Supporters of a $345 million bond for EvergreenHealth in Kirkland spent hundreds of thousands of dollars to create ads, host phone banks and send out flyers before the August primary election. Their opposition spent just $34.

And yet, for the second election in a row, the proposed bond for the publicly funded hospital fell short. In the August primary election, 58.5% of voters approved it, short of the 60% margin needed for bond measures.

Why, despite money-backed, organized support, did the bond fail? Officials with the Kirkland facility, which serves nearly half a million people on the Eastside as a public hospital district, say they’ve just started analyzing why it failed — and how it will complete projects that the bond would have funded.

But voters who cast a “no” vote cited several reasons: frustration with taxes rising with property values; questions about the need for a public hospital district; and backlash to a controversial mailer that showed voting histories of individual voters and their neighbors.

“As you would expect, we are disappointed with the results of the bond measure, and we’re disappointed for the public hospital district patients who depend on us every day, as well as our doctors and nurses,” said Kay Taylor, EvergreenHealth senior vice president for marketing.

The proposed 20-year bond would have paid for a new critical-care unit, an updated maternity center and seismic upgrades to the hospital’s original building. The new bond would have extended the current tax rate of 29 cents per $1,000 of assessed value, so property owners wouldn’t have had a new tax rate beyond what they already pay.

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This was different from EvergreenHealth’s April election bond measure, which would have added an additional 18 cents per $1,000 of assessed value over 20 years. That measure also failed.

Hospital officials said before the August election that they hoped the unchanged tax rate would satisfy voters, who they learned were concerned about tax increases.

But for some voters, that wasn’t enough. For Chris McDaniel, who lives in Kirkland, the proposed tax rate, combined with the local taxes for the Lake Washington School District and state taxes imposed under the McCleary education-funding decision, was too much. He voted “no.”

“They (EvergreenHealth) are a cash machine and I see no reason why we need to support them with tax dollars when the school district here already has us over a huge barrel,” he said.

An opposition group was led by Paul Hess, who with others spent $34 to pay for a web domain name and website. Hess objects to the existence of a public hospital in a suburban area with several options for medical care.

Still, he says, “I love the hospital, I just don’t like their funding methods.”

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Toward the end of the campaign cycle, voters received a “voter report card” that graded them based on their voting history. Citing public records from King County Elections, the recipient was urged to “get your grade up by returning your ballot” by Aug. 6.

It also included a list of neighbors and noted if they had voted in the primary elections from 2015 to 2018. The mailer  noted that it was paid for by the Approve Prop 1 committee and sponsored by the EvergreenHealth Foundation.

Recipients criticized the mailer, saying that they felt “voter-shamed” by information that — although it was publicly available — they didn’t think should be published. They also questioned the accuracy; one women’s mailer said she voted in the 2015 election, yet she didn’t move to the area until 2016.

King County Elections received several calls from people who were upset, said elections spokeswoman Halei Watkins.

Sending out voting records is a “fairly standard practice” to increase voter turnout, Watkins said, but not widely seen in candidate campaigns because of the potential backlash, as shown by the EvergreenHealth flyer.

“A lot people don’t know that whether they voted is public record, and it’s not something they are often confronted with,” she said. “When they are, it’s, ‘How did you get my information?’ That is always the first question people ask. That’s where the concern comes in.”

Taylor apologized for the flyers on behalf of EvergreenHealth. “That was a mistake,” she said.

It is unclear if EvergreenHealth will put another measure on the ballot in the future. Election rules prevent the hospital from another ballot measure this year. Expansion of the medical center’s critical-care unit and upgrades to the maternity center are a priority, Taylor said. But those upgrades may take longer than if the bond had passed.

“We are going to listen to our community, and see what we can learn,” she said.