If you build it, they will come. And they are. Washington state’s charity care rules require hospitals to provide non-emergency charity care without regard to residency. It’s a recent change to decades-old policy limiting non-emergency charity care to state residents. House Bill 2250 is a good proposal that can help put needed guardrails back in place for scheduled, non-urgent care, while protecting emergency access for all.
Testimony on HB 2250 made it clear that hospitals — especially border hospitals — can become the default provider for an entire region, at Washingtonians’ expense and with real consequences for access and hospitals’ financial stability. The bill warns the current approach could make Washington state a “medical tourism destination,” drawing patients from other states and countries for free or reduced-cost care, and that the costs of that additional uncompensated care would be passed along to paying patients. Testimony bore that out. It also showed that our overly expansive requirement for charity care is being taken advantage of — in a variety of ways.
HB 2250 was introduced by Rep. Andrew Engell, R-Colville, and inspired by a hospital on the Washington-Idaho border, but it will rightly apply to all hospitals in the state. I testified in support of this bill that could fix a Department of Health (DOH) decision that isn’t working out.
Washington state's hospitals provide significant benefits to communities in the form of charity care for both emergency services and non-emergency or scheduled services. The bill notes that in 2022, hospitals statewide provided $483 million in charity care. The demand and costs have increased, in part because of the new way of doing business. Charity care and required discounts apply based on income — often up to 400% of the federal poverty level, depending on the hospital’s category. Using 2025 federal poverty guidelines, 400% FPL is $124,800 for a family of four.
The bill asks the state to return to the long-standing policy that existed before these changes took effect, limiting non-emergency charity care to Washington residents. The policy was reversed in September 2023, and an interpretive statement required hospitals with geographic limits to remove them by 2024.
HB 2250, if passed, will not eliminate emergency care for out-of-state residents. If your brother-in-law from Idaho has a heart attack cheering on the Seahawks with you at the NFC Championship in Lumen Field, he still gets emergency care in our hospitals regardless of where he is from or his ability to pay. HB 2250 treats people receiving emergency care as residents for charity-care purposes. But if your brother-in-law thinks that it would be cheaper or more convenient to schedule all his medical appointments in life here instead of in his own state, Washington state hospitals would not have to provide free or reduced-cost charity care for those scheduled services.
I testified Tuesday in support of this common-sense policy. Charity care increases the cost of care, and that cost is often passed on to consumers who pay for services or who are insured. The hidden tax shows up as higher prices and higher premiums, not just hospital accounting.
Some opponents of the bill argued that it would make it harder for nonresidents to access free or reduced-cost care in the state, especially people who travel here specifically to obtain care. It will. Health care cannot be made more affordable for people in Washington state if hospitals are required to serve people from anywhere on a routine basis.
I hope the bill moves forward. Requiring that hospitals only need to offer non-emergency charity care to people in their own state makes sense. My testimony follows:
Thank you, Chair and committee members. I’m Elizabeth New with Washington Policy Center. I direct our Center for Health Care.
We all agree health care costs are burdensome, and we should also all agree that cost-containment is needed, not more cost-shifting.
Right now, hospitals provide non-emergency charity care to people living outside the state at Washingtonians’ expense. The care isn’t “free.” The cost shows up somewhere else, often as higher charges or increased premiums for commercial payers who live in the state. It can also result in decreased access for Washington patients or more pressure on already-strained facilities. This is a stewardship issue.
Charity care is also a safety net, and safety nets have limits. They should not be stretched until they snap. HB 2250 keeps emergency care protected and restores guardrails for non-urgent care, especially in communities where the nearest hospital sits on a state line and can become the default provider for an entire region. HB 2250 doesn’t exclude immigrants who live in Washington — immigration status can’t be considered in the residency determination.
You’ve heard credible reports of sharply increased out-of-state demand after the Department of Health interpretation change, and I know lawmakers have a goal of making health care more affordable.
Thank you for your time. I’m happy to provide some of our cost-saving health care ideas if interested.
