This bill amends existing law and adds new sections to create a dedicated public hospital infrastructure funding mechanism and to expand cooperation authority among public hospital districts and publicly owned or operated health care entities. It explicitly authorizes public hospital districts not affiliated with a nonpublic entity (per RCW 70.44.240) to enter into cooperative agreements and contracts with other public hospital districts and publicly owned or operated health care entities, applies chapter 39.34 RCW to those cooperative arrangements, and expands definitions in RCW 70.37.020 (including “participant”) to expressly include any publicly owned or operated health care entity. The measure establishes a new annual assessment on each authorized insurer or taxpayer subject to tax under RCW 48.14.020 or 48.14.0201 equal to $0.75 per coverage month in the prior calendar year, with the initial assessment due March 1, 2027 and annual filings and payments due by March 1 thereafter. It creates the public hospital infrastructure account to receive all assessment revenues, limits spending from that account to appropriated funding assistance for public district hospitals or publicly owned/operated health care entities undertaking major new construction or modernization projects, and allows refunds for overpayments if requested within six years. The bill sets filing, penalty, interest, and enforcement procedures: a schedule of late penalties (5% by month-end, 10% by 45 days, 20% by 60 days), interest at the maximum legal rate beginning 61 days after due date, collection by distraint or civil action, and authority for the insurance commissioner to revoke certificates of authority or registration for delinquent payers until amounts are paid. It requires the assessment be borne by insurers/taxpayers and not passed through to enrollees, subjects carrier compliance to the commissioner’s rate filing review, and authorizes the commissioner to adopt implementing rules. Missing from the provided text are the contents of RCW 70.44.240 (which defines affiliation with a nonpublic entity), the precise scope of premiums or prepayments covered under RCW 48.14.020 and 48.14.0201, a definition of “major new construction or modernization project,” details of how chapter 39.34 RCW will apply in practice, and the external affiliate definition referenced under RCW 21.20.450.

If enacted, public hospital districts and other publicly owned or operated health care entities would be able to form formal cooperative arrangements for sharing services, buying equipment together, and contracting jointly, which could lower capital and operating costs and make large construction or renovation projects easier to plan and finance. To pay for those projects, the bill creates a new public hospital infrastructure account funded by an annual assessment of $0.75 per coverage month on each insurer or taxpayer subject to the referenced insurance taxes, with the first payment due March 1, 2027; those funds can only be spent after the Legislature appropriates them and only for major new construction or modernization projects. Insurers and other taxpayers subject to the tax are most directly affected financially and administratively: they must file an annual statement by March 1 each year showing coverage months, cannot pass the assessment through to enrollees, and face stepped penalties (5%, 10%, 20%) and high interest plus possible certificate revocation for late or unpaid amounts. It’s unclear from the provided text which specific insurers, what premiums are counted, and how “major new construction or modernization project” will be defined, so exact eligibility for funding and the full size of the assessment burden cannot be determined here.