Rural Hospitals on the Brink: Washington State’s Charity Care Crisis
A quiet crisis is unfolding in rural Washington state, as hospitals grapple with a surge in unpaid medical bills stemming from a state law intended to expand access to healthcare. Newport Hospital, located near the Idaho border, is at the epicenter of this challenge, experiencing a dramatic increase in “charity care” – free or discounted services provided to patients unable to afford them.
The Unintended Consequences of Expanded Charity Care
Washington’s charity care law, originally passed in 1989, allowed hospitals to set geographical limits for providing free care. But, a 2023 state Department of Health ruling eliminated those limits, stipulating that charity care eligibility should be based solely on income. This change, intended to broaden access, has led to an influx of patients from neighboring states – particularly Idaho – seeking care in Washington hospitals.
“Our margins are already very, very thin,” explained Justin Peters, interim CEO of Newport Hospital. “Charity care for our community is one thing, but having people reach from other states and providing that charity care really puts a strain on our hospital.”
A 43% Surge in Unpaid Bills
The financial impact has been significant. Newport Hospital saw a 43% jump in charity care expenses between 2024, and 2025. Nearly half of that charity care is now being provided to out-of-state patients. This isn’t an isolated incident. Pullman Regional Hospital experienced a 28% increase in total charity care during the same period. MultiCare Deaconess Hospital in Spokane spent nearly $2 million more on charity care in 2024 compared to the previous year, while Providence Sacred Heart Medical Center saw an $18 million increase.
Statewide, charity care spending rose by 34% from 2023 to 2024, with approximately 65% of applications being approved.
Legislative Attempts and Ongoing Debate
Recognizing the strain on hospitals, State Representative Andrew Engell (R-Colville) proposed a bill to limit non-emergency charity care to Washington residents. However, the bill stalled due to concerns about wording and opposition from some groups. Engell remains optimistic about revisiting the issue next year, stating, “It’s really about, how much can Washington and our hospitals be expected to bear at no cost?”
Senator Manka Dhingra (D-Redmond) highlighted a broader issue, suggesting that Washington is bearing the burden of healthcare access gaps in neighboring states. “This is another example of what happens with national politics at our state level,” she said.
Beyond State Lines: A National Trend?
The situation in Washington reflects a growing national trend. Rural hospitals across the country are facing financial pressures, exacerbated by factors like declining reimbursement rates, increasing operating costs, and a lack of access to care in other states. The influx of patients seeking charity care in Washington is a symptom of a larger problem: uneven access to healthcare across state lines.
Justin Peters fears that changes to federal healthcare policies, such as potential increases in insurance premiums under the “One Sizeable Gorgeous Bill Act,” could further exacerbate the problem, leading to more uninsured patients and increased charity care burdens.
The Role of Federal Funding
While a federal fund established by the “One Big Beautiful Bill Act” is expected to provide $181 million to support rural health in Washington, Peters believes this funding will be insufficient to offset the rising costs of charity care. “It’s kind of a misconception that that’s going to help offset a lot of this charity care,” he stated. “We don’t feel like it’s going to even touch the surface of what it truly is going to have the impact for.”
Frequently Asked Questions
What is charity care? Charity care refers to free or discounted medical services provided by hospitals to patients who cannot afford to pay. Eligibility is typically based on income.
Why is Washington experiencing a surge in charity care? A 2023 state ruling eliminated geographical limits on charity care, leading to an influx of patients from neighboring states seeking free or discounted services.
What is being done to address the issue? State legislators have proposed bills to limit charity care to Washington residents, but these efforts have faced challenges. The issue is expected to be revisited in the future.
What services does Newport Hospital provide? Besides emergency care, Newport Hospital offers orthopedic surgery, behavioral health care, and gynecological services.
Did you know? Washington’s charity care threshold is 300% of the federal poverty level – meaning a family of four earning less than $100,000 per year may be eligible.
Pro Tip: Rural hospitals are vital community resources. Supporting local healthcare initiatives and advocating for policies that address healthcare access disparities can help ensure their long-term sustainability.
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