Attorney General Request legislation increases health care access by strengthening state’s social safety net for low-income residents

OLYMPIA — Attorney General Bob Ferguson announced today that he is working with Rep. Tarra Simmons, D-Bremerton, to propose a bill in the next legislative session to increase access to affordable health care for millions of Washingtonians.

Every legislative session Attorney General Ferguson introduces a slate of Attorney General Request bills. “Attorney General Request” is a formal designation for bills proposed by his office. Since 2013, 27 Attorney General Request bills have been signed into law.

The legislation, House Bill 1616, makes 2.2 million more Washington residents eligible for free or reduced-cost health care at hospitals and affiliated clinics. The bill increases the eligibility for full write-offs of out-of-pocket hospital costs from 100 percent to 300 percent of the federal poverty level. It increases eligibility for discounts for those earning up to 400 percent of the federal poverty level. Ferguson’s bill is consistent with legislation passed in Oregon in 2019, which also extended discounts up to 400 percent of the federal poverty level.

Ferguson’s and Simmons’ bill strengthens Washington’s charity care law. The charity care law requires hospitals — for-profit and non-profit, public and private — to forgive some or all of the out-of-pocket cost of essential health care for low-income patients who qualify. The bill sets a statewide standard for increased charity care access. Several Washington hospital systems currently offer different levels of charity care eligibility, which causes confusion.

The bill does not cost taxpayers, or require any additional government appropriation.

“Health care is essential for every Washingtonian, not just for those who can afford it,” Ferguson said. “A single parent working two minimum wage jobs to make ends meet is not eligible for charity care under current law. No one should be forced to choose between health care and putting food on the table. This bill helps provide more equitable health care access to millions of low-income Washingtonians.”

“Charity care requires corporations that make a profit off the health and safety of Washington residents to give back to those in our society who need it most,” Rep. Simmons said. “The ambiguity in Washington’s charity care law allows corporations to create confusing standards and inconsistent policies that too often results in the denial of care to those who need it most. This bill will raise and standardize the threshold for people to qualify for charity care making these policies fairer and more equitable for the people of Washington.”

Nationwide, about two-thirds of individuals who file for bankruptcy cite medical issues as a key contributor, and more than half of collection items on credit reports are for medical debts.

Access to care is also an equity issue, as communities of color are disproportionately underinsured, and especially vulnerable to catastrophic and unexpected medical expenses.

For example, according to 2019 data from the Federal Reserve, the median bank account balance for Black households is about $1,500, less than one-fifth the median balance for white households of $8,200. The median account balance for Latino households is about $2,000. One in five individuals in majority nonwhite zip codes have at least one medical debt in collections on their credit report.

Bill significantly expands charity care eligibility

Under Washington’s current law, full forgiveness of out-of-pocket medical debt is only available to Washingtonians who are at or below the federal poverty level — about $12,900 per year for an individual, or $26,500 for a family of four. Discounts — on a sliding scale determined by individual hospitals — are available to those who make up to 200 percent of the federal poverty level.

Ferguson’s bill makes nearly 1.2 million more Washingtonians eligible for full write-off of their medical debt. It also makes full write-offs available for those who are currently only eligible for partial discounts.

Under the bill, individuals making up to $38,600 and families of four with an income of $79,500 — 300 percent of the federal poverty level — will be eligible to receive full write-offs of their out-of-pocket costs.

The proposal also makes charity care discounts available to an additional 1 million Washingtonians.

People earning up to $45,000 per year and families earning up to $92,700 — 350 percent of the poverty level — could see three quarters of their hospital debt forgiven. Individuals with a $51,500 annual income, and four-person households earning up to $106,000 — 400 percent of the poverty level — are eligible for a 50 percent discount.

AGO enforcement of charity care law

Ferguson has filed lawsuits against two Washington hospitals for violating Washington’s Consumer Protection Act by preventing low-income patients from accessing charity care. 

Under state law, hospitals are required to:

• Provide notice of the availability of charity care both verbally and in writing;
• Screen patients for charity care eligibility before attempting to collect payment, and;
• Only require patients to provide one income-related document to prove charity care eligibility.

As the result of a 2017 lawsuit, CHI Franciscan provided $41 million in debt relief and $1.8 million in refunds, in addition to rehabilitating the credit of thousands of patients who were not offered charity care when they were eligible at eight of its hospitals in Washington. CHI Franciscan also paid $2.46 million to the Attorney General’s Office to cover the costs of the investigation and enforcement of the Consumer Protection Act.

Ferguson also sued Capitol Medical Center in Olympia the same year over its charity care practices. To resolve the lawsuit, Capitol provided at least $250,000 in refunds and more than $131,000 in debt relief. In addition, Capitol paid $1.2 million to the Attorney General’s Office.

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Washington’s Attorney General serves the people and the state of Washington. As the state’s largest law firm, the Attorney General’s Office provides legal representation to every state agency, board, and commission in Washington. Additionally, the Office serves the people directly by enforcing consumer protection, civil rights, and environmental protection laws. The Office also prosecutes elder abuse, Medicaid fraud, and handles sexually violent predator cases in 38 of Washington’s 39 counties. Visit www.atg.wa.gov to learn more.

Media Contact:

Brionna Aho, Communications Director, (360) 753-2727; Brionna.aho@atg.wa.gov

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