The Coalition for Orcas Health Care wants the public to be as well informed as possible about the upcoming public hospital district measure.

The coalition held its second town hall in a series of five meant to prepare the community to vote on the public hospital district in April.

“We believe that all members of the community should have access to urgent and after-hours care,” said Art Lange, one of the co-founding members of COHC. “We think that’s terribly important for our community, too.”

Joining Lange in facilitating the gathering at the school cafeteria was fellow coalition member Patty Miller. The room was filled with curious islanders, waiting to hear how other public hospital districts around the state have operated clinics in rural communities.

The town hall guests were Ben Lindekugel, executive director of the Association of Washington Public Hospital Districts, Christa Campbell, Lopez Island Public Hospital District commissioner and Sandy Robertson, superintendent of Mason County Public Hospital District No. 2, which represents the northern part of that county.

“The interesting thing about the hospital district statute, which is RCW 70.44, is that it really has a fairly, extremely broad – thank goodness – scope in terms of what people can do to meet their particular health needs,” Lindekugel said. “Everything’s different; in fact, the old cliche: ‘If you’ve seen one public hospital district, you’ve seen one public hospital district. They are very different.”

Lindekugel noted that though there are many differences between each public hospital district, there are similarities between them as well. Firstly, most of the public hospital districts operate in a rural community. He added that public hospital district taxes typically account for 4-5 percent of a clinic’s budget.

“Across the country, a lot of rural clinics and hospitals have closed lately … most of them are highly (mainly) Medicare and Medicaid – in fact, in our rural communities the average combined of Medicare and Medicaid is about 80 percent,” Lindekugel said. “You have to have two things to be successful as a hospital. One is volume and the other is payer base. Meaning you have to have enough private pay to offset the Medicare and Medicaid. What do rural [communities] have? No volume and a bad payer base.”

There has been no rural hospital or clinic closures in Washington state yet, though there have been numerous nationwide. The two reasons, Lindekugel explained, were that Medicaid expanded and the other is because of public hospital districts. He said that most rural clinics break even because of public hospital districts.

Lindekugel was asked why the commission gets to pick the tax amount and it isn’t put to public vote. He said the public hospital district measure was adopted in 1945 and hasn’t changed much since. He said the best advice he can give is to elect good commissioners who will do their job.

“The folks are managing a business (the hospital district). Several thousand into the millions in some cases,” said Lindekugel. “I would suggest that you have a good partnership with the commissioners you elect.”

Robertson then introduced herself and explained the history of the public hospital district for which she is superintendent. Her district was created when the first county public hospital district decided that the clinic in north Mason County was not performing to its standards and would no longer fund it, forcing it to close.

“The fact of not having primary care to (north Mason county residents) was just not acceptable,” Robertson said. “That’s pretty much when a coalition, similar to what has been formed here on Orcas, was formed by the north Mason residents to look into establishing a second hospital district to cover the north Mason area. Very similar to what you guys are trying to do here.”

One thing that is different, explained Robertson, is that the North Mason area was already paying a hospital district tax, so there wasn’t a new tax. However, they were guaranteed that the rate would not be raised above what they were already paying. The election to form the Mason County Public Hospital District No. 2 happened in November 2007 and was overwhelmingly approved, said Robertson.

Next to introduce herself was Campbell from Lopez. She was previously on the Catherine Washburn Medical Association board when Island Hospital notified the Lopez clinic it was terminating its contract. Campbell was part of the five-member search committee that sought a new provider for the Lopez Medical Center. CWMA approached nine medical institutions in Western Washington, including returning to Island Hospital if a public hospital district was created. It declined to negotiate a new contract.

Lopez was a break-even hospital, Campbell said. Without associating with a medical institution with a manageable Medicare reimbursement rate, Lopez Medical Center was automatically in a deficit of more $300,000.

“So the message to us was pretty clear that even if we went independent (we) still weren’t getting that reimbursement rate. So (we) had to be making up the money somewhere,” Campbell said. Lopez voted on its public hospital district, with more than 84 percent of voters approving it.

“If you’re wondering what the alternatives are to being associated with UW, I don’t know what your choices are except going independent,” Campbell said. “That can be done. I think that it’s daunting … I have to admit, I was extremely relieved because I wasn’t sure how we were going to be able to pull that off. But that is a possibility, but I don’t think without a hospital district.”

Campbell said that the Lopez voters also did not know what they were going to be expected to pay when they voted for the district, but they knew they would have to be able to bridge the funding, approximately $600,000.

“So, we said, ‘It will likely be at the highest amount until we get through the first couple years of this district and we’ve paid back our loans,’” Campbell said. “It passed in February, and it allowed us to start collecting money next year in May.”

Lopez’s tax rate will be set at 75 cents per $1,000 assessed value until it breaks even from its bridge loan debt, and then it will do an assessment.

“You have to know what your purpose is,” said Lopez Public Hospital District commissioner Becky Presley, who was an audience member. “Our purpose is to provide quality health care to everyone on the island … we care about what we do.”