Antitrust Immunity in Rural Washington: A Good Answer, but What's the Question?

Abstract

Abstract: State action immunity from antitrust liability has been proposed as an important tool for preserving and strengthening fragile rural health care delivery systems. Washington is a leader in the use of state action immunity, having passed a statute and having approved several applications for immunity. This paper summarizes the current status of state action immunity, both in general and in Washington, including a review of the literature and an explication of issues of particular relevance to rural areas. Additionally, a summary is presented of inter‐views with key informants in nine rural Washington communities, including an organization that had received a grant of immunity, one rural community just across a state border, and one other organization with rural operations that was given a grant of immunity. The interviews suggest that antitrust immunity, given the current interpretations of laws and guidelines by the courts, the Federal Trade Commission, and the Department of Justice, is not playing a significant role in the plans and decisions of health care providers in rural Washington. In larger rural areas, it was thought that activities could be structured to avoid antitrust liability without needing to apply for immunity; in smaller areas, there was little knowledge of antitrust issues, few resources to obtain knowledgeable advice, and little activity for which immunity might be useful. Overall, the authors did not find a large role for state action antitrust immunity in health care in rural Washington under current conditions.