Maintaining healthcare services in a rural community can be financially challenging.

To help ease this burden, nearly half of Washington state’s 90 hospitals are part of a public health district, which allows for a tax levy to fund medical services.

Orcas, Lopez and San Juan each have separate hospital districts — as approved by voters — governed by a board of commissioners. The districts are tasked with managing local service providers and meeting the healthcare needs unique to each community.

Citing rising labor costs and the growing needs of islanders, the Orcas Island Health Care District is asking voters to approve a temporary 28.5¢ increase in its annual property tax levy on the April 22 ballot. If approved, the rate would increase the levy for 10 years from 41.5¢ to 70¢ per $1,000 of assessed property value. For example, a $750,000 home would mean an increase of $213.75. The maximum levy rate for the district is 75¢ per $1,000 of assessed value.

“It is essential and necessary to increase the levy rate to continue to provide for island-appropriate, quality primary and acute/urgent medical care (including after-hours care) and related specialties, to all members of our community in a financially sustainable and cost-effective manner,” according to the resolution approved by commissioners Mark Salierno, Alison Sanders, Chelsie Guilford, Diane Boteler and Dave Zoeller.

OIHCD will hold two informational town hall meetings on Friday, March 28 from 1-2:30 p.m. and Wednesday, April 9 from 5:30 – 7 p.m. at the Eastsound Fire Hall. More information about the levy can be found at https://www.orcashealth.org/sustainable-community-based-care.

Background

In 2018, with the prospect of clinics closing, islanders sought reliable funding to provide long-term healthcare options. In line with Lopez and San Juan, which already had public hospital districts, voters overwhelmingly approved the formation of the Orcas Island Health Care District (San Juan County Public Hospital District No. 3). Five elected commissioners govern the health district. A full-time superintendent and a part-time administrative assistant handle day-to-day operations.

The Orcas Medical Foundation dissolved and transferred ownership of the land, building and equipment of the Orcas Medical Center to the district. UW Medicine ended its contract on Orcas, and Island Health, based in Anacortes, assumed clinic management.

Island Primary Care — Orcas provides family medicine, obstetrics and gynecology, internal medicine and pediatrics and is open regular business hours and after-hours for emergencies when warranted after phone triage with a provider. In 2024, the clinic saw 3813 unique patients for a total of 11,053 clinic visits. Approximately 55% of patients use Medicare/AppleHealth and 40% use commercial insurance.

“The acute care and after-hours care by phone and in person if clinically needed is available to anyone on Orcas Island — no matter where they access their primary care. We also have scheduled blood draw and x-ray availability for any islander,” explained Commissioner Boteler. “We have dramatically improved the working relationship between Orcas Fire/EMS and the clinic to work together to provide appropriate care for our shared taxpayers. We have continued to work to coordinate health care resources beyond the clinic and to strategize how to provide more care on the island to decrease the cost and time of off-island trips.”

Commissioner Zoeller said Island Health initially did not fully grasp the island’s unique community.

“In working with the district, and also Aaimee Johnson, a long-time islander who is the Orcas clinic manager, I feel this has improved significantly. I now hear administrators from IH advocating for things based on the needs of our more isolated community, recognizing that the definition of primary care depends greatly on geography and what other services are readily available on Orcas. This has been a very satisfying joint effort,” he said.

In 2020-21, the board underwent extensive projects to repair or replace the major systems in the clinic building. In conjunction with the consolidation of the island clinics, there is a larger volume of patients which could eventually lead to the need to expand the clinic footprint, as well as the growing need for affordable options to house visiting providers, specialists and health care workers from the mainland who fill in for staff who are sick or on leave.

The district has agreed to a new 10-year deal starting in 2026 with Island Health to staff the clinic at its current level of services.

“Now that we have a tentative financial agreement for the new contract, we know that our current levy will be short of funds for clinic operations in the next four to five years,” explained Boteler.

The board is also looking at remodeling and possibly expanding the clinic building; providing housing options to staff (the district owns a vacant parcel of land); and expanding primary care clinical services by recruiting new physicians and other providers. Inflation and competition for clinical staff have significantly driven up labor costs, and as demand for services increases, the district needs to expand the clinic to allow space for new providers who will expand primary care visit capacity.

“We will continue to collaborate with local organizations and residents to prioritize and address the island’s evolving health needs,” said District Superintendent Chris Chord, noting the district-supported Community Dental Clinic that has provided dental treatments to more than 200 islanders since May 2024.

San Juan County Council member Justin Paulsen said “there has never been a more critical time” for locally controlled health services.

“The current Board of Commissioners is rightly focused on bolstering availability of care that targets those in our community who can least afford the time and investment required by trips off-island,” he said. “Whether someone actively uses the local facility for their primary care or not, I believe that assuring our entire community has access to health care is a core obligation that we all owe our fellow citizens.”

Boteler says if the levy is not approved, there will be uncertainty about fulfilling the new contract with Island Health.

“We will also not be able to plan for remodeling and possibly expanding the clinic building over the next 5-8 years as we have envisioned. In addition, we will need to review our ability to modernize the clinic to achieve our goal of keeping more care on the island.”

Zoeller, a 50-year resident of Orcas and paramedic for 30 years, says the district is on firm footing financially.

“The initial board worked hard to provide this, and subsequent members have shown financial responsibility to the taxpayers, even to the point of not budgeting the amount of the full levy for several years,” he said. “So while the clinic should be able to operate at the current capacity for three to five years, we could find ourselves in the situation of playing ‘catch up’ if we fail to plan and act now with a view to the future.”