Imagine a small hospital, nestled in the rural landscapes of Eastern Washington, suddenly becoming a lifeline for patients from across the border in Idaho. But here's where it gets controversial: this hospital, Newport Hospital, is now overwhelmed by the very policy meant to help its community—Washington state's 'charity care' program. This program, designed to provide free or discounted medical care to uninsured individuals meeting certain income thresholds, has inadvertently turned Newport Hospital into a magnet for out-of-state patients, straining its already thin resources.
Newport Hospital, just a stone’s throw from Idaho and over an hour’s drive from the nearest major city, has seen a staggering 43% jump in charity care spending from 2024 to 2025. And this is the part most people miss: nearly half of the charity care provided goes to patients from outside Washington. While the hospital is prepared to offer emergency care to anyone in need, the influx of out-of-state patients seeking non-emergency services like orthopedic surgery, behavioral health care, and gynecological services has become a significant burden.
'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 come from other states and providing that charity care really puts a strain on our hospital.' This sentiment is echoed by Jenny Smith, the hospital’s spokesperson, who added, 'We fully expect to provide charity care, especially for emergencies, but when it comes to other services, it really gets tricky.'
The issue has sparked legislative action. A bill introduced by Rep. Andrew Engell, R-Colville, aimed to limit nonemergency charity care to Washington residents. However, the bill faced opposition and was not passed due to concerns over its language and wording. 'It’s really about how much can Washington and our hospitals be expected to bear at no cost?' Engell questioned. Despite the setback, he remains optimistic: 'I think we can work it out. I feel pretty optimistic we could probably get this through next year.'
The roots of this crisis lie in the evolution of Washington’s charity care law. When it was first passed in 1989, hospitals could set their own geographical limits for charity care. That changed in 2023 when the state Department of Health eliminated these limits, arguing that eligibility should be based solely on income, not location. In Washington, the income threshold is set at 300% of the federal poverty level—meaning a family of four earning less than $100,000 annually qualifies.
This shift has had far-reaching consequences. Sen. Manka Dhingra, D-Redmond, pointed out, 'This is another example of what happens with national politics at our state level. Over and over again, what we are finding is that the state has to spend more resources taking care of people that should have access to health care in their own state.' The financial strain is evident: Pullman Regional Hospital saw a 28% spike in total charity care from 2023 to 2024, and MultiCare Deaconess Hospital in Spokane spent nearly $2 million more on charity care in 2024 compared to 2023. Providence Sacred Heart Medical Center’s spending increased by $18 million in the same period.
Statewide, charity care spending rose by 34% from 2023 to 2024, with hospitals approving around 65% of charity care applications in 2024. Engell emphasized, 'The real concern for me that I was trying to fix is about Newport Hospital on the Idaho border.'
Adding to the worry is the potential impact of President Donald Trump’s 'One Big Beautiful Bill Act,' which established a fund to support rural health. While Washington is expected to receive $181 million from this fund, Peters doubts it will be enough. 'It’s kind of a misconception that that’s going to help offset a lot of this charity care,' he said. 'We don’t feel like it’s going to even touch the surface of what it truly is going to have the impact for.'
Here’s the bold question: Should states like Washington bear the burden of providing charity care to out-of-state residents, or should there be stricter limits to protect local resources? As the debate continues, one thing is clear: the issue of charity care is far from resolved, and its implications for rural hospitals like Newport are profound. What do you think? Share your thoughts in the comments below.
