In recent weeks, several public hospital district candidates and supporters have said they believe that many of the island’s health care needs could be met by creating a hospital district and raising about $1.5 million annually from local taxpayers.

This amount would support a more robust system of primary care and “light” urgent care, campaign officials say, and could be raised with a tax rate of $.45 per $1,000 of assessed property value. The idea is not to support the status quo, organizers have said repeatedly, but to develop and support a well functioning rural clinic.

“We are not here to sustain Neighborcare. We are here to get back to a clinic that meets island needs,” Tim Johnson said last week.

Johnson, a member of the hospital district campaign, Protect Vashon Health Care, said he and his colleagues arrived at the $.45 estimate by talking with health care providers about expected costs of care and from looking at what amount would likely be available without hurting the park district, given the state’s current property tax system. Under Washington law, the combined limit for cities, counties and most special districts is $5.90 per $1,000 of assessed value. Beyond that limit, so-called “junior” taxing districts would see reductions to their levy rates; on Vashon, the park district would be the first to be affected and lose tax revenue.

The idea is not to fund everything a hospital district could legally fund, Johnson said, but to support the island’s most basic needs: a small increase in the number of providers to make same-day appointments easier to get, longer clinic hours and regular access to basic urgent care, such as x-rays for suspected broken bones and stitches for lacerations.

“We believe we can have that level of service within the constraints of the $5.90,” Johnson said.

He also said that the $.45 rate is an estimate and that it would be up to the commissioners, if the hospital district measure passes in November, to determine the rate and contract for desired services with medical providers.

At the Vashon Park District, Executive Director Elaine Ott- Rocheford recently expressed both optimism and caution that the hospital and park districts could co-exist, noting she is pleased three commissioner candidates have already indicated they would not want to hurt the park district.

“Of course our biggest concern is that they (commissioners) will choose a rate that will harm the park district,” she said. “But I am confident that they will be true to the process and listen to the constituents’ needs and weigh all those variables, and they will make a decision that is right for the community. We hope that the decision that is right for the community includes not affecting the park district.”

She also stressed that the state’s property tax system is complex, with many moving parts — unknown from one year to the next.

Given 2019 property values and tax rates, including the park district’s request for a $.45 levy rate, which islanders will also vote on this fall, she said her calculations show there is $.52 of “wiggle room” under the $5.90 limit — room enough for the hospital district to levy $.45 without any effects on the park district.

However, she said other variables could change that picture. For example, the King County Library System had been going to seek a levy lid lift this year, from its current $.33 rate to $.50. Should it do so next year, the wiggle room — using today’s figures — would drop from $.52 to $.36.

The difference in using a $.36 rate would mean about $300,000 less for the hospital district, Ott-Rocheford said, bringing the hospital district levy down to $1.2 million annually instead of $1.5 million. If the public hospital district commissioners elected to go with the $.45 rate and the library system was at $.50, that would mean a cut of $303,000 to the park district, or 20% of its revenue, she added, stressing that she was using today’s dollars in her calculations. She acknowledged this scenario, too, has “moving parts,” including rising property values and corresponding lower taxing rates of other districts that could make several more cents available to the hospital district without affecting the park district.

Overall, she said that the what-if scenarios are complicated and that the park district hopes to keep the message simple — that both districts could co-exist.

“This is not an either-or-vote,” she said.

By state law, public hospital districts can levy up to $.75 without a public vote. Once commissioners establish a rate, like other taxing districts, a hospital district would be subject to a 1% annual increase in its levy (total tax collected) unless voters approved a larger amount.

The law also establishes commissioner terms. On Vashon, nine candidates are running for five seats. If the hospital district measure passes, the two candidates with the most votes would have six year-terms; the two with the middle number of votes would have four-year terms, and the two with the least number of votes would serve two-year terms, according to a King County Elections spokesperson. Each commissioner would be eligible to run for re-election.

This effort to create a hospital district was fueled by Neighborcare CEO Michael Erikson writing an op-ed for The Beachcomber last year, indicating that Neighborcare was losing $350,000 annually at the Sunrise Ridge clinic. This year, the budgeted shortfall there is nearly $640,000, according to Mary Schilder, Neighborcare’s director of marketing communications. Several people, including those involved with the hospital district campaign, have recently stated that Neighborcare will leave the island if the hospital district fails; Erikson addressed that assertion last week in an emailed statement.

“As I have said before, if there continues to be no source for sustainable funding, Neighborcare Health will have to evaluate whether we can maintain services at the primary care clinic on Sunrise Ridge, given our ongoing operational shortfall. We have not created any plans for departure at this juncture. We believe without sustainable funding, no other provider can long maintain services on Vashon either. That is why we believe that it is in the voters’ best interest to approve the hospital district to support sustainable health care for islanders,” he said.

In the coming weeks, at least one public meeting focusing on the possible creation of a district is expected, and a candidate forum is set for 7 to 8:30 p.m. Thursday, Oct. 10, at the Methodist church. This Friday night, during the gallery walk, campaign representatives will answer questions in front of The Hardware Store Restaurant beginning at 6 p.m. and will also be available for conversation at several upcoming Farmers Markets.

At a glance: island health care

Currently on Vashon, there are four medical clinics: Fern Cove Natural Medicine, which does not accept insurance, Vashon Natural Medicine and Neighborcare, which also operates a school-based clinic at Vashon High School. Vashon Natural Medicine and Neighborcare are the largest island clinics and recently provided some statistics about their practices.

Vashon Natural Medicine is owned by Kelly Wright, ND. It provides primary care for patients of all ages, from 3 days old and older. The clinic has more than 5,500 active patients (individuals seen within the last three years), Wright said, and six practitioners: two naturopathic physicians and one medical doctor, two advanced registered nurse practitioners and one registered nurse. All but one practitioner is taking new patients. Four providers see patients every day. The clinic is open from 9 a.m. to 5 p.m. Monday through Friday and provides pager service for patients who need care after hours. Same-day appointments are provided for established patients with acute care needs. The clinic does not take Medicare.

At Neighborcare on Vashon, between July 1, 2018, and June 30 this year, the Sunrise Ridge clinic provided approximately 12,900 medical visits to 3,900 patients: About 480 patients were under age 18, 1,800 were between 18 and 64, and 1,600 were 65 and over. In that same time frame, on average, the clinic saw 865 patients per month in 1,100 patient visits. Currently, there are five providers filling the equivalent of 3.5 full-time providers. For primary care visits, patients are usually scheduled within a span of one to three weeks. For urgent care, some same-day appointments are offered. Clinic hours are 8 a.m. to 5 p.m. Monday, Tuesday, Thursday and Friday, variable on Wednesday and 9 a.m. to 1 p.m. Saturday.

Neighborcare Health is a federally qualified health center and receives higher reimbursements than other clinics for seeing patients covered by Medicaid and Medicare. Medicaid is the only form of payment that meets or exceeds the cost of care, officials there say. The payer mix for the year that ended on June 30 was approximately 4% uninsured, 17% Medicaid, 38% Medicare and 41% private coverage.

This version corrects the number of clinics on the island and includes Neighborcare’s student clinic at Vashon High School.