Bill that would regulate hospital mergers in Washington passes Senate, may join other legislation protecting abortion access

Eight health care systems own more than 90% of the hospital beds in Washington. And one health care system owns 100% of the hospital beds in six counties.

Right now, Democratic lawmakers in Olympia are pushing for legislation to ensure hospital mergers don’t limit patient access to abortions, gender-affirming care or medically assisted suicide.

The bill was partially inspired by concerns over access to abortion and gender-affirming care in hospitals with religious affiliations, especially in the wake of the U.S. Supreme Court’s 2022 overturn of Roe v. Wade.

Sen. Emily Randall, D-Bremerton, sponsored Senate Bill 5241, also called the Keep Our Care Act. If passed, the bill would prohibit health care system mergers that would “detrimentally affect accessible, affordable health care.”

The proposal would require hospitals, clinics and health care systems to meet new requirements when reporting a proposed merger or purchase to the state, including increasing the required notice period to 120 days. Most notably, however, the bill would give the Washington attorney general the power to grant permission or veto a proposed merger, if they find a consolidation would harm patient care.

The bill passed 28-21 in the state Senate on Feb. 8. The vote was divided across party lines, with Sen. Mark Mullet, D-Issaquah, the only Democrat to vote against the proposal. It still has to make its way through the House and get passed before it sees the top of Gov. Jay Inslee’s desk.

Nearly half of the hospital beds in Washington are in medical centers that do not offer abortion care. Supporters of Randall’s bill argue this figure harms patients, both those who live in the state and those who travel from other states for abortions.

“This number is unacceptable and limits access, especially in rural areas,” said Nicole Kern, the government relations manager at Planned Parenthood Alliance Advocates. “Many health system mergers also lead to restricted access to contraception, medical aid in dying and gender-affirming care.”

Those opposed to the bill argue the proposed law would burden smaller hospitals with bureaucracy, and that the cost incurred by hospitals to meet the bill’s standards would fall on the backs of patients.

Some say the bill grants too much power to the state attorney general.

Jim Walsh, R-Aberdeen, spoke at a House Civil Rights & Judiciary Hearing Committee public hearing, saying the proposal would hurt the competitive nature of the current health care marketplace.

“Some of us are concerned that the use of the state’s Consumer Protection Act to restrict transactions actually limits consumer choice,” Walsh said. “Especially in an area as critical as the delivery of health care services.”

Randall responded by saying her bill would help consumers by providing commonsense oversight for health care providers.

“When we are treating our health care system like a business proposition, we see decisions made to close wings and departments that are no longer performing financially,” Randall said, “which leaves communities without access to labor and delivery, or surgical wings, or comprehensive reproductive health care.”

Randall added that hospital mergers have affected the health care system in the region she represents.

In 2017, Washington’s attorney general sued CHI Franciscan over health system consolidations that the state said hurt thousands of patients living on the Kitsap Peninsula.

The patients “faced higher prices, increased wait times, difficulty in scheduling procedures, and a reduction in their choice of services and locations,” the attorney general’s office found. “As a result, CHI Franciscan has netted well over $1 million in ill-gotten gains so far.”

“These are unintended consequences to unchecked and unregulated consolidation,” Randall said. “Those consequences sit on the shoulders of patients, they sit on the shoulders of providers. They sit on the shoulders of folks who are trying to pay their health care bills.”

Randall said Washington has one of the most consolidated health care systems in the country. A 2023 report by the Seattle Times found more than 48% of the hospital beds in Washington are tied to a religious organization.

Arguments on both sides

Along with Planned Parenthood Alliance Advocates of Washington, a number of local organizations sent representatives to testify at Wednesday’s hearing in favor of the proposal.

Justin Gill works as an urgent care nurse practitioner at Providence Regional Medical Center in Everett. Gill is the president of the Washington State Nurses Association, an organization advocating for more than 20,000 nurses . Gill said the organization he leads supports the proposal.

“I’ve seen the direct impacts on care access and decreased options for my patients,” Gill testified. “Unchecked health care consolidations are problematic. When hospitals consolidate, we as nurses have seen decisions go from the hands of health care experts to oftentimes far-removed executives that might prioritize profits over patient care.”

