OP-ED: Safeguarding Charitable Medicines Programs in America

By Dr. Benjamin F. Chavis, Jr., President and CEO, National Newspaper Publishers Association

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There are zero requirements for hospitals to use the cost savings from 340B to help needy patients, and there isn’t any rule requiring these hospitals to let patients know they are eligible for these drugs.

All Americans should have equal access to high quality healthcare. As our nation steadily emerges out of the awful debilitating aftermath of the COVID-19 pandemic, the majority of communities of color, and in particular the African American community, are all facing lingering challenges and prolonged difficulties in having access to affordable and quality healthcare.

The United States Department of Health and Human Services (DHHS) has many important and life-saving public health related programs that are structured and funded to ensure access to the best of healthcare offerings including the provision of affordable pharmaceuticals with respect to the most vulnerable and underserved communities across the nation.

One of those important governmental healthcare programs is known as the Charitable Medicines Program (340B). The 340B program began in the early 1990s when Congress wanted to require pharmaceutical manufacturers, as a condition of benefiting from government programs, to donate at low or no cost prescription drugs to charitable hospitals. These hospitals, overwhelmingly located in underserved urban and rural communities with patients of all races and ethnicities, were in turn expected to use these discount price medicines to serve patients who otherwise could not afford these drugs.

Today, Americans are facing unprecedented times. We are rebuilding our economy from a global pandemic. But there is another epidemic in this country (Entities putting profits over people) which must be addressed, and it must be addressed now. It’s one of the few things reasonable Americans on all sides of the political spectrum can agree on these days. Where it happens, there ought to be robust, bipartisan reform efforts to fix it. When it happens inside the context of a government program meant to help the poorest among us, it should mean robust oversight from the Congress and the Administration. That’s exactly what’s going on now with the charitable medicines program known as “340B.”

For a while, the program worked as intended. The average discount on a 340B drug is nearly 60%, and for many drugs it’s much more than that. But over time, greed has cropped up and made a mockery of the program resulting in practices which furthers health inequities in our nation. The definition of a “charitable hospital” was never welldefined in law, and today 57% of all hospitals participate in the drug discount program. They are happy to accept the cheaper medicines, but where do they end up? Out of the nearly 13,000 hospitals and community pharmacies participating in the 340B program today, fully six in ten are in middle class and affluent areas, not the poorer zip codes the program is meant to

“Just Around the Corner!”

By Lou K. Coleman

How is this possible? How has a program Congress created to get Big PhRMA to give affordable drugs to charitable hospitals gone so far off the rails? The answer is that no one is minding the store in Washington. There are zero requirements for hospitals to use the cost savings from 340B to help needy patients, and there isn’t any rule requiring these hospitals to let patients know they are eligible for these drugs.

In addition, stand-alone hospitals are now the exception compared to the rule of a broad hospital network with facilities in diverse income areas. A hospital or clinic that qualifies for the discounted drugs in this program might be one of dozens of health care centers in a network conglomerate. As a result, the drug price reductions are eagerly gobbled up and the drugs fed into the larger system. To put a fine point on it, medicines intended for poor urban and rural areas are being re-routed and sold at full price to insured patients in more affluent areas. That’s the definition of health inequity.

This is not a mere theoretical concern. Last year, the New York Times https://www.nytimes. com/2022/09/24/health/bonsecours-mercy-health-profitpoor-neighborhood.html broke a story that Bon Secours, a hospital network in the Richmond, VA area, was accepting 340B discount drugs at Richmond Community Hospital, not telling local patients they were eligible for these free-to-inexpensive medicines, and selling the drugs for full price to patients in more affluent hospitals in their network. This led Richmond mayor Levar Stoney to send a letter to Bon Secours, charging them with using “loopholes [to increase] profit margins for the hospital system while they have reduced services in one of our predominantly Black communities.”

Notably, Mayor Stoney also called on the Biden Administration to increase oversight of the 340B program:

“I request for your administration to urgently investigate the effectiveness and unintended consequences of 340B–not only regarding Bon Secours in the City of Richmond, but in other localities across the country.”

Untold stories like this exist in communities across the country. But the fact is the hospital lobbyists have influenced Congressional and Administration oversight officials from both political parties for decades. Every Congressman has a hospital in their district, and the 340b program must be used by the hospitals as Congress mandated.

That’s why I was proud to hear about a panel earlier this year organized by the Rev. Al Sharpton on this topic where he stated, “This affects everybody. If you are having people abuse government funds that should be reinvested, this is not a rightwing or left-wing issue.”

