure the people with active TB who are contagious are taking their medication, which often takes six to nine months or more to get over the TB.”