Health care dominates Engell visit to county

NEWPORT – State Rep. Andrew Engell, R-Colville, got an earful about health care when he met with Pend Oreille County commissioners Tuesday, Oct. 28, in Newport.

Republican commissioner Robert Rosencrantz, a former hospital board commissioner, called attention to the upcoming health insurance premium increases through the Affordable Care Act, which have been subsidized with tax credits, which expire at the end of the year.

“If those subsidies expire, premiums will go up in Washington State Congressional District 5, Mr. Bruchman, by 243 percent,” Rosencrantz said pointedly to Steve Bruchman, a field representative for U.S. Rep. Michael Baumgartner, R-Spokane. Bruchman was attending remotely via Zoom. Baumgartner represents District 5 in the U.S. House of Representatives.

Monthly premiums would rise from $602 to $2,064 for a silver plan for a 60-year-old couple with a combined income of $85,000, Rosencrantz said.

“In Pend Oreille County this couple will be paying an additional $17,544 a year,” he said. He said Idaho’s 1st Congressional District would face slightly lower increases.

Because of changes to Washington’s charity care law in 2022, Newport Hospital and Health Services is on the hook for charity care. For hospitals the size of Newport’s that means a 100% write off by the hospital for people making less that 200% of the poverty level, 75% discount for those earning 201% to 250% of the federal poverty level, and 50% for those earning 251% to 300% of the federal poverty level.

The 100% write off means that the hospital doesn’t get paid at all, NHHS CEO Kim Manus said.

Rosencrantz said he was recommending Engell seek a change to the law to exempt hospitals like Newport’s that are in distressed, frontier counties that share a border with a neighboring state from the charity care provisions.

Rosencrantz had invited Manus and spokesperson Jenny Smith to talk to Engell about the impacts on the hospital and clinic.

Manus told Engell that NHHS was struggling to absorb the charity care, partially because a change in February 2024 meant that people didn’t have to live in Washington to receive the charity care.

Engell asked if it was a rule or law. Manus said it was an interpretation of a law by the state Department of Health.

Manus said the state hospital association asked for an interpretation from DOH. DOH interpreted the law in a way that hurt NHHS, she said. The interpretation was that hospitals couldn’t tell someone that didn’t live in the state that they weren’t eligible for charity care.

Manus said that NHHS provides many Idaho residents with charity care. In 2023, NHHS provided Washington residents with $258,444 of charity care while out of state people, mostly from Idaho, got $236,054 in charity care. That jumped in 2024 to $491,127 for out of staters and $417,450 for Washington residents. Through the first three quarters of 2025, out of staters had received $467,544 of charity care compared to $400,526 for Washington residents.

Jenny Smith told Engell that part of that was due to Idaho’s law’s regarding medical debt.

“The ramifications of not paying your bill to an Idaho provider is that they can come after your personal property,” Smith said.

Engell said that after this year, in Washington medical debt couldn’t be reported to a credit agency.

“So who is going to pay their medical bill?” Manus said.

Manus said on the federal level, when the subsidies go away for marketplace plans through the Affordable Care Act, it means that more people will go without health insurance.

“And those individuals that are getting those subsidies are ones that are below 200% of the federal poverty guidelines,” she said. “So now they’re a charity case. Or they’ll go to a bronze plan which is a much higher deductible, I think it is $10,000 a year.”

She said another thing Washington does differently than Idaho is when people are signing up for Medicaid if someone is living in the household with another but is not married, their income is not counted. If they are married it is counted.

Engell asked if Manus had been in contact with the Department of Health. Manus said yes. He asked if the Washington State Hospital Association has been involved.

“They’ve been involved and we lost the battle,” Manus said.

“We just need a bill to change it,” Engell said.

Manus said that even the Newport Health Center clinic was subject to charity care provisions.

Republican county commissioner Brian Smiley said hospital care was like any other community service and those who abuse the system take away from those who don’t.

“There’s always going to be somebody that legitimately really needs it and maybe can only afford so much,” Smiley said.

Engell said that hospitals should be able to set their own policy. Or NHHS could go back to the way it used to be when there was a 20-mile radius around Newport hospital where people who live within that radius, regardless of state, could qualify for charity care. That included Priest Lake, Manus said earlier.

“Where you could go into Idaho but not any part of Idaho,” Engell said.

Manus said Idaho patients were a part of Newport’s health care community.

“They’re part of what has made us successful,” she said.