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
  requirements.

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
2/8/2024

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!