NPI's Cascadia Advocate

Offering commentary and analysis from Washington, Oregon, and Idaho, The Cascadia Advocate provides the Northwest Progressive Institute's uplifting perspective on world, national, and local politics.

Thursday, February 8th, 2024

VICTORY! Washington State Senate finally passes the Keep Our Care Act

An incred­i­bly momen­tous and pro­duc­tive day in the Wash­ing­ton State Leg­is­la­ture got even bet­ter this evening when the Sen­ate vot­ed 28–21 to revive the Keep Our Care Act and send it over to the Wash­ing­ton State House for fur­ther con­sid­er­a­tion. Spon­sored by Sen­a­tor Emi­ly Ran­dall (D‑26th Dis­trict), the bill would “ensure hos­pi­tal merg­ers and acqui­si­tions don’t restrict patients’ access to crit­i­cal health care, such as end-of-life, repro­duc­tive and gen­der-affirm­ing care.”

Sen­ate Bill 5241 was intro­duced, heard, and exec’d last ses­sion, but it stalled out in the Rules Com­mit­tee and was nev­er pulled to the floor. Because bills car­ry over from odd to even year ses­sions, it was able to be resus­ci­tat­ed. A num­ber of Demo­c­ra­t­ic sen­a­tors sub­se­quent­ly worked on improv­ing the lan­guage, and on Jan­u­ary 30th, the bill was retrieved Sen­ate Rules “X” file and placed on sec­ond read­ing. Today, it was select­ed for bill action by lead­er­ship and debated.

“Vot­ers have over and over again told us that they want to pro­tect repro­duc­tive health­care,” said Ran­dall in a state­ment. “A right with­out access is not a right.”

“Since the over­turn­ing of Roe v. Wade, patients from around the nation rely on states like Wash­ing­ton to pro­vide life-sav­ing abor­tion and gen­der-affirm­ing care ser­vices,” said Sami Alloy, Inter­im Exec­u­tive Direc­tor of Pro-Choice Wash­ing­ton (for­mer­ly an affil­i­ate of NARAL Pro-Choice Amer­i­ca, which is now known as Repro­duc­tive Free­dom For All). “It is even more essen­tial that we pro­tect these ser­vices from dis­ap­pear­ing in our state due to unchecked health sys­tem con­sol­i­da­tions. The Keep Our Care Act will do just that.”

“For all Wash­ing­to­ni­ans to have the same health care rights, it’s essen­tial that care remain afford­able and acces­si­ble to those who need it most,” not­ed Planned Par­ent­hood Alliance Advo­cates in a recent call to action for SB 5241.

“Con­sol­i­da­tions between health care enti­ties like hos­pi­tals, hos­pi­tal sys­tems, and provider orga­ni­za­tions are pro­lif­ic in Wash­ing­ton State and can neg­a­tive­ly impact cost, qual­i­ty, and access to nec­es­sary health care ser­vices. The Keep Our Care Act ensures health enti­ty merg­ers, acqui­si­tions, and con­tract­ing affil­i­a­tions improve rather than harm access to afford­able qual­i­ty care with­in a community.”

The ACLU of Wash­ing­ton says the Keep Our Care Act is need­ed because:

  • Merg­ers and con­sol­i­da­tions dri­ve up costs for patients.
  • Merg­ers and con­sol­i­da­tions do not improve the qual­i­ty of care.
  • Wash­ing­ton has seen recent con­sol­i­da­tions restrict access to crit­i­cal health care ser­vices, includ­ing repro­duc­tive and end-of-life care. Con­sol­i­da­tions can also result in restric­tions and bar­ri­ers in access to gen­der affirm­ing care. These bar­ri­ers and restric­tions are dis­crim­i­na­to­ry and unsafe.
  • Over­sight is need­ed to hold big health sys­tems account­able. Large health sys­tems in our state sit on bil­lions of dol­lars in cash reserves and invest­ments and receive our tax-pay­er mon­ey but face lit­tle account­abil­i­ty to the com­mu­ni­ties they serve.
  • Unin­sured and under­in­sured indi­vid­u­als are dis­pro­por­tion­ate­ly harmed when health sys­tems do not pri­or­i­tize com­mu­ni­ty needs.
  • Merg­ers and con­sol­i­da­tions can exac­er­bate sys­temic inequities. Lack of mar­ket com­pe­ti­tion, com­bined with pri­vate health sys­tems’ efforts to increase rev­enues by attract­ing more patients with pri­vate insur­ance, has been found to lead to wors­en­ing health care access for Med­ic­aid patients — who are dis­pro­por­tion­ate­ly peo­ple of color.
  • Rur­al com­mu­ni­ties deserve bet­ter, as the high costs, lim­it­ed ser­vices, and lack of alter­na­tive care sites asso­ci­at­ed with con­sol­i­da­tions cre­ate insur­mount­able bar­ri­ers to care for peo­ple in rur­al communities.

