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 healthcare to uninsured individuals meeting certain income thresholds, has inadvertently turned Newport 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 expenses 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 burden of providing non-emergency services like orthopedic surgery, behavioral health care, and gynecological services to out-of-state residents is pushing it to the brink.
“Our margins are already razor-thin,” explained Justin Peters, Newport Hospital’s interim CEO. “While we’re committed to serving our community, the influx of patients from other states is putting an unsustainable strain on our resources.”
This issue has sparked a heated debate in the Washington Legislature. Rep. Andrew Engell, R-Colville, introduced a bill that would limit nonemergency charity care to Washington residents. Boldly, Engell asks: “How much can Washington and its hospitals be expected to bear at no cost?” The bill, though not passed due to wording issues, highlights the growing tension between compassion and fiscal responsibility. Engell remains optimistic, stating, “I think we can work it out. I’m hopeful we’ll get this through next year.”
The roots of this crisis trace back to 2023, when the Washington Department of Health eliminated geographical limits for charity care eligibility, arguing that income—not location—should determine who qualifies. In Washington, a family of four earning less than $100,000 annually (300% of the federal poverty level) is eligible. This change has led to a 34% statewide increase in charity care spending from 2023 to 2024, with hospitals like Pullman Regional and MultiCare Deaconess in Spokane feeling the pinch.
Here’s where opinions diverge: Some argue that Washington is unfairly shouldering the burden of providing care for residents of other states, whose own healthcare systems may be lacking. Sen. Manka Dhingra, D-Redmond, notes, “This is another example of national politics spilling over into state-level issues. We’re constantly forced to allocate more resources to care for people who should have access to healthcare in their own states.”
Others worry about the broader implications of rising healthcare costs. With the passage of the “One Big Beautiful Bill Act” under President Donald Trump, there are fears that increased premiums and reduced insurance access will exacerbate the demand for charity care. Justin Peters warns, “That’s a huge worry for us. More uninsured or underinsured patients will only increase our charity care burden.”
While the Act established a $181 million fund to support rural health, Peters is skeptical. “It’s a misconception that this will offset the growing costs of charity care. It won’t even scratch the surface of the real impact,” he said.
What do you think? Is Washington justified in limiting charity care to its residents, or should healthcare remain borderless? Let us know in the comments—this is a conversation that needs your voice.
