Washington’s Keep Our Care Act, which would have increased oversight of the state’s hospital and health care consolidations, has failed to make it over the finish line this legislative session.
Senate Bill 5241 has been introduced the past three sessions to address the growing presence of large health care and insurance chains in the state — a topic that has concerned many independent providers and lawmakers who worry these mergers and acquisitions are limiting access to certain services, driving up health costs and reducing market competition.
The bill was approved in the Senate last month but stalled in the House over the past few weeks and never came up for a floor vote before the deadline last Friday.
“Many of us are still mourning,” Rep. Tarra Simmons, D-Bremerton, wrote to The Seattle Times Tuesday. Simmons, sponsor of the House companion bill and a former registered nurse, called the issue “very personal” as she’s watched consolidations of hospitals and clinics on the Kitsap Peninsula over the years, including the hospital where she once worked.
“It has left my neighbors without many choices in healthcare, increased costs, and without access to services such as reproductive healthcare, gender affirming care, and the right to die with dignity,” Simmons wrote. She hopes to continue working on education around the “many harms of health care consolidation.”
“I just hope it isn’t too late before we pass this policy,” she wrote.
If it had passed, the Keep Our Care Act would have added more public discussion to the health care consolidation process — including those involving large national hospital systems and health insurers and private equity firms looking to take over or merge with smaller health care organizations. The bill would have also allowed Washington’s attorney general to play a bigger role in reviewing transactions.
Attorney General Bob Ferguson, whose office testified in support of the bill, on Tuesday reiterated a need to protect affordable health care, including specifically reproductive health services, which the bill would have required consolidations to preserve, in addition to emergency, primary, end-of-life and gender-affirming care.
“In the wake of recent Supreme Court decisions, protecting that access is more important than ever,” Ferguson said in a statement. “I’m disappointed the Legislature did not take action to better protect reproductive freedom.”
Leah Rutman, health policy program director of the ACLU of Washington, which supported the bill, also expressed “deep” disappointment in the news.
“Without this essential bill, health entities can continue to choose profits over patients, and Washingtonians risk losing access to critical health services, like reproductive, end-of-life and gender affirming care, when health entities consolidate,” Rutman said in a Tuesday statement. “Everyone deserves access to affordable, quality care, and we will continue to fight every day to ensure Washingtonians have access to the care they need.”
Although the Attorney General’s Office already oversees these types of health care transactions, the bill would have granted the office more authority to impose conditions or reject a transaction altogether if a review found it would have negative effects on patient care. The decision would have been subject to judicial review, according to the bill.
During testimony, bill supporters shared unease about consolidation’s impact on a rise in health costs and reduced services. According to a recent state report, eight large health systems maintain more than 90% of licensed beds in the state.
The preliminary report, published by the state Office of the Insurance Commissioner, pointed to the state’s increasing number of health care consolidations as a large reason for more expensive premiums and deductibles. The finding echoed similar conclusions from other studies and experts from around the country that found consolidation has consistently led to higher care prices and more narrow access to services.
But hospital industry leaders pushed back against those claims, arguing instead that chronic government underfunding of public health insurance programs and rising costs of medication, supplies and staffing were to blame.
Other bill opponents also worried the Keep Our Care Act imposed too many additional requirements for health systems interested in these transactions and could discourage future deals — which could ultimately force smaller, financially unsustainable hospitals and clinics to close.
The bill included three levels of requirements for organizations involved in transactions, depending on who’s involved in the deal and how large they are. For those that generate less than $25 million in health care revenue, the list was fairly straightforward. They would have to send the Attorney General’s Office the names and business addresses of involved parties, locations of clinics and facilities, descriptions of the nature and purpose of the transaction, and the anticipated effect date of the transaction.
Larger organizations would also be required to submit financial statements from the past three years, board of director statements that detail the anticipated effect of the transaction, community health needs assessments, information on charity care provided in prior years, billing and debt collection policies, staffing policies and policies around certain types of care (including reproductive health, end-of-life and gender-affirming), among other pieces of information.
Last month, Zosia Stanley, vice president and associate general counsel of the Washington State Hospital Association, called the extra requirements a “significant burden” for hospitals. Stanley felt the bill didn’t truly take into account “the fact that there may be providers who are seeking a partner in order to survive and keep being able to provide care in their community.”
While the hospital association agreed with the overall purpose of the bill — to keep health care affordable and accessible — Stanley said Tuesday that Keep Our Care wasn’t the right solution.
She again shared concerns the hospital association had with the legislation, including the significant authority it would have given the Attorney General’s Office in these transactions, versus placing that power within an agency like the state Department of Health, which has more “expertise to do health care work in the state,” Stanley said.
“For a complex policy bill that didn’t have a lot of work done in terms of allowing input from health care providers, we were pleased to see it not move forward this year,” said Chelene Whiteaker, the hospital association’s senior vice president of government affairs.
They would not, however, be surprised to see the concept return in future sessions, Stanley said.
“The idea of affordable, accessible health care continues to be on the forefront of our minds,” she said. If the bill does come back next year, she said, “We hope there would be additional work on it.”