The ver­sion of the bill approved in com­mit­tee (Law & Jus­tice, then Ways & Means) back in 2023 was sum­ma­rized by non­par­ti­san staff as follows:

  • Mod­i­fies report­ing require­ments for merg­ers, acqui­si­tions, or con­tract­ing affil­i­a­tions between hos­pi­tals, hos­pi­tal sys­tems, or provider orga­ni­za­tions (par­ties).
  • Requires par­ties to sub­mit addi­tion­al doc­u­men­ta­tion relat­ed to char­i­ty care; access to care, includ­ing repro­duc­tive, gen­der-affirm­ing, emer­gency, and end-of-life care; all cur­rent poli­cies and pro­ce­dures; and expla­na­tions of how any of these areas would be affect­ed by the pro­posed transaction.
  • Requires the attor­ney gen­er­al to deter­mine, through a pub­lic process, if the trans­ac­tion would detri­men­tal­ly affect the con­tin­ued exis­tence of acces­si­ble, afford­able health care in the state for at least ten years after the trans­ac­tion occurs.
  • Gives the attor­ney gen­er­al author­i­ty to place con­di­tions or modifications
    on the trans­ac­tion, or dis­ap­prove of the trans­ac­tion if the trans­ac­tion will
    be detri­men­tal to acces­si­ble, afford­able health care.
  • Requires the attor­ney gen­er­al to mon­i­tor an approved trans­ac­tion for at least ten years to ensure com­pli­ance with all access and affordability

Sen­a­tor Ran­dall pro­posed a strik­ing amend­ment with the fol­low­ing changes:

  • Adds a def­i­n­i­tion of “affil­i­ate”
  • Clar­i­fies that “mate­r­i­al change trans­ac­tions” apply to cer­tain affil­i­ates and in-state entities
  • Requires reg­u­la­to­ry fees to be adjust­ed based on pre­lim­i­nary or com­pre­hen­sive reviews
  • Mod­i­fies the process and analy­sis for review­ing mate­r­i­al change transactions
  • Allows remote par­tic­i­pa­tion in spec­i­fied hearings
  • Autho­rizes fines for unpaid bills
  • Grants rule-mak­ing author­i­ty to the Attor­ney Gen­er­al. Changes effec­tive dates
  • Adds a sev­er­abil­i­ty clause.

The strik­ing amend­ment was adopt­ed with amend­ments from Demo­c­ra­t­ic Sen­a­tor Pat­ty Kud­er­er and Repub­li­can Sen­a­tor Ron Muz­za­ll rolled in. A slew of oth­er amend­ments (most­ly from Repub­li­cans) were reject­ed or with­drawn. A sep­a­rate strik­ing amend­ment offered by Demo­c­ra­t­ic Sen­a­tor Mark Mul­let that would have sub­stan­tial­ly changed the bil­l’s scope was ruled out of order.

The roll call on final pas­sage was as follows:

Roll Call
ESB 5241
Health care marketplace
3rd Read­ing & Final Passage

Yeas: 28; Nays: 21

Vot­ing Yea: Sen­a­tors Bil­lig, Cleve­land, Con­way, Dhin­gra, Frame, Hansen, Hasegawa, Hunt, Kauff­man, Keis­er, Kud­er­er, Liias, Lovelett, Lovick, Nguyen, Nobles, Ped­er­sen, Ran­dall, Robin­son, Sal­daña, Salomon, Shew­make, Stan­ford, Trudeau, Valdez, Van De Wege, Well­man, Wil­son (Claire)

Vot­ing Nay: Sen­a­tors Boehnke, Braun, Dozi­er, For­tu­na­to, Gildon, Hawkins, Holy, King, MacEwen, McCune, Mul­let, Muz­za­ll, Pad­den, Rivers, Schoesler, Short, Tor­res, Wag­oner, War­nick, Wil­son (Jeff) Wil­son (Lyn­da)

Hav­ing failed to get the changes to the bill that he want­ed, Mul­let (a can­di­date for gov­er­nor) vot­ed against it, mir­ror­ing his actions from last year, in which he vot­ed against My Health, My Data after he could­n’t get oth­er mem­bers of his cau­cus to agree to water it down. He was the only Demo­c­ra­t­ic sen­a­tor to vote nay.

No Repub­li­can sen­a­tor vot­ed for the bill.

Last March, in a win­ter­time sur­vey, NPI found 59% sup­port among like­ly 2024 Wash­ing­ton State vot­ers for the Keep Our Care Act, with only 32% opposed and 9% not sure. 49% of all respon­dents expressed strong sup­port for the legislation.

A few months lat­er, in a July 2023 sur­vey of just Sno­homish Coun­ty, Wash­ing­ton’s third-largest sub­di­vi­sion and a blue-lean­ing polit­i­cal bat­tle­ground, we cor­rob­o­rat­ed that statewide result when we found 60% sup­port and 33% oppo­si­tion, with 7% not sure. A total of 50% of respon­dents expressed strong support.

It’s a relief to see this bill pass out of the Wash­ing­ton State Sen­ate and build on the work that was done to pro­tect access to essen­tial care in the 2023 ses­sion. Thank you to the twen­ty-eight Demo­c­ra­t­ic sen­a­tors who lis­tened to the peo­ple and vot­ed yes on this impor­tant, time­ly leg­is­la­tion. On to the House!

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One Comment

  1. Thanks to all of the Sen­a­tors who vot­ed to Keep Our Care Act.

    There are chal­lenges for rur­al areas try­ing to fig­ure out how to age in place with the help of fam­i­ly and in-home care. We need as many ser­vices close to this large­ly retire­ment com­mu­ni­ty as possible. 

    Thank you for every step you can take to bring equi­ty to our health care.

    From Ray­mond, WA

    # by Kristine Nevitt, CPA :: February 12th, 2024 at 6:17 PM

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