There are some big decisions to make this election year. In November, King County voters may face a vote on a $1.74 billion bond to renovate and expand Harborview Medical Center.

The hospital, situated on First Hill, is owned by King County, but staffed and operated by the University of Washington. As a publicly owned and operated hospital, Harborview serves many people who need healthcare and would not be able to pay for it including, but not limited to, the area homeless population.

In addition, Harborview serves as the Level 1 trauma center for the states of Washington, Alaska, Idaho and Montana. It is the disaster preparedness and control hospital for Seattle and King County. In short, if you find yourself there, something very, very bad has likely happened.

The hospital has 413 beds, 40 of which are in single rooms, and 20 of those 40 are reserved for patients in need of psychiatric care. The hospital says that typically, 50 beds in double rooms can’t be used because of infection protocols. According to the King County Executive’s office, it had more than 16,000 admissions last year. All this adds up to a hospital that routinely has more patients than it has places to put them.

To address this, the county convened a working group in 2018 to search for possible solutions. The group’s report, released earlier this month, calls for a series of changes and expansions to the campus.

The biggest ticket item would be a new, $952 million tower on what is now open space behind the hospital. The 10-story building would create space for 360 single occupant rooms. It would help allow for better disaster preparedness, and allow the building to better meet privacy and infection control standards.  It would also reconfigure the emergency department, and have a helipad placed on top, with a direct connection to the emergency department.

Another $79 million would go toward a new behavioral health building, focusing on patients with psychiatric or substance abuse problems. The behavioral health clinics at Harborview have a combined 51,000 visits per year.

Most of the rest of the funds would go toward other renovations and seismic upgrades in the existing buildings. The plan also calls for demolishing the “East Clinic” on 9th Avenue and Alder Street to create new open space. Lumped in with the Harborview main campus renovations would be renovations and seismic improvements to the Pioneer Square Clinic at Third and Washington (also operated by Harborview).

Harborview is home to an enhanced shelter for homeless people. The proposal calls for maintain that either at Harborview Hall, its current location, “or the most appropriate location.”

Harborview was last renovated in 2000, and that upgrade was paid through 20-year bonds which are expiring. Most of the cost of this new project would likely be paid by county (not just Seattle) property owners.

The other states served by the hospital are not likely to help with the capital costs. The county executive’s office notes that those out-of-state residents pay for their services, the same as anyone else. The office also said that only about 200 of last year’s trauma patients were from out of state, a fraction of the total.

For the King County residents footing the bill, if the entire cost is paid through bonds, it would add about 17 or 18 cents per $1,000 of assessed value to property taxes. For the median county homeowner (a $580,000 house) that translates into $95-105 per year. The expiring bond costs about $18 per year, leaving the net impact at $77 to $87 per year, according to the County Executive’s office.

On Capitol Hill, where our median home value is closer to $1 million, it would mean about $170 or $180 per year, which translates to a net increase of about $140 per year.

Those are the highest the numbers could go. The county may ask the state to pick up some of the tab, and if it does, the direct cost to county residents will go down (though we’ll still be paying, since, you know, the state still gets a good bit of its money from us). And the hospital is planning to seek donations from private philanthropists, which may reduce the number further.

Right now, the proposal has to jump through a few bureaucratic hoops. Including approval by the County Executive and King County Council, neither of which has to approve the plan as presented. If things go according to schedule, a version of the proposal would come before the County Council in April, which could then place the measure on the November ballot. As a bond measure, it would require 60% approval by county voters.

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