Is Washington's generous 'charity care' policy inadvertently creating a healthcare crisis on its borders? A small hospital in Eastern Washington, nestled right on the Idaho state line, is finding itself overwhelmed by a growing number of patients traveling from across the border to access free or discounted medical services under Washington's progressive charity care policy. This situation is putting a significant strain on their already tight financial resources.
Newport Hospital, located just a stone's throw from Idaho and a considerable drive from any major city, is at the forefront of this challenge. The hospital's interim CEO, Justin Peters, expressed his concern, stating, "Charity care for our community is one thing, but having people come from other states and providing that charity care really puts a strain on our hospital." He highlighted that their margins are already very, very thin, making it difficult to absorb the costs of out-of-state patients.
The impact is stark: Newport Hospital saw a 43% jump in the money spent on charity care between 2024 and 2025. Alarmingly, nearly half of all the charity care provided by the hospital is now going to individuals from out of state. While emergency care is a given for any hospital, the strain intensifies when charity care extends to other services like orthopedic surgery, behavioral health, and gynecological care, as spokesperson Jenny Smith noted, "But when you’re looking at it for other services, it really gets tricky."
But here's where it gets controversial... A legislative bill, introduced by Rep. Andrew Engell, aimed to address this by limiting non-emergency charity care to Washington residents. Engell questioned, "It’s really about, how much can Washington and our hospitals be expected to bear at no cost?" Although the bill didn't pass this year due to some language issues, Engell remains optimistic about revisiting it next year, believing a solution can be found.
For context, Washington's charity care law, enacted in 1989, originally allowed hospitals to set their own geographical limits for providing free or discounted care to uninsured individuals who meet certain income criteria. However, a 2023 state Department of Health ruling, based on a law passed the year prior, barred these geographical restrictions, asserting that eligibility should solely be based on income, not location. In Washington, this means a family of four earning less than approximately $100,000 per year could qualify.
This issue has broader implications, as highlighted by Sen. Manka Dhingra, who commented, "This is another example of what happens with national politics at our state level... Over and over again, what we are finding is that the state has to spend more resources taking care of people that should have access to health care in their own state."
Other hospitals are also feeling the heat. Pullman Regional Hospital reported a 28% spike in total charity care from 2023 to 2024. Healthcare systems like MultiCare, which owns Deaconess Hospital in Spokane, supported Engell's bill, with spokesperson Kevin Maloney stating it would "allow us to continue to focus our resources towards care for Washington State residents." MultiCare Deaconess alone spent nearly $2 million more on charity care in 2024 compared to 2023, and Providence Sacred Heart Medical Center saw an $18 million increase in the same period. Across the entire state, charity care spending rose by 34% from 2023 to 2024, with hospitals approving about 65% of applications.
And this is the part most people miss... The passage of President Donald Trump’s “One Big Beautiful Bill Act” has added another layer of concern. While it includes a fund to support rural health, estimated at $181 million for the state, hospital leaders like Peters fear it won't be enough. He worries that potential premium increases and subsequent loss of insurance could lead to more uninsured or underinsured patients, thereby increasing charity care cases.
What are your thoughts on this? Should states be responsible for providing charity care to residents of other states, especially when it strains local resources? Let us know in the comments below!
