Washington State Hospital Association Challenges State Charity Care Requirement

The Washington State Hospital Association has generally been a friend of efforts to expand health care to indigent patients.  It even filed an amicus brief in support of Obamacare when advocates challenged Obamacare.  But last month the State Department of Health issued an interpretive opinion concluding that the state’s charity care law requires hospitals to provide free health care for families earning less than 4 times the poverty level and without regard to residency.  WSHA filed a complaint seeking to enjoin the interpretation because it says that the Department is reversing 30 year old precedent limiting Washington hospitals’ charity care obligation to Washington residents.  By the way, it seems most likely that the Department was concerned with in-state residential restrictions when it issued the interpretation last month.  The Department seems to have gotten wind of hospitals limiting free health care to patients living within the hospital’s area or zip code, for example.   But the WSHA is complaining that by invalidating residency requirements, the State makes hospitals liable to treat the whole dadburn world.  The complaint makes a pretty good argument regarding the law of unintended consequences:

19.  For years, Washington hospitals have absorbed significant financial losses, resulting in a decrease in the availability of some services for some Washingtonians.

20. In 2022, Washington hospitals had $2.1 billion in operational losses from delivery of patient care. In the first six months of 2023, Washington hospitals had $750 million in operational losses.

21. If Washington hospitals are required to provide free care to indigent persons from other states and countries, Washington’s hospitals will be required to offer scarce, costly and complex medical care such as organ transplants and cancer treatment to non-Washingtonians who, based on current requests to hospitals, will likely come from around the world. Hospitals will also be required to offer common procedures, which may appeal to those in adjoining states and provinces. In many instances these services will be provided by hospitals without any source of reimbursement whatsoever.

22. The Department’s new (and erroneous) interpretation of the Act will result in the exact opposite of the Legislature’s intent in enacting the Charity Care Act: By requiring Washington hospitals to provide free or discounted care to indigent persons from anywhere in the world, the Department will decrease access for Washingtonians, and will increase the costs of care for Washingtonians who will inevitably subsidize the costs of free care to others from outside of the State.  

darryll k. jones