# Real Briefings — Full Meeting Narrative: Joint Health Board and PHAB Meeting Tackles Medicaid Cuts and Columbia Valley Blight On a crisp September morning, the two bodies that guide public health in Whatcom County came together for a sobering examination of federal policy changes that could reshape healthcare access for thousands of local residents. The joint meeting of the County Council serving as Board of Health and the Public Health Advisory Board lasted over two hours, weaving together discussions of massive Medicaid cuts, persistent environmental health challenges in rural communities, and ongoing efforts to reform local governance structures. ## Meeting Overview The hybrid meeting, held on September 16, 2025, in the County Council chambers, brought together all seven Health Board members (the full County Council) and ten members of the Public Health Advisory Board. Health Board Chair Jon Scanlon presided over what would become one of the most substantive policy discussions of the year. The agenda promised three major presentations and one ongoing discussion item, but the weight of the topics—particularly a detailed analysis of impending federal Medicaid cuts—gave the proceedings an air of urgency rarely seen in routine health board meetings. Dr. Christine Espina had recently assumed the role of PHAB chair, replacing Kelly Carroll, and used her opening remarks to signal the advisory board's commitment to tackling difficult challenges ahead. With Rachel McGarrity as her vice chair, Espina would guide PHAB through discussions that touched on everything from federal healthcare policy to local environmental health crises. The meeting's tone was set early by public comment from Natalie Chavez, who delivered a pointed critique of COVID-19 vaccines, citing recent statements from Florida and Louisiana Surgeon Generals questioning vaccine safety. Her comments served as a reminder of the ongoing tensions around public health messaging that continue to complicate the work of local health officials. ## The $1 Trillion Medicaid Cut: A Looming Crisis The centerpiece of the meeting was Dr. Amy Harley's comprehensive presentation on Medicaid and the devastating implications of the recently passed Budget Reconciliation Act—dubbed the "One Big, Beautiful Bill Act" by supporters. Harley, serving as co-health officer while Interim Director Charlene Vermont was unavailable, delivered a masterclass in policy analysis that left board members grappling with the enormity of what lies ahead. ### Understanding the Stakes Harley began by establishing the fundamental importance of health insurance access to population health. "Affordable and accessible healthcare gives people access to preventive and necessary care, resulting in better health outcomes and lower mortality," she explained, using data to demonstrate that Medicaid recipients access healthcare at rates comparable to those with commercial insurance. The scope of the federal program she described was staggering: Medicaid covers 80 million Americans—one in five—and accounts for one-sixth of all national health spending at $870 billion annually. In Washington State alone, Apple Health (the state's Medicaid program) covers 2 million residents, roughly 25% of the population, at a cost of $21 billion per year. For Whatcom County specifically, the numbers were equally significant. With 56,000 residents covered by Medicaid—24% of the county population—and 41% of children enrolled in the program, any reduction in coverage would ripple through every corner of the community. "Eighteen percent of hospital payments in Whatcom County come from Medicaid," Harley noted, "so obviously a significant amount, and just underscores the financial impact of coverage decisions on our local health care." ### The Human Face of Coverage Harley brought the statistics to life through three carefully constructed vignettes that illustrated Medicaid's role in supporting families across the economic spectrum. Sarah, a single mother running a small bookkeeping business while caring for a developmentally disabled eight-year-old, represented the working families who depend on home and community-based services. Without Medicaid covering her son Daniel's specialists, therapies, and caregiver support, Sarah would face "thousands in out-of-pocket costs" and might have to abandon her work entirely. Margaret, a 78-year-old with COPD and early dementia, embodied the growing population of seniors who need support to remain in their homes. Through Medicaid's home and community-based services, she receives assistance from a trained caregiver several times per week, allowing her to "stay in her home of 40 plus years, near her neighbors and her family with dignity and safety and at a lower cost than it would be to put her in a nursing home." John's story highlighted Medicaid's role in addressing the opioid crisis. After a near-fatal overdose, his enrollment in Apple Health enabled access to medications for opioid use disorder, mental health counseling, and housing support through case management—comprehensive services that "stabilized his health reducing his risk of future overdose and emergency room visits." ### The Coming Cuts The heart of