Washington’s healthcare affordability crisis ‘amplified in rural areas,’ industry leaders say


Shane Ersland


Rural Washington residents face many challenges in seeking healthcare services, not the least of which is affordability.

Industry leaders considered financial factors and new programs aiming to improve affordability at the Inland Northwest State of Reform Health Policy Conference in Spokane. Sam Hatzenbeler, senior policy associate at the Economic Opportunity Institute, said lower-than-average graduation rates, housing, food, and transportation all contribute to rural healthcare affordability challenges. 

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“We have to take an intersectional approach as we think about challenges facing rural folks,” Hatzenbeler said. “In a survey taken in Washington, we found that 50 percent of rural residents reported that they’re going through medical debt or are foregoing basic needs in medical care.”

Patient Coalition of Washington Executive Director Jim Freeburg said rural Washingtonians enjoy certain financial benefits, including cheaper living costs, than those in large cities. But those affordability perks do not translate to healthcare, he said.

“It’s cheaper to live in a rural community but when it comes to healthcare, there’s this weird dichotomy that healthcare is not at all cheaper in rural areas,” Freeburg said.

Freeburg said he compared costs for certain procedures at Washington HealthCareCompare. He said an MRI at Providence Holy Family Hospital in Spokane costs $750. An MRI at Lincoln Hospital in Davenport costs $2,200, he said.

“If you’re in Bellevue, it’s only $300 for an MRI at certain outpatient clinics. So there’s an incredible variation in the cost of healthcare that people in rural areas are seeing in their pockets. So what’s going on here?”

— Freeburg

Freeburg said he also compared costs for cataract surgery, noting that it would cost $4,000 at Pullman Regional Hospital. Cataract surgery at Confluence Health in Wenatchee would cost $10,000, he said.

“It’s hard for anyone to be a smart shopper and choose the most cost-effective surgery,” Freeburg said. “If you’re in rural areas, there are barriers. It’s not as easy as just driving an hour to the next hospital. You have to work, you have to find child care. And they may be out of your network. So you may not even have a choice, most of the time, as to where you’re seeking care. To me, this points to a massive affordability crisis that’s even more amplified in rural areas.”

Freeburg said the coalition conducted a survey last year that showed that 85 percent of rural residents worry about the cost of healthcare, and 65 percent of people in rural areas went without needed healthcare services. 

“We have priced ourselves out of healthcare for the people we’re trying to serve,” he said. “We cannot afford the prices that hospitals and doctors are charging us.”

Hatzenbeler noted that the US spent more than $1.3 trillion on hospital care in 2021, which was the highest amount spent on any health expenditure. Healthcare consolidation has been a major driver for rising costs, she said.

“We’ve seen really disturbing trends over recent years. Small, local hospitals used to be the backbone of our local communities. But more and more, we’re seeing monopolies. We might think that (if) a hospital gets bought out by a larger hospital that they would be able to keep prices down. But in reality, we’re seeing the opposite. Prices are going up. Prices can sometimes go up by up to 30 percent after consolidation.”

— Hatzenbeler

Panelists also discussed programs that could help improve rural healthcare affordability. The Washington State Health Care Authority’s Theresa Lampkin Tamura said the Centers for Medicare and Medicaid Services’ new Making Care Primary (MCP) model recently issued a request for applications

The MCP model will be launched on July 1st, 2024, and will be tested in eight states—Washington, Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, and Massachusetts. The 10.5-year model aims to improve care management and care coordination, equip primary care clinicians with tools to form partnerships with healthcare specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs like housing and nutrition. 

“It is a 10-and-a-half year model with different tracks that people can join. You have to sign up in 2023 in order to participate in the 10-and-a-half year model. It basically moves primary care away from fee-for-service.”

— Lampkin Tamura

The MCP model features three participation tracks that build upon previous primary care models, and aims to improve care for beneficiaries by supporting the delivery of advanced primary care services. Interested applicants must submit their application by Nov. 30th.

Jen Sanders, vice president of network management at Premera, highlighted some recent investments the health plan made in rural healthcare. Its $10 million investment in 2019 will support the University of Washington’s (UW) School of Medicine to support the integration of the collaborative care model into primary care clinics across rural areas. To date, 23 clinics have implemented the collaborative care model through the grant. 

Premera also provided a $4.7 million grant to the UW School of Nursing in 2020, which established the Rural Health Nursing Health Initiative, Sanders said. The program has placed nearly 40 advanced nurse practitioner students in rural practices.

“Primary care is a key to helping reduce costs,” Sanders said. “One of Premera’s long-term strategies is our rural health funding. Studies show that students and teachers that are trained in a rural community stay in a rural community.”