Gill added that the bill would not prohibit mergers from happening, but rather make sure the mergers won’t harm patients.

Farther north in Snohomish County, Kirk Normund said hospital mergers are preventing first-responders from being able to do their jobs. Normund, a fire captain with North Snohomish County Professional Firefighters, testified on behalf of the Washington State Council of Firefighters in support of the bill.

All the hospitals Normund serves in the region have been subject to mergers, he said, and ever since, fire crews can no longer meet patient demands. The firefighter reported he has seen patients get treated in hallways while they wait for beds, with a line of 12 more ambulance crews waiting with patients.

“That time it takes our crews to return from the hospital is untenable,” Normund said. “A normal 15-minute transfer is taking upward of four hours before a hospital will receive a patient. … It’s only a matter of time before a major emergency is met with a region devoid of firefighters able to respond.”

The American Civil Liberties Union of Washington also has been outspoken in its support of the proposal. ACLU health policy program director Leah Rutman said research shows that health care consolidations drive up costs, decrease access to services and decrease the quality of care patients receive.

Hospital consolidations can drive up costs more than 20%, according to a 2019 study presented before the U.S. House of Representatives. Black and Latino people are more likely than white people to miss a doctor’s visit due to the cost.

Diane Blake, CEO of Cascade Medical, the critical access hospital and public hospital district in Leavenworth, testified at the hearing in opposition of the bill, calling it “harmfully restrictive.”

“The scope of this bill goes far beyond the stated focus and threatens access to crucial health care services,” Blake said. “Especially in rural communities like mine.”

Blake added that nearly half of the people in the service region of her health care district live in poverty and said costs incurred by health care systems like hers to meet the standards in the bill would fall on the backs of patients.

“Sometimes partnerships are necessary to maintain existing access or stabilize cost,” Blake said. “But those partnerships may not be approved.”

Dave Hargreaves, the board chair of Yakima Memorial MultiCare Hospital, also testified against the bill. Hargreaves said the Yakima Hospital’s merger with MultiCare last year was their “lifeline.”

“Without this partnership done quickly, we could not have survived,” Hargreaves said. “(SB)5241 does not allow for the necessary discretion and flexibility, and one size of oversight does not fit all.”

If the proposal makes it out of committee, it will then move to the House floor for a vote. The state’s legislative session this year lasts until March 7.

Protections exist

Randall’s bill is among a collection of legislation introduced the past two years intended to uphold abortion access in Washington. A bill last year made it illegal for health care professionals to be punished or denied a professional license for performing abortions, administering reproductive health care or offering gender-affirming care (such as gender reassignment surgery).

A hiccup with the language used in the final version of the bill last year spurred Rep. Marcus Riccelli, D-Spokane, to propose a complimentary bill this year to mend the mistake.

“If you’re doing things that are consistent with the standard of care in Washington around reproductive health and gender-affirming care, you should be protected as a provider,” Riccelli said during a House floor debate in January.

Last year’s bill didn’t clearly state that health care professionals who handle reproductive and gender-affirming care are protected from both disciplinary action and license-related penalties. Riccelli’s new bill works to harmonize the language so health care professionals are equally protected in each area under the Uniform Disciplinary Act.

This year’s “technical cleanup” passed the House in a 56-37 vote with five representatives excused, and Joe Schmick, R-Colfax, as one of the nay votes.

He urged lawmakers to be respectful of other states’ laws and hold health care workers to the standards of care they’re originally licensed in.

“We expect professionals to follow the laws here, so I believe we should expect professionals to follow the laws that they are licensed in. Professional ethics matter,” Schmick said.

If a health care worker in Texas faced disciplinary action for performing an abortion, relocating to Washington wouldn’t result in license denial or further punishment, Riccelli said in an interview. Since abortions are a standard measure of care in Washington, their previous discipline wouldn’t be taken into consideration when issuing a license.

Riccelli’s bill passed out of the Senate Committee on Health and Long Term Care on Friday and now moves to another Senate committee.