Harley's presentation focused on the Budget Reconciliation Act's provisions, which she described as implementing "$1 trillion cut in federal Medicaid funding over the next 10 years." The mechanics of these cuts revealed a deliberate strategy to reduce enrollment through administrative barriers and eligibility restrictions. The legislation increases the frequency of eligibility checks for Medicaid expansion recipients from annually to every six months—"an administrative burden that has been shown to lead to loss of coverage for folks." Work requirements of 80 hours per month would be imposed, despite evidence showing such requirements "doesn't actually have evidence that improves employment, but does have strong evidence that leads to loss of coverage due to the difficulty navigating the reporting requirements." Perhaps most troubling was what Harley characterized as the law's failure to acknowledge existing realities: "About 70% of Medicaid adults are already working, and 20% qualify for an exemption due to disability or acting as caregivers." The cruel irony, she noted, was that "if you lose your health coverage, you of course, are more likely to become unemployed." ### Local Implications The projected impact on Washington State was sobering: an estimated loss of $3 billion annually in federal funding, potentially forcing 329,000 people to lose coverage. For Whatcom County, this translated to approximately 9,000 residents—about one in six current recipients—losing health insurance. Harley quoted leaders from the Washington State Hospital Association and Medical Association to underscore the broader implications. "There's no way we can absorb this level of cuts in the Medicaid program without massive impacts to all Washingtonians access to care," warned the hospital association president. The medical association president was equally blunt: "This massive loss of coverage and funding will affect everyone. We will see the loss of health care services, more medical practice closures, longer wait times, and more stress on an already fragile health care system." The cuts would be particularly devastating for rural areas like parts of Whatcom County, where providers already struggle with lower reimbursement rates and higher proportions of Medicaid patients. Harley cited estimates suggesting seven hospitals in Washington State face immediate closure risk, with 19 more at risk over the next decade. ### Preparing for the Impact Recognizing the county's limited ability to influence federal policy, Harley focused on local response strategies. She outlined several areas where the county might concentrate its efforts: assessing impacts on the local health system, coordinating with providers and payers, monitoring changes in access and enrollment, and tracking changes in health outcomes and disparities. "If we can expand or realign local funding to help protect critical safety net services and prioritize services for those high need populations, which we expect to be impacted just seniors, people with disabilities, people are unhoused, those with behavioral health conditions and low income working adults," she suggested, acknowledging the county's budget constraints. The discussion that followed Harley's presentation revealed both the complexity of the challenge and the interconnected nature of the county's programs. Council Member Todd Donovan immediately zeroed in on the practical implications for county operations: "I need to figure out how the potential Medicaid cuts affect some of the programs... running the Ann Deacon center, jail medical treatment... the 23 hour center that we're supposed to stand up, the EMS reimbursements... housing stuff." His questions highlighted a critical gap in the county's preparation: they lacked a comprehensive inventory of programs dependent on Medicaid funding, either directly or indirectly through partner organizations. Deputy Executive Kayla Schott-Bresler acknowledged this limitation, noting they were "more concerned about community level impacts than we are sort of on the county institution." ### A Call for Community Engagement Health Board Chair Scanlon recognized the timing challenges, noting that budget decisions would need to be made before their next meeting if any immediate adjustments were needed. The discussion revealed the delicate balance between immediate crisis response and longer-term strategic planning. PHAB Vice Chair Rachel McGarrity raised a crucial point about public understanding, noting the disconnect between public perception of "Medicaid" versus "Apple Health"—the state's branded version of the same program. "There was a huge discrepancy between how people felt about, say, Medicaid and how people felt about Apple Health, because they don't realize that those are actually the same thing," she observed. Her comment sparked discussion about the need for proactive public education about the risks to healthcare access, particularly as the cuts would affect not just Medicaid recipients but anyone needing healthcare in a system with reduced provider capacity and longer wait times. ## Environmental Health Crisis in Columbia Valley The meeting's second major presentation shifted focus from federal policy