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Chris Skorupa


Americans across the country face health care challenges every day, but those challenges are particularly noticeable in rural areas where access to doctors and medical treatment remains a critical issue.

In comparison to urban areas, rural residents have greater distances to travel to see a doctor, which is then compounded by the fact that doctors are often scarcer in these regions. There are less than 40 primary care doctors for every 100,000 people in rural areas. There continues to be a noticeable wage earning gap in rural areas as often times folks are working hard with less of a paycheck than their urban counterparts.

For these reasons, the 340B Drug Pricing Program is extremely beneficial for rural hospitals and residents. For 25 years, the 340B program enabled underserved patients to get the outpatient medicines and medical care they needed. The program worked simply: Pharmaceutical manufacturers discounted drugs for hospitals that treated a disproportionate share of low-income patients, and in return, they were guaranteed a market (and notable profits) in the Medicaid system.

The savings from the 340B program allowed hospitals to not only supply eligible patients with the outpatient drugs they needed, but also enabled hospitals to use those monies for local health priorities, such as diabetes clinics, cancer outreach or mental health assistance. The percentage of rural hospitals operating at negative margins increased to 44 percent this year; savings from the 340B drug discounts allowed many to keep their doors open. This is incredibly important, considering that 122 rural hospitals have closed since 2005.

However, the 340B program has come under attack in the last several months, and this will mean significant changes for both rural and urban patients who rely on it. In November 2017, The Centers for Medicare and Medicaid Services finalized a ruling that cut the program’s drug reimbursement rates by nearly a third. This would result in many hospitals being forced to decrease, or completely discontinue, local care initiatives.

Now, harmful legislation introduced in December by Indiana Congressman Larry Bucshon. H.R. 4710, the “340B Protecting Access for the Underserved and Safety-net Entities Act” (called the 340B PAUSE Act), specifies three further changes to the 340B program’s disproportionate share, cancer and children’s hospitals. These changes include a moratorium on allowing any new entities to participate in the program; increased and onerous data reporting; and required reports by the Office of Inspector General and Government Accountability Office on charity care provided by existing 340B institutions.

The 340B PAUSE Act would endanger vulnerable patients and decrease health care availability across America. Hospitals already face wire-thin operating margins, and the new reporting requirements will be a costly burden which some hospitals might not be able to afford, costing rural areas an expansion of services that are very much needed.

Leading rural and agriculture groups this month voiced their opposition to the 340B PAUSE Act. The 340B Drug Pricing Program provides accessible and affordable health care for millions of Americans, especially those in rural areas. This is a partnership that works, let’s keep it that way.

Chris Skorupa, vice president of Rural and Agricultural Council of America, is president of Beartooth Fertilizer Company in Fox, Montana.