Illinois' Health Equity Crisis Demands 340B Reform

Op-ed

Illinois' Health Equity Crisis Demands 340B Reform
By Reverend Alvin Love

This weekend, thousands of doctors gathered in Chicago for the country's largest oncology conference. The event happened just weeks after the host organization -- the American Society of Clinical Oncology -- endorsed the expansion of 340B, a federal drug discount program that large hospitals have transformed from a safety-net tool into a lucrative profit center.

That should concern anyone who cares about health equity in Illinois.

Congress created 340B to help hospitals serving low-income and uninsured patients stretch scarce resources and expand access to care. The program allows qualifying hospitals to purchase medicines at steep discounts, with the expectation that those savings will support vulnerable communities.

But weak oversight and years of unchecked expansion have allowed many hospitals to exploit the program for financial gain, while doing little to improve access to care for the patients 340B was meant to serve.

Despite years of reform efforts, Illinois remains plagued by persistent healthcare disparities. The state's Black residents die from cancer at significantly higher rates than white residents. Hispanic and American Indian patients are much more likely to be uninsured. Hospital and clinic closures throughout Chicago's South and West Sides have left many neighborhoods without reliable access to maternal care, pharmacies, and specialty treatment.

In my own community of Roseland, as many as one in 10 people are uninsured, and the average income is less than $27,000 per person. Roughly half of Roseland residents have high blood pressure, while 20% have diabetes. It's exactly the kind of place 340B was supposed to help.

Instead, many hospitals now use the program less as a safety-net tool than as a revenue generator. Hospitals can buy medicines at deeply discounted 340B prices, bill insurers at full rates, and pocket the difference -- often without demonstrating that the money improves care for low-income patients.

Here in Illinois, 69% of 340B hospitals provide below-average levels of charity care. These facilities also earn an estimated 2.7 times more in revenue from the program than they spend caring for low-income patients.

As more providers embraced this financial model, the program expanded dramatically. By 2020, enrollment had grown to roughly 2,600 hospitals nationwide -- up from the expected 90 in 1992.

There has been a similar explosion in so-called contract pharmacies -- outside pharmacies that partner with 340B hospitals to dispense discounted drugs. Nationwide, the number of contract pharmacies has surged from roughly 1,300 in 2010 to about 32,000 today.

Consider Rush University Medical Center. According to a Pioneer Institute analysis, the Chicago hospital operates 413 contract pharmacy relationships through 340B, including many outside Illinois, while devoting less than 1% of its operating expenses to charity care.

Rush is hardly an outlier. A recent study published in JAMA Health Forum found that 340B contract pharmacies increasingly cluster in wealthier neighborhoods while their presence has declined in predominantly Black and Latino communities.

In Chicago, this expansion has coincided with worsening pharmacy access gaps in many South and West Side neighborhoods already struggling with provider shortages and poor health outcomes. While the Loop has more than 161 pharmacies for every 100,000 residents, Roseland has fewer than 23.

In other words, as 340B has expanded, many historically underserved communities have been left behind -- even as many participating hospitals continue to thrive financially.

ASCO's new statement nevertheless endorses policies that could further expand the program's reach, including broader use of contract pharmacy arrangements and changes to eligibility.

Expanding a broken program without meaningful reform will only worsen health inequities in Illinois and across the country. Lawmakers must make 340B work for the vulnerable patients it was intended to serve.

If hospitals receive billions in discounts intended to support vulnerable patients, the public should be able to see where those dollars go and whether they are improving care in underserved communities.

In the fight for health equity, success is not measured by how much money flows through a federal program. It is measured by whether patients in communities like Roseland, Englewood, Austin, Little Village, and North Lawndale can actually access affordable care close to home.

Right now, too many still cannot.

Reverend Alvin Love is the pastor at Lilydale First Baptist Church and a community leader in Roseland.

  

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