Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 — the only state ever to do that. The governor, Jay Inslee, a Democrat, is pushing the Legislature even now to pass a law at a special session on Monday requiring health insurers to pay for elective abortions, another first for the state if it makes it to Mr. Inslee’s desk.
But now a wave of proposed and completed mergers between secular and Roman Catholic hospitals, which are barred by church doctrine from performing procedures that could harm the unborn, is raising the prospect that unelected health care administrators could go where politicians could not.
The merger wave is mirrored around the country, driven by the shifting economic landscape in health care and the looming changes in federal regulation. Previous Catholic takeovers in Kentucky, Illinois and Pennsylvania have made news and drawn scrutiny.
The concentration of mergers here, through happenstance and history — Catholic nuns arrived in Washington with the first waves of settlers in the 1850s — is particularly pronounced. If all the proposed religious and secular combinations go through, almost half of the hospital beds in the state — the highest percentage in the nation, and up from less than a third at the beginning of last year — would be controlled by the Catholic health systems, according to Merger Watch, a nonprofit group in New York that tracks hospitals.
Another wrinkle is that many Washingtonians are not that keen on religion to start with. A poll by Gallup conducted throughout 2012 put the state at 12th from the bottom in percentage of people who described themselves as “very religious.†It is also one of only two states — Oregon is the other — where voters have approved a physician-assisted suicide law for terminally ill people. Centuries of Catholic teaching hold suicide as a mortal sin.
“You happen to be the hot zone,†Sarah A. Dunne, the legal director of the American Civil Liberties Union of Washington, said on a recent evening to a group of 75 or so residents here in Mount Vernon who are opposing the mergers.
Skagit Valley Hospital in Mount Vernon, about an hour north of Seattle, has joined with two other small local hospitals in seeking a merger partner and is entertaining bids from two Catholic and two secular hospitals. A decision is expected this summer.
The A.C.L.U. has been “exploring plans for possible litigation,†as Ms. Dunne put it in an interview, over whether mergers involving religious and secular hospitals that get taxpayer support could violate a provision of the State Constitution barring public funds for religious purposes. Ten counties out of 39 in the state would have 100 percent of their hospital beds in Catholic health system hands by year’s end if all the proposed mergers went through, according to the A.C.L.U.
“Frankly, I wish we could do nothing,†said Vince Oliver, the chief executive at the 43-bed Island Hospital in nearby Anacortes, which is one of the three hospitals, including Skagit Valley, that are shopping for a partner. “But the future for a small independent hospital is not a very rosy picture right now,†he said.
Catholic hospital leaders said that changes in the medical and economic landscape could threaten service to millions of Americans in rural and suburban areas who might have no choices at all if their local hospital closed or shrank, and that Catholic partners — driven by a mission to serve the underserved — are uniquely fitted to help. The issue is not availability of abortion or consult to the dying, they say, which will still be available in secular institutions not that far away, but access to care at all.
“The Catholic health system is in many of the communities we’re in because other health care providers have not wanted to serve those communities and have not had a commitment to serve every human being,†said Peter Adler, a senior vice president at PeaceHealth, a Catholic hospital system based in the Pacific Northwest that is one of the bidders for the three hospitals in northwest Washington.
But critics said that Catholic hospitals do not, in fact, serve every human being because they deny certain reproductive services or end-of-life care that could help a dying patient end his or her suffering.