to hyperlocal challenges, as the Health Department's environmental health team detailed their ongoing work in Columbia Valley, an unincorporated area about 45 minutes from Bellingham that has become a focal point for complex environmental and social health issues. ### Understanding Columbia Valley Sue Sullivan, Environmental Health Manager, painted a picture of a unique community facing significant challenges. With an estimated population of 3,600 residents—about 1.5% of the county's total—Columbia Valley represents one of ten designated urban growth areas but struggles with rural isolation and limited services. "Most folks out there will say they likely combine trips to Bellingham to get health care, to have access to healthy and affordable food, and do other errands because it's 45 minutes away, right if you have your own vehicle," Sullivan explained. The area has seen steady growth, with a 1.6% annual population increase since 2013, but economic indicators reveal significant hardship. Fifteen percent of East County residents live below the federal poverty level, making it second only to Bellingham in county subdivisions for poverty rates. Perhaps more significantly, a much larger percentage falls into the ALICE category—Asset Limited, Income Constrained, and Employed—representing households that earn above the poverty line but below the basic cost of living in the county. "These households can't afford essentials and often have to prioritize one need over another, so say, fixing your car versus getting necessary dental work done," Sullivan noted. In nearby Maple Falls, an astounding 57% of residents fall into the ALICE category, the highest percentage in the county. ### Sewage and Solid Waste Challenges The environmental health team's work in Columbia Valley reveals the intersection of poverty, inadequate infrastructure, and public health risks. Hayli Hruza, who supervises the on-site sewage program and has earned the title "the sewage lady," detailed the scope of challenges in an area served by approximately 1,500 septic systems. Since 2020, her team has received 128 community concerns and complaints related to sewage issues in Columbia Valley alone. Of these, 120 were unique properties, meaning eight were "frequent offenders" requiring repeated interventions. Surprisingly, 73% of these cases were "county generated"—meaning health department staff identified them through routine inspections rather than responding to neighbor complaints. Hruza walked through a typical case from earlier in the year that illustrated both the complexity of enforcement and the human challenges involved. A complaint about sewage under a trailer led to discovery that a resident had disconnected their kitchen drain, allowing wastewater to drip onto the ground rather than flow to the septic system. "For us, that's still sewage," Hruza explained, describing the subsequent months-long process of education, coordination between property owners and residents, and verification of corrections. The case highlighted the delicate balance environmental health staff must maintain. "We recognize that there is a delicate balance between enforcing code and placing vulnerable individuals in a more precarious position," Sullivan acknowledged. Many situations they encounter "are a symptom of larger complex factors such as economic instability and systemic inequalities." ### Solid Waste Accumulation Jennifer Hayden, supervisor of the solid waste program, described equally challenging conditions related to garbage and debris accumulation. Currently, her team manages 31 open complaints in Columbia Valley—representing 19% of all open solid waste complaints county-wide despite the area's small population. "From our experience in the area, many of the complaints we respond to are tied to issues like hoarding and poverty, and we also see cases of speculative accumulation, which is where people will collect things that may have value, like scrap metal, but they continue to kind of pile them up so that they degrade and they lose their value," Hayden explained. The county has attempted various interventions, including a 2021 cleanup day that removed 76,000 pounds of waste but proved unsustainable due to capacity limitations. Tire recycling events in 2021 and 2023, supported by state Department of Ecology funding, served over 1,000 customers and recycled 20,000 tires, demonstrating significant community need. A 2022 survey of residents with active solid waste complaints yielded limited responses despite gift card incentives, but the feedback received was telling: "Low income and lack of reliable transportation were their major barriers and financial support was their number one answer for how they could better manage their solid waste." ### Community Response and Advocacy The meeting took on added urgency when community members who had been working on these issues for years presented their perspectives and experiences. Christina Michele Martens, project manager for the East Whatcom County Health Equity Zone, provided context for understanding the environmental challenges as part of broader health disparities. The Health Equity Zone, one of only three in Washington State and the only