Bill would clarify tribal representation on local boards of health

The Senate Local Government Committee heard House Bill 1946, sponsored in the House by Representative Natasha Hill, which seeks to clarify tribal membership on local boards of health and health district boards.

Committee staffer Karen Epps summarized current law: counties are responsible for establishing a county health department or health district and each local public-health jurisdiction is governed by a local board of health. Current membership rules require county commissioners or representatives from the county legislative authority and unelected members from three categories (health-care providers, residents who are consumers of public health, and other community stakeholders); those categories must be balanced in specified ways and approved by a majority of the board of county commissioners. Epps said the bill would add that when a federally recognized tribe holds reservation or trust lands in a county, or when an urban Indian organization registered as a 501(c)(3) serves American Indian and Alaska Native people in the county, the local board or health district board must allow a tribal representative from each such tribe or organization and the tribe or organization must select its representative.

Representative Natasha Hill said the bill grew out of lessons from the COVID-19 pandemic in Spokane, where tribal organizations stepped in to deliver vaccines and other services and where the sponsor said a lack of tribal representation hindered equitable rollout. "Increasing representation is just what it sounds like. It increases representation," Hill said, describing the effort as an equity measure intended to improve communication and public-health outcomes for Indigenous communities.

Key text and timelines: the bill would require the State Board of Health to adopt rules establishing timelines for modifying board membership, and those rules must take effect no later than one year after the bill’s effective date. Until the State Board of Health rules take effect, county commissioners must modify membership within 60 days of receiving notice of a tribal representative’s selection. Karen Epps noted the bill passed the House 61-36 and that a fiscal note is available; a revised fiscal note was requested on March 20.

Concerns and implementation issues: committee members asked whether adding tribal representatives would require expanding the number of elected officials on a board in order to preserve the statutory balance between elected officials and other members. Epps and Representative Hill confirmed the bill does not amend the equal-balance language; as tribal representatives are added, the number of elected officials would need to change to maintain parity. Several senators noted that some counties recently expanded the number of county commissioners and have found recruiting unelected members administratively difficult; one senator asked whether the bill provides funding to assist counties with recruitment and was told it does not.

Public comment: Medgraf Flatman testified remotely in support and tied the bill to disparate COVID-19 outcomes for American Indian and Alaska Native people. Flatman said local boards in Spokane failed to prioritize communities of color in vaccine rollout and that tribal organizations used their sovereign authority to reprioritize doses for elders and other high-risk groups. "The only way that is possible is for these communities to be on the board influencing policy themselves," Flatman said.

History and clarifying language: Representative Hill said earlier legislation in 2021 was interpreted by some counties to mean a single tribal representative for a region rather than one representative per tribe or organization; this bill is intended to make the original intent clear. Hill also said the final bill removed language about "usual and accustomed" lands to keep the board size manageable while still increasing representation.

Ending: The bill has no Senate companion; it passed the House 61-36 and remains under Senate committee review.