The executive branch runs the 340B program out of the Health Resources and Services Administration, a branch of the Department of Health and Human Services. HRSA, as it’s known, makes determinations of what entities are covered by the program, and they have been very generous over the years. According to the Government Accountability Office, the number of hospitals and clinics HRSA has approved has increased from fewer than 10,000 in 2010 to nearly 13,000 today–an increase of 30 percent in a little over a decade.

And while HRSA is supposed to collect information and conduct audits on 340B covered entities, they simply don’t have the manpower to do so. The little number of questions they do raise are answered and accepted, because there is no real oversight possible. There are only the staff resources to facilitate drug discounts to hospitals.

What’s urgently needed is a combination of Congressional hearings and a more inquisitorial HRSA. Until that happens, low income patients across America will be the excuse giant hospital chains use to get drugs at a discount rate and sell them at full price to more affluent patients.

“Just Around the Corner!”...continued makes his appearance in the temple of God.

Lou K. Coleman

Is a time that is going to be more severe than any other time we have ever known. Wake Up People, Wake Up!

In [Matthew 24:15-28], Jesus talks about an “Abomination of Desolation” in the Olivet Discourse as He referenced a future event mentioned in [Daniel 9:27]. Jesus says, “So when you see the abomination of desolation spoken of by the prophet Daniel, standing in the holy place [let the reader understand], then let those who are in Judea flee to the mountains. Let the one who is on the housetop not go down to take what is in his house and let the one who is in the field not turn back to take his cloak. And alas for women who are pregnant and for those who are nursing infants in those days! Pray that your flight may not be in winter or on a Sabbath. For then there will be great tribulation, such as has not been from the beginning of the world until now, no, and never will be. Wake up people, wake up, the “Abomination of Desolation” is just around the corner.

Pay attention to world events and do not be distracted. The Antichrist is soon to be revealed and when the Antichrist exalts himself to the point of deity, a series of devastating events will be transformed into a battleground of world-wide destruction, impending doom, so much so that the aftereffects of this “great tribulation” all life on Earth would be threatened and held in the balance. This is not an overstatement. The wars that are going to engulf mankind at the end of this age will be so destructive that the very death of the Earth is not beyond the realm of possibility. The Lord indicates this very fact in the Book of Matthew chapter 24, verse 22. Jesus says that if God does not intervene to save his people, there should no flesh be saved.

Pay attention to world events and don’t be distracted, because just around the corner is the “Abomination of Desolation” a time period which will be much worse than the World Wars of the Twentieth Century. So much so, that the Bible describes it as a period that will take us all the way up to the Battle of Armageddon and ultimately to the very moment of the return of Christ. And it all will

Wake Up People, Wake Up! The “Abomination of Desolation” is just around the corner. If you have not received the Lord as your Lord and Savior, do it NOW. For NOW, is the acceptable time, NOW is the now find offensive. Yet still, they kept practicing love together, and now no one can even imagine there was a time when their church wasn’t ONA.

I thought about this church on the last few days of Synod when the sanctuary that love built was breached by the harmful words and actions of siblings from another denomination with which we shared convention space. I’ve replayed my Sunday at University UCC as I’ve read pain-filled messages from some who were unsafe.

I am angry that we were violated. I lament the harm inflicted upon our gathering because some who lost their love lost their way. I grieve the fear and painful memories evoked in LGBTIA+ siblings who deserved to simply delight themselves in what should be the safest place on earth, the Church. But the Church is not safe for everyone and, in the spirit of Ubuntu, that means the Church is not safe for anyone.

I am grateful their leadership called to apologize. While I know leaders cannot control the actions of every member, apologies must be accompanied by repentance that indicates a commitment to change the way one shows up in the world. These harmful actions disrupted our peace and damaged their witness. May repentance come as I anxiously await the day when we, the Church, the One body of Christ, can’t even imagine that we were ever anything with and to one another other than love. I believe that day is coming, but until then, I will be right here, practicing love with all of you, until love is all we know.

Traci Blackmon is Associate General Minister, Justice and Local Church Ministries for the United Church of Christ.

The Heat Is On: California Ramps Up Coping Strategies...continued

from page 2 consecutive days, from July 3-6.

Marta Segura, chief heat officer and director of climate emergency mobilization for the city of Los Angeles Segura was joined by UCLA Professor V. Kelly Turner, Dr. Lucia Abascal of the state Department of Public Health, Dr. Kimberly Chang, of Asian Health Services and Sandra Young, founder of the Mixteco Indigenous Community Organizing Project.

Extreme Heat Can Kill

Two days before, OCPSC had launched a $20 million “Heat Ready California” campaign to help people stay safe from the deadly effects of extreme heat.

Turner spoke of how urban development has created “heat islands” where asphalt predominates over shade and green space.

