Delays in accessing treatment are a matter of life and death. Rural Californians rely on small hospitals to be the first line of defense in emergency medicine. Where they are not able to serve a patient fully, they are able to stabilize and arrange rapid transport with medical personnel accompanying the patient to the nearest trauma center.
This year, the community of Glenn County suffered the loss of its rural hospital and now must travel more than 30 miles for the closest hospital. Tragically, the hospital falls just outside of the safety net distance that would have provided a lifeline to the struggling hospital. Here in Kern County, we have seen funding cuts threaten facilities like Kern Valley Hospital and Adventist Health Tehachapi.
The collapse of the rural hospital network is not the result of a singular policy but of a myriad of safety net programs that have failed to adequately ensure that Americans have access to quality, affordable, and emergent medical intervention.
With the astronomically high cost of drugs we are seeing, one such example of an effort to curb costs for underserved communities, is the 340B program. The 340B Program was created in 1992 with the intention to benefit the most vulnerable patients who can’t afford healthcare, but its lack of transparency has subjected it to being preyed on by large players in the healthcare system, like major hospital groups and big insurers. Essentially, the 340B program was designed to provide drug discounts from manufacturers to hospitals, with the goal of passing those savings on to patients. The concept is simple enough – hospitals are in a position to leverage discounts on behalf of the medically underserved populations by offering the discounted drugs to those patients most in need.
If the 340B program was working correctly, the cost of the medicine would be lower for patients in underserved rural communities, but evidence suggests those savings are not reaching patients. In fact, there are bad actors that buy deeply discounted prescription drugs and then turn around and charge the patients and insurance companies higher prices and pocket the difference. Without congressional oversight, this program will continue to fail patients who are most in need.
Reforming this broken program was the focus of a United States Senate HELP hearing recently. The 340B program lacks transparency and oversight, and the data reveal a rapidly escalating problem. Investigative reports show that hospitals across the country, including those here in the Central Valley, were sending medical bills to patients who qualified for charity care and misleading patients about their treatment coverage. This has become an ongoing practice in California, with monopolistic healthcare systems in hospital deserts getting away with charging patients exorbitant prices for basic medical care.
As local regional hospitals continue to close, the concentration of care in the hands of fewer and fewer corporations not only causes fewer providers to be able to care for the patients, but a more nefarious practice has been demonstrated. Only 35% of 340B hospitals are located in the medically underserved area they are meant to serve. Yet, the discounts are flowing to the other 65%, and leaving low-income communities across the country without support.
There has been progress in uncovering the various factors driving the growing unaffordability of healthcare and the widening health disparities. Examining the complex web of funding streams is long overdue to pass savings onto the vulnerable patients they are intended for.
Congressional leaders here in the Valley must take concrete steps to reform the 340b program so that it helps the patients, like those in our rural communities, it is meant to serve.
