Frequently Asked Questions
What is a Public Hospital District?
A Public Hospital District (PHD) is a “special taxing district.” It works a lot like your local school
district. A PHD’s job is to oversee local healthcare and raise public money for shared healthcare needs. It
belongs to local voters — not a company, not the state.
What can a Public Hospital District do?
They can do almost anything healthcare-related. Individual districts choose a few projects to tackle based on
what is feasible for their size. Across Washington, different PHDs run their own primary care facilities and
hospitals, partner with networks to subsidize expansion or maintain an important service in a community,
provide public health and healthcare education and outreach such as youth substance use prevention programs,
recruit and retain healthcare workers, offer wellness classes, provide charitable healthcare services, in-home
care, and assisted living. The model's flexibility is its strength. While no single district can solve every
local problem, PHDs are an effective tool that allows communities to tackle local challenges.
Are there other Public Hospital Districts in Washington?
Yes — there are 58 of them across the state. Some are large and run full hospitals. Others are small and run a
single clinic. Skagit Valley Hospital, just south of Whatcom County, was built by a PHD. If you’ve lived in
Washington for a while, there’s a good chance you’ve already received care at a place connected to a PHD, even
if you didn’t know it.
What are the healthcare gaps in Whatcom County?
From rural Whatcom County to Bellingham, everyone needs access to care: access to healthcare providers closer
to where we live, community health workers, wellness classes, primary care, and behavioral health. Numerous
studies of healthcare and public health in Whatcom County document community needs, including: behavioral
health, substance use disorder/opioids, youth mental health, housing, homelessness, affordability, healthcare
workforce needs, primary care access, specialty care access, access to dental care, food insecurity, Medicare
access issues, aging population demographics in rural areas & small cities, racism → impact on health,
wildfire risk/air quality, EMS gaps in rural county, transportation barriers, childcare cost & access, fewer
insured people in rural areas compared to Bellingham.
References
How are districts formed?
Public Hospital Districts are created by local vote. Here’s the process:
- Voters equal to 10% of the people who voted in the last general election (within the proposed district) must sign a petition to get the question on the ballot.
- The question goes on the ballot.
- A simple majority of voters in the district must vote yes.
Can public hospital districts levy property taxes?
In Washington, Public Hospital District commissions can levy a property tax to fund district operations. The
maximum levy is $0.75 per $1,000 of assessed value, set under RCW 70.44.060(6).
Are there tax exemptions for seniors and those with disabilities?
Yes. Whatcom County, the State of Washington, and several local cities offer property tax exemptions, relief,
and deferral programs for low-income seniors, people with disabilities, churches, nonprofits, local
government, people with homes damaged by flood and natural disasters, widows/widowers of military veterans,
and for home improvement projects. See more at https://www.whatcomcounty.us/3406/Exemptions-Tax-Relief
Can public hospital districts levy taxes without voter approval?
After the district is created, the commission can levy a property tax anywhere in the range of $0.01 to $0.75 per $1,000 of property value without needing additional voter approval one time. Once the levy rate is set, any future increase past what the growth limit (RCW 84.55.010/.050) allows will need to be placed on the ballot for voter approval. For example, the commission could set an initial levy at $0.30 per $1,000 of property value without going to the ballot, but once that rate is set the commission could not raise it to the $0.75 cap without putting that increase back on the ballot.
Districts also have a few other funding options, some of which require asking for voter approval. These are:
- Revenue bonds — repaid solely from hospital/clinic revenue, not taxes — can be issued by commissioner resolution alone, no vote required (RCW 70.44.060(5)(a), chapter 39.46 RCW).
- General obligation (GO) bonds, repaid by property tax levy, are capped by RCW 39.36.020: a district can incur GO debt up to 3/4 of 1% (0.75%) of the district's total assessed property value without a vote.
- To go beyond that — up to a ceiling of 2.5% of assessed value — requires voter approval: a 60% supermajority (three-fifths), and turnout at that election must equal at least 40% of the votes cast in the last general election (the constitutional validation requirement).