rural one, has identified trash cleanup and property conditions as the eighth priority among ten focus areas developed through nine months of community engagement. Martens had recently toured the area with community advocates Ivy Little and Rochelle Hollowell, documenting 14 problematic properties within a 45-minute drive. "The most powerful one is top middle, and then middle middle that you can see in the back that the manufactured home that was on the property has collapsed onto itself," Martens said, referring to a collage of photographs she'd presented to illustrate current conditions. ### Personal Stories of Impact Ivy Little's testimony provided the most visceral account of the public health implications. She described working with health department staff on a property where an alcoholic woman was living in conditions that included "52 buckets of poop in five gallon buckets on the ground" because the septic system was not connected. The woman's trailer was overrun with rats, and despite family attempts to get help through adult protective services, "there was nothing they can do." The story's tragic conclusion—the woman died two weeks before the meeting, and "the rats ate part of her face"—stunned the room into silence. Little's account continued: "The rats up there are bad. There's people up there do not have septic hook up. The trailers they have up there are not being moved or taken out for porter bodies. They just are using buckets and burying it in the ground." Beyond the sewage issues, Little described ongoing environmental hazards: "There's a lot of oil, there's a lot of antifreeze and transmission fluid. It's in the ground. It's soaking, which is going in the water because we're off a well that we all have up there with the community." Her testimony revealed the interconnected nature of the problems: unauthorized scrap yards, people living in structures without permits, children playing in contaminated areas, and neighbors who feel powerless to address the situation through official channels. ### Calls for Systemic Change Rochelle Hollowell, who has worked with Little and others for seven to eight years on community cleanup efforts, presented the most comprehensive set of policy recommendations. She described how problems have worsened since COVID-19, with increased rodent problems, illegal drug activity, vandalism, and theft accompanying the environmental health hazards. "We are getting increased rodent problems. We have more illegal drug activity going on, vandalism, theft. On top of that, we have people who are now establishing businesses and they're not paying business taxes," she testified, describing one property owner with "at least a story high of junk" accumulated over six or seven years. Hollowell's frustration with current enforcement was palpable: "There's no consequences. We've talked to some of these people, and they said, I don't care, you know, report me to the Health Department. I don't care. They can't do anything, and they can't their hands are tied." Her recommendations were specific and sweeping: County Council should pass laws allowing the county executive to foreclose on blighted properties after property owners refuse to clean them up. She also called for a special task force including representatives from the executive's office, health department, code enforcement, sheriff's department, and four to six East County residents. "You need to have all of these agencies working together so that one will know what the other ones do and can and can't do," she explained, "and you also hearing from the residents in the community about what is and what is not working." ### The October 4 Request The immediate request that brought urgency to the discussion was Martens' appeal for county support of Habitat for Humanity's Build Community Day on October 4. The organization was already planning a volunteer event at the East Whatcom Regional Resource Center, and property cleanup had emerged as the number one request from residents seeking help. "I would love it if the county would consider donating five dumpsters on October 4, at least having a discussion about it," Martens requested, noting that Habitat for Humanity had provided a quote for two trailers and was prepared to coordinate the event. Chair Scanlon confirmed he had already forwarded the request to relevant council members and county staff. Deputy Executive Schott-Bresler indicated the executive's office was "working to see sort of what is eligible for solid waste funding as well as what can be accommodated within our budget authority." ### Council Response and Next Steps The community presentations sparked immediate action from council members. Chair Scanlon expressed strong support for creating a task force, suggesting it should include himself and Council Members Buchanan and Byrd, given their districts' involvement in the affected area. Council Member Byrd revealed he had been working on this issue for years and had attempted to form a task force in 2021 and 2022. "I have a almost completed ordinance related to exactly that that I can bring forward here next council meeting," he announced. The discussion revealed the scope and persistence of the problem. Byrd