Engell’s charity care bill gets hearing

Bill would confine charity care to state residents

OLYMPIA – Providing charity care for out of staters creates an unsustainable financial burden for border facility Newport hospital, Justin Peters, interim CEO for Newport Hospital and Health Services told the House Wellness and Health committee.

“In 2025, 49% of our total charity care, over $550,000 was provided to residents outside of Washington state,” Peters said Tuesday, Jan. 27 in Olympia. He was testifying in support of 7th District Rep. Andrew Engell’s house bill that is seeking to limit charity care to state residents, HB 2250. Most of the increase in charity care in Newport hospital was for non-emergency care.

In 2022, the state Legislature made a law that said charity care must be offered regardless of where people lived in the world. Charity care is discounts on medical care offered to people who are below 400% of the federal poverty level, sometimes 100% discounts.

Robert Rosencrantz, Pend Oreille County commissioner, also testified in Olympia in support of Engell’s bill.

“Previous charity care changes may have been well intentioned, but they pose a threat to hospital sustainability,” Rosencrantz said. “I worry about this because in the long run, the failure of Newport hospital or the erosion of any of its services would be devastating.”

Lisa Thatcher of the Washington State Hospital Association supported Engell’s bill.

Thatcher maintained that the since the first charity care bill was enacted in 1989, the state Legislature always intended Charity Care to apply to state residents. She said people traveling in the state from elsewhere can always get charity care for emergencies. She said combined with the Medicaid changes in HR1 (The One Big Beautiful Bill Act) hospitals statewide are concerned that people from other states will come to Washington for elective procedures.

Peters was asked if he was concerned if a neighboring state rolled back its Medicaid expansion, that uncompensated care could get worse.

Peters said Newport Hospital was anticipating that would happen.

Several people spoke against limiting charity care to Washinton citizens.

Niyura Jasso, an attorney with Columbia Legal services said the bill would make it more difficult for Washingtonians to get healthcare.

“This bill is not about financial sustainability,” she said. “It is about limiting access to care.”

She said the wording in the bill that says charity care is for patients who “intend to reside here indefinitely,” is vague and subjective.

She said it was problematic for people in the country on worker and student visas, as well as other immigrants.

Engell, R-Colville, said that wasn’t the bill’s intent and asked her if she would work with him to improve the bill.

Hasso said yes, but that she didn’t see how the residency requirement would not exclude people who are already living here.

Engell said that the bill’s intent was regardless of a person’s immigration status, that if they had the intent to stay in Washington and were acting like a resident, that they would not be excluded from charity care.

Jasso said that the word residency was so tied to immigration status that it was going to be a deterrent for people to get necessary care.

Eli Rushbank, an attorney from Dollar Four, a patient advocacy organization, spoke against the bill.

The bill says that the current application of charity care creates the opportunity to make the state a medical tourism destination. Rushbank said that isn’t real.

“This fear of medical tourism is unfounded because the vast majority of Washington hospitals haven’t had a residency requirement and they haven’t been overrun in the over 35 years that we’ve had a charity care law,” Rushbank said.

He said charity care is required nationally and both Idaho and Oregon hospitals had charity care programs. He said neighboring countries Canada and Mexico have universal health care.

Suzanne Vanderwerff of Seattle Children’s Hospital spoke in favor of the bill and provided examples of people coming to that hospital from other countries.

“We have seen patients from Canada seeking charity care to avoid queues in their own home country for surgeries and imaging,” she said. “We recently had a patient flown to us from Asia specifically to receive charity care that are available from many parts of the world.”

Vanderwerff said the hospital has a broad charity care program that provides services to people from Alaska, Oregon, Washington and Idaho.

She said the hospital’s program is broader than the minimum standards and they didn’t intend to change that. But she said the hospital didn’t want to provide non emergent care that was available nearer to where the person lived.

She gave the example of a patient from California who qualified for charity care but “then wanted to stay for months for non-emergent charity care rather than returning to California where the same care was available nearer to home.”

Vanderwerff said that charity care increased 44% at Seattle Children’s Hospital between 2024 and 2025. That was for more reasons than residency and she said because of the impacts of HR1, she knew more people would need charity care this year.

She said the hospital needed to prioritize caring for all children in the region without having to pay for care for children outside the Pacific Northwest and outside the United States. She said the bill provides a floor and doesn’t prevent Seattle Children’s from having a more generous charity care policy.

Others speaking against the bill said it would create barriers to such care as abortion, miscarriage management or gender-affirming care.

A companion bill to HB 2250 was introduced in the Senate. SB 5959 is sponsored by a bipartisan group that included Sen. Shelly Short, R-Addy, and Washington Senate Majority Leader Jamie Pederson, D-Seattle. Pederson was in Newport and met with local officials, including Newport hospital district CEO Kim Manus last September. The Senate bill was referred to the Health & Long-Term Care committee.