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Growing with Monroe, Sky Valley and Snohomish Valley

Understanding Proposition 1: The Hospital Bond Proposal

EvergreenHealth Monroe is operated by Snohomish County Public Hospital District No. 1 and governed by elected commissioners. The district is planning for a replacement hospital on the existing Monroe campus to address growing demand for care, capacity limits and aging infrastructure.

Proposition 1 is the district's hospital bond measure on the November 3, 2026 ballot. If approved, it would authorize the district to issue up to $382 million in bonds for a replacement hospital and capital improvements on the Monroe campus. Snohomish County Elections lists Public Hospital District No. 1 Proposition No. 1 on the November general election ballot.

What Would Proposition 1 Fund? Additional FAQ

Proposition 1 At A Glance

Source for population projections: IntelliMed, 2024-2029.

Why is a replacement hospital being proposed?

The number of individual patients receiving care from EvergreenHealth and EvergreenHealth Monroe within Snohomish County Public Hospital District No. 1 increased from about 30,000 in 2022 to nearly 45,000 in 2025, an increase of nearly 50%.

Public Hospital District No. 1 is projected to grow from approximately 113,770 residents in 2024 to 117,206 in 2029, adding more than 3,400 residents. Several surrounding ZIP codes are also projected to grow faster than the district average.

Source: IntelliMed population projections, 2024-2029.

The current hospital also has space, infrastructure and site limitations that affect its ability to accommodate additional capacity and modern care environments. EvergreenHealth Monroe's Emergency Department currently has 14 treatment rooms and serves 60-80 patients each day. The hospital is the only full-service hospital between Wenatchee and Everett.

What does "full-service hospital" mean?

EvergreenHealth Monroe provides hospital-based care that includes:

• 24/7 emergency and inpatient hospital care
• Washington State-designated Level IV trauma care
• Diagnostic imaging and laboratory services
• Pharmacy services
• Surgical and procedural care
• Medical/surgical inpatient care
• Progressive care and telemetry for patients who require additional monitoring
• Outpatient services

Why now?

The district's planning considers both current utilization and projected population growth.

The number of individual patients receiving care within the district increased from approximately 30,000 in 2022 to nearly 45,000 in 2025. The district is also projected to add more than 3,400 residents between 2024 and 2029.

Planning for major hospital facilities takes years. The district's planning process considered current patient volumes, historical utilization trends, projected population growth, health care trends, industry standards and future community needs.

A Community Health Needs Assessment and subsequent planning work identified goals that include increasing local access to care, reducing transfers when appropriate and planning facilities that can adapt as patient needs and medical technology change.

What does "aging infrastructure" mean?

Aging infrastructure refers to more than the age of the building itself. Several characteristics of the current hospital affect how the facility can be used and expanded:

• Patient rooms: Many rooms were designed to older standards. Their size and configuration can make it more difficult to accommodate larger medical equipment and current patient-care needs.
• Mechanical and utility systems: Parts of the hospital's air-handling, plumbing, piping and other building systems have been in service for decades and require ongoing maintenance.
• Structural standards: The existing hospital was constructed under older structural standards. A replacement hospital would be designed to current seismic requirements for new hospital construction.
• Building layout: The hospital has undergone eight major additions over time. The resulting configuration limits options for further large-scale expansion.
• Site constraints: The campus is constrained by surrounding property and railroad tracks, limiting where the existing building can expand while hospital services remain operational.

Does this mean the current hospital is unsafe?

No. The current hospital is not considered unsafe and continues to operate with infrastructure that meets standards applicable to the facility's age. The reference to seismic standards reflects that requirements for new hospital construction have changed since the current facility was built. A replacement hospital would be designed to current seismic requirements for new hospital construction.

Why replacement instead of renovating or expanding the current hospital?

The Board of Commissioners considered three primary approaches: renovating the existing hospital, expanding the existing hospital or building a replacement hospital. The evaluation considered long-term health care needs, patient experience, construction and financing costs and the ability to keep hospital services operating during construction.

Renovating the current hospital

Renovation could address individual deficiencies in the existing facility. It would retain the existing building and its underlying layout, mechanical systems and expansion constraints, and renovation work would need to occur while hospital services continued.

Expanding the current hospital

Expansion could add capacity to the existing facility. The hospital has already undergone eight major additions, and further expansion is constrained by the existing configuration, available space and nearby railroad tracks. Large-scale expansion would also require construction while hospital services remained in operation.

Building a replacement hospital

A replacement hospital would create a new facility designed around the planned inpatient, emergency, surgical and procedural capacity. It would require new construction and bond financing, use an area currently used for parking during construction and eventually require removal of the current hospital. Under the current plan, the existing hospital and Emergency Department would remain operational while the new facility is built.

After evaluating the three approaches, the Board selected the replacement-hospital approach based on the factors described above.

What would Proposition 1 fund?

If approved, Proposition 1 would authorize up to $382 million in bonds for a replacement hospital and capital improvements on the Monroe campus.

Current planning includes:

• Construction of an approximately 200,000-square-foot replacement hospital
• 48 inpatient beds, up from 26 today
• 22 Emergency Department rooms, up from 14 today and including behavioral health rooms
• More than twice the current surgical capacity
• Flexible inpatient spaces designed to support different levels of care, including progressive care and intensive care
• New patient-care and support spaces
• Infrastructure designed for modern medical equipment and future technology
• Patient parking

Planning also considers the ability for the campus to add inpatient capacity in the future if future community needs require it.

For more information regarding the Proposition 1 Hospital Bond, please see our FAQ.