Something as simple as a shade structure, she said — strategically placed tree plantings, awnings, or bus shelters — can reduce people’s body heat temperatures by tens of degrees.

But currently, she said, “most Californians are effectively living in shade deserts.”

Less Asphalt, More Shade of these and other resources is available by county at the “Heat Ready California” website.

Dr. Lucia Abascal of the state Department of Public Health.

Secondly: “Stay hydrated!” Especially high-risk populations such as those with disabilities, the young, the old, and pregnant women.

But “even somebody that’s healthy can suffer from heat stroke,” she said. Dizziness, leg cramps, disorientation are three warning signs.

Shade Structures day of salvation. Then he said to me, “These words are faithful and true.” The Lord God of the holy prophets sent His angel to show His servants the things which must shortly take place. [Revelation 22:6]

Neighborhoods that have been short-changed in access to nearby public parks and green spaces that might offer shade, or whose residents have to travel farther to get health care, also have higher incidence of heat-related health problems.

“Los Angeles wants to take the lead by investing in those areas that have been historically neglected,” Segura said. As part of the “Heat Relief for L.A.” campaign, she said, all 73 libraries will be open, along with 10 cooling centers.

WITNESS FOR JUSTICE #1160

Practicing Love Together

Traci Blackmon

Last November I had the joy of worshipping with University UCC in Seattle for Ubuntu Sunday. Ubuntu is an African concept of the interconnectedness of community most often translated with the phrase: “I am because We are.”

On this Sunday, the invitation to Our Churches Wider Mission (OCWM) was offered by a parent at the church. The mom began by sharing an encounter she’d had with her child who was not feeling like going to church that day and asked her: “Why do we always go to church?”

This mom’s response to the question arrested my attention. She told her child: “We go to church to practice love together.”

As this mom stood before us reflecting on the response she’d shared with her child, I asked myself: Is this why we go to church, to practice love together? While I was still pondering the statement, she began to tell the story of University’s journey to becoming an Open and Affirming (ONA) Congregation, reminding the gathered church of the challenges, the anxiety filled moments, and the strained conversations they’d shared. She talked about how everyone loved the church, but that some couldn’t find their way to agreement about the direction of the church. She shared how many stayed and some left, and said that both acted out of their deep sense of love for the church they knew.

No matter how difficult the conversations or painful the separations, the majority of people kept showing up. They kept pushing. They kept talking, and they kept listening. She reminded everyone that back then there were common phrases used that we would never say now, and beliefs held that we

It gets worse according to where you live. For example, research conducted in Pacoima, in Los Angeles’ San Fernando Valley, found that less than 10% of the space at the schools provided shade.

“Play yards need less asphalt and more shade,” she said.

Other research has shown that some types of dwellings, such as mobile homes, even when airconditioned, can’t always be sufficiently cooled.

She recommended “shade audits” for those communities that haven’t done them yet, as well as rental unit regulation not just for sufficient protection against cold, but for heat as well. And then, she mentioned, 40% of heat-related deaths currently are among those with no housing at all.

UCLA’s Luskin Center for Innovation, where she works, has published two extensive reports, Identifying and Addressing Heat Inequities in the City of Los Angeles, and Turning Down the Heat that detail disparities across Los Angeles’s communities that affect hot weather health, and recommendations for improvements.

Stay Cool

“Of all the natural disasters, heat is the main killer,” Abascal said. “It’s very, very important for everyone to understand the dangers of heat.”

“Stay cool,” she said. For those who can’t afford to run their home air conditioning or don’t have any, she recommended libraries, malls or cooling centers. A list

Among the efforts she advocated are accelerating current plans to add shade structures to bus stops in communities that rely on public transit and finding ways to make air conditioning more affordable to low-income users.

Communities already impacted by pollution, she noted, are also additionally vulnerable, because “heat exacerbates pollution.” Workers, she said, should be aware of their rights to take breaks and ensure they stay hydrated.

Workers’ Rights

Sandra Young also addressed the circumstances of agricultural workers, acknowledging that most are undocumented and therefore less likely to challenge employers about substandard working conditions.

Often, even when water is available, it’s too far from where the workers are to make it easily accessible without risking heat exhaustion and lost earnings.

Sandra Young, founder of the Mixteco Indigenous Community Organizing Project She called for on-site advocacy for adequate working conditions and a health care system that goes beyond being service providers to being advocates for their clients.

“Our health care system still has a long way to go to meet the needs of the farmworker community,” she said.

Asian American Elders Are Vulnerable Dr. Kimberly Chang addressed some issues for AAPI communities in Oakland, where she works, and in the Central Valley, where in a single decade