COEUR d'ALENE - A local Republican group is gearing up to aggressively campaign for two seats on the Kootenai Hospital District Board of Trustees - seats that largely have gone uncontested for decades.

"When I ran for the board, we didn't even have to hold an election because I was uncontested," said Leise Razzeto, the only incumbent in a field of four candidates vying for the two positions.

In fact, she said, the only contested race that she can recall drew about 70 votes countywide. Even then, those voting were typically involved somehow in the medical community.

"I would say there is definitely a change in the landscape now," she added.

According to Jeff Ward, of the Kootenai County Reagan Republicans, the days of uncontested elections - even in the smallest nonpartisan taxing district races - are over.

"These taxing districts control hundreds of millions of tax dollars," he said. "This is public money we are talking about, and they are making decisions on how this money is spent."

Ward wants to make sure these boards have a conservative voice.

His group has yet to officially endorse any candidates for the hospital race, but Ward said two of the candidates - Donna Montgomery and Jim Pierce - are members of his group. Pierce sits on the Reagan Republicans' board of directors.

Pierce, a banker with Washington Trust Bank, is out of town and could not be reached for comment.

But Montgomery, a former small business owner, said she is running to ensure the hospital is using sound business principles, and to make sure a conservative approach is considered in the decision making.

"They need a different voice on the board," she said. "And I am a hand-up instead of a hand-out type of person."

As a volunteer for her church, Montgomery said she spends a considerable amount of time at the hospital, and she has learned a lot from talking with hospital staff over the years.

"I have heard that a number of doctors have recently left the hospital," she said. " And I would like to prevent more of them from leaving."

In part, that is one of the reasons Dr. Neil Nemec jumped in the race. He said a number of oncology doctors have left recently and he personally respects every one of them.

"I don't know all of the details because I am not on the board," he said. "But there is always at least two sides to the story and I've only heard one."

Nemec, who is a primary care family doctor, said he is pleased with direction of the current board and has tremendous faith in the administration's ability to run the hospital in these very complex times.

He explained that regulatory mandates such as the Affordable Care Act, commonly referred to as Obamacare, and the state healthcare exchange that was passed by the Idaho Legislature last month are going to take some expertise to implement, without damaging the community's healthcare delivery system in the process.

"The future of healthcare delivery is very complex right now, and there are no rules," Nemec said, adding that a newcomer to these issues will be hard pressed to catch up. "And we don't have a lot of time to play catch up here."

Both Nemec and Razzeto were concerned that some candidates may be running for purely ideological reasons, and they feel that has the potential to cause undue damage to the healthcare delivery system in Kootenai County.

"This absolutely should be nonpartisan," Nemec said. "When it comes to healthcare, we should leave all of the politics at the door."

Ward said the Reagan Republicans have specifically targeted the hospital district for fiscal and policy reasons.

He concedes the hospital has not raised taxes since 1995, but said that also poses other problems. In Idaho when a taxing district doesn't take its allowable 3 percent in property taxes each year, the district builds up a surplus of taxing authority, known as foregone taxes. The hospital district has accumulated nearly $13 million in foregone taxes.

"That just keeps on ballooning up," Ward said. "They could levy those taxes at any time."

Razzeto said the current board has a very long conservative history of not raising taxes, and she is confident the board has absolutely no intention to levy its foregone taxes.

"In fact, if I could forego foregone taxes, I would do it in a minute," the incumbent said. "Honestly we spend about 30 seconds out of 250 hours of work per year to vote no on raising taxes."

She said it concerns her that a candidate may be running simply to have his or her say on a 30-second issue.

"What are they going to do for the other 250 hours - that's what worries me," she said

Nemec said he would take the same conservative position as Razzeto's on the taxes. Montgomery would as well.

Ward said members of his group are also concerned about the hospital's advocacy on policy issues such as the Affordable Care Act, and the state healthcare exchange.

"The hospital is a huge business in this community," he said. "It shouldn't be using its political power and public money to promote healthcare policy."

Ward said Jon Ness, CEO of the hospital, has been vocal in his support for creating a statewide healthcare exchange, which his group is opposed to, and he said the hospital has also been supportive of certain elements of "Obamacare."

Razzeto said even if an ideological candidate is elected to the board, he or she will find that the board doesn't play a role at all in policy development for the hospital. The board, she added, is focused on governance and making sure the community's healthcare needs are met.

"The hospital is a community asset, and we are the stewards of that asset," she said.

The top two vote-getters in the election will win the seats available.