noted that "the meeting minutes for the county council go back before 2010 that this has been coming forward, and the community out there has been asking for help." Rather than creating a temporary task force, he suggested establishing a permanent mechanism that could meet as needed based on complaint volume. Council Member Elenbaas offered a perspective that would prove both insightful and emotionally challenging. Drawing on personal experience with someone close to him, he suggested that many blighted property situations involved untreated mental health issues, particularly what he described as a form of addiction similar to alcoholism. "People that live like this have the same type, and I believe there's a lot of research that supports this. It's just not mainstream yet," he said, his voice catching with emotion. "I've cleaned their place up before, numerous times, and it returns because the evidence suggests mental illness." His comments highlighted the complexity of enforcement approaches and the need for solutions that address underlying causes rather than just symptoms. "The visceral reaction of the individual when you take their stuff from them is debilitating to watch," he observed, warning against approaches that might simply "kicking in properties and condemning them and cleaning them up" without addressing mental health components. ## Health Board Restructuring Continues The final agenda item provided an update on the ongoing effort to restructure the Health Board by expanding membership beyond the current seven County Council members. Chair Scanlon reported on recent outreach to tribal councils and small cities to gather feedback on proposed changes. The working group's efforts had generated significant public response, with PHAB Vice Chair McGarrity reporting they had received 38 letters supporting restructuring and only three recommending keeping the current structure. The feedback demonstrated strong community interest in expanding health governance beyond elected officials. Council Member Galloway raised concerns that had emerged during the process, particularly regarding "delegation of legislative authority over Title 22"—the county's health code. Council Member Elenbaas shared similar concerns while also noting broader challenges: "Another of my concerns is related to the distrust regarding public health in the county and across the nation... much of the distrust is political in nature." The discussion reflected ongoing tensions between expanding community representation and maintaining clear lines of authority and accountability. McGarrity noted that much of the public feedback focused on "repairing public trust," which had become "a priority for the workgroup." Scanlon emphasized that depoliticizing the Health Board was part of the state legislature's intent in encouraging broader membership, but the complexity of balancing representation with governance effectiveness remained unresolved. ## Closing Reflections As the two-hour meeting drew to a close, the breadth of challenges facing public health in Whatcom County was clear. From federal policy changes that could strip healthcare coverage from thousands of residents to hyperlocal environmental health crises requiring immediate attention, the discussions revealed the interconnected nature of health governance. The meeting demonstrated both the strengths and limitations of the current public health system. Health department staff showed deep expertise and commitment to addressing complex problems with limited resources, while community advocates like Little and Hollowell displayed remarkable persistence in seeking solutions for their neighbors' health and safety. Yet the challenges outlined—whether Medicaid cuts or blighted properties—highlighted the need for solutions that transcend traditional departmental boundaries and require sustained political commitment. The unanimous agreement on creating a task force for environmental health issues suggested recognition that current approaches, while well-intentioned, were insufficient for the scale of need. The meeting adjourned at 12:07 p.m. with clear next steps: the executive's office would continue reviewing the October 4 dumpster request, Council Member Byrd would bring forward his task force ordinance at the next meeting, and the Health Board restructuring work would continue with ongoing community engagement. What remained was whether these various efforts—policy analysis, community organizing, and institutional reform—could coalesce into effective responses to challenges that seemed to grow more complex by the month. The meeting served as both a testament to the dedication of public health professionals and advocates, and a sobering reminder of the enormous work ahead in protecting and promoting the health of all Whatcom County residents. For community members who attended in person or watched online, the message was clear: the decisions being made in council chambers and federal Congress would have very real impacts on their daily lives, their neighbors' wellbeing, and their community's future. The question now was whether local government could respond with the urgency and creativity these challenges demanded.