Stalled Bill Would Have Protected Reproductive Health When Hospitals Merge

by Megan Burbank

When hospital systems merge, it can result in patients losing access to critical medical treatments, including reproductive health care and medical aid in dying. But a new bill introduced in this year's legislative session offers a potential solution: a system of strengthened oversight and transparency that would require hospitals to spell out policies on these types of care before a merger is even approved.

The Keep Our Care Act (SB 5688/HB 1809) would introduce new reporting requirements when health care systems merge, including documentation of potential impacts on reproductive health, gender-affirming treatments, and end-of-life care. The bill would also require a determination from the attorney general on how a proposed merger could impact patient care and, if a consolidation is approved, ongoing monitoring for compliance with affordability and access standards across a 10-year period.

"We have to prioritize people's health care needs over big organizational corporate growth," said bill sponsor Sen. Emily Randall on Tuesday, Jan. 18, in a public hearing in the Senate's Law and Justice Committee attended by stakeholders representing hospital leadership, reproductive rights advocacy, end-of-life care, right-wing activism, and medical workers.

Randall said hospital mergers threatened Washingtonians' access to comprehensive medical care. Particularly in rural communities, she said, "mergers can take care — reproductive health care, gender-affirming treatment, and end-of-life care — further out of reach of residents."

This is often true when mergers occur between secular and religiously-affiliated hospital systems, where certain types of care may be limited by guidelines based on religious doctrine rather than evidence-based medicine. Catholic hospitals, for example, follow Ethical and Religious Directives set by the United States Conference of Catholic Bishops, which explicitly ban abortion care and medical aid in dying.

In Kitsap County, where Randall's district is located, she said, only residents served by the Naval Hospital have access to secular health care. Mergers, she said, "harm health care access and outcomes for our most vulnerable patients — Medicaid patients and folks who are disproportionately People of Color."

Others at the hearing to support the bill shared concerns that hospital mergers in the state have impacted Washingtonians' access to emergency services and appropriate medical care for transgender, nonbinary, and gender nonconforming patients.

Medical social worker Pattie Pritchard recalled having to take out a loan to pay for care for her child, who is transgender, because her employer, CHI Franciscan, did not provide coverage for gender-affirming care, a discrepancy she described as a "discriminatory exclusion." Lannette Sargent, the parent of an intersex child, put it this way: "All it takes is one person to stop you from getting care."

Representatives from hospital systems and their professional organizations spoke out in opposition, expressing concerns about the costs the bill would place on hospitals, with some suggesting the legislation would force struggling clinics to close altogether.

Zosia Stanley, vice president and associate general counsel at the Washington State Hospital Association, called the bill "a sweeping regulatory scheme" that would be burdensome.

Heavy burdens aren't a new development if you work in health care.

The legislation is under consideration at a time when hospital staff — particularly nurses — are increasingly burnt out from the onslaught of working in health care during a pandemic. At the hearing, Katharine Weiss, a representative of the Washington State Nurses Association (WSNA), spoke in support of the bill. "WSNA members are concerned that the rapid consolidation of our health system is preventing them from being able to do their jobs to their full ability," she said.

It's also worth noting that the need for reproductive health care access — something hospital mergers often threaten — may be more acutely felt in the coming year if the Supreme Court overturns Roe v. Wade or blunts its power.

Planned Parenthood's Yvette Maganya, speaking in support of the bill, said that if Roe is gutted, abortion restrictions elsewhere will likely drive patients across state lines into Washington for care, potentially burdening existing providers with increased demand for a health care service often sacrificed when health care systems merge. Planned Parenthood would work to meet that increase in patients, she said. "But we cannot meet that need alone."

Unfortunately, the Keep Our Care Act will not advance this session. "While we are disappointed that it did not pass this year, complex bills like this one often take a few years to develop and to get the votes that they need to pass both chambers," said Leah Rutman, health care and liberty counsel with the ACLU of Washington, of the bill's trajectory. "We anticipate that next year could be the breakthrough year for this bill and the coalition is working hard with legislators to make that happen and to ensure access to affordable, quality care for everyone in Washington."

Featured Image: Illustration via ByEmo/Shutterstock.com. Editing by Emerald staff.