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.”
- 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:
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!