Diana Harshbarger

At Tennessee Health Care Campaign (THCC), our mission is simple: to ensure that every Tennessean – no matter their ZIP code, income or background – can access quality, affordable health care close to home.

But as we talk with families across the state, we’re hearing more and more heartbreaking stories of people going without care because it’s simply out of reach, especially in our rural communities. In 70 out of our 95 counties, at least half of Tennesseans live in rural areas. Since 2010, we’ve had 13 rural hospital closures.

Rural access to care is weakening, and it’s putting the health of entire communities at risk. Emergency departments, maternity wards and oncology units are shutting down at local hospitals because facilities don’t have the funding to keep these specialized services running.

As a result, families are forced to drive for hours just to see a doctor, find emergency care, or access treatment. These long distances lead to missed preventive care, delayed diagnoses and higher mortality rates. No Tennessean’s health should be dependent on whether or not they can reach the nearest hospital in time.

Large hospitals, big chain pharmacies tap federal dollars under 340B program

So on paper, it might seem like a good solution when large health systems swoop in to purchase struggling community hospitals. They often promise better care, more resources and long-term stability. But residents have every right to ask: “What’s the real motivation?”

One reason is the expanded access and additional profits they get from tapping into, and in some cases, misusing the federal 340B drug discount program.

The 340B program was created to help safety-net providers, like our small, community hospitals that serve rural Tennessee, provide discounted medicines to underserved patients, expand access to specialized services and invest in community-health programs. But because the program lacks meaningful guardrails, it has grown far beyond its original intent. Today, even large, well-resourced hospitals and big chain pharmacies qualify – and even benefit the most from it.

When these large health care systems purchase our community hospitals, they aren’t delivering on their promises. Instead, they are stripping those hospitals of their services, or quietly consolidating services in urban areas to boost profits. The community, and the people the hospital was built to serve, end up with less health care than before.

340B program needs more guardrails to save rural health care

And the result is painful and personal. Tennesseans are traveling farther, paying more and waiting longer for the care they need. For example, Ashley Davis was caring for her mother, Lisa Davis, in rural Jamestown, Tennessee. Ashley shared with THCC that Lisa received a diagnosis of long COVID during the height of the pandemic. But in 2022, she was found to have cancer that had metastasized over time. Lack of access to quality, affordable specialty care had cost Lisa Davis her life.

No one should face that reality. We need a system that strengthens rural hospitals and ensures they have the resources needed to continue serving their communities. That starts with 340B dollars actually reaching the patients the program was designed to help.

That’s why Congress must act. Tennessee’s own Rep. Diana Harshbarger has introduced the federal 340B Access Act, a bipartisan proposal that brings much-needed transparency and accountability to the program. It would ensure that 340B savings are used as intended: to help hospitals of all sizes provide affordable medicines and better care for underserved communities, including the rural patients who rely on these facilities the most.

Tennessee Health Care Campaign will continue fighting for policies that bring quality health care closer to home and keep it there. Rural hospitals are the backbone of their communities and allow Tennesseans to access care when and where they need it.

We urge Congress to pass the 340B Access Act and make sure that no patient in Tennessee – or anywhere in America – has to suffer from a lack of lifesaving care that should be available in their community.

Logan Ebel is the executive director of Tennessee Health Care Campaign.