It’s looking more and more likely that rural hospitals in America might be staring down a taxpayer-funded bailout soon—no matter who wins the 2024 election. And no one is talking about it. According to Joe Grogan, a former Trump White House policy advisor with deep connections to the pharmaceutical industry, a financial rescue may become unavoidable if Big Pharma gets its way. Yet this looming crisis has barely registered in national media coverage, which tends to focus more on the big urban centers along the coasts than the quiet struggles of rural communities in middle America.

If you live in a red state or rural America, you’re probably aware of the dire state of local healthcare providers. Small hospitals in places like Louisiana, Arkansas, and other heartland states have been hanging by a thread for years. But if you live in New York or Los Angeles, you may not know how close these hospitals are to financial collapse.

For many of these hospitals, the only lifeline has been a federal program called 340B, which allows healthcare providers to purchase drugs at steep discounts and resell them at regular prices. The profits help fund essential services—paying nurses, maintaining equipment, and keeping doors open. But the pharmaceutical industry has been on a mission to gut this program, arguing that it’s “out of control.” If they succeed, hospitals may face closure—and rural communities will suffer the most.

What Is 340B, and Why Does Big Pharma Want It Gone?

The 340B program is simple in theory: hospitals and clinics that serve low-income or rural patients get to buy discounted drugs from pharmaceutical companies. These providers use the savings to offer affordable care to patients and reinvest in hospital operations. The program costs taxpayers nothing.

Yet drug companies, which made record profits during the pandemic, have been lobbying for years to curtail 340B. They argue that hospitals are abusing the system by pocketing the profits instead of passing them along to patients. But the truth is, without these discounts, many rural hospitals wouldn’t survive. If drug companies succeed in “reforming” 340B, hospitals will lose a critical revenue stream—and taxpayers may end up on the hook for the fallout.

Senator Jerry Moran (R-KS) has reportedly shown some sympathy toward Big Pharma's agenda, raising concerns among conservatives who support the program. With the future of 340B hanging in the balance, the question is clear: Will lawmakers cave to Big Pharma and force a bailout, or will they defend the program that has kept rural hospitals afloat without burdening taxpayers?

Joe Grogan's Warning: A Bailout May Be Unavoidable

Even Joe Grogan, a former Trump official with close ties to the pharmaceutical industry, is sounding the alarm. At the recent Association for Value-Based Cancer Care Annual Summit in New York, Grogan admitted that if 340B is dismantled, some hospitals “are going to be under pressure” and the federal government “doesn’t have the money to shore up the community hospitals.” This means lawmakers could soon face a stark choice: either taxpayers fund a bailout, or struggling rural hospitals start shutting down.

Grogan’s position is particularly noteworthy because he isn’t a critic of Big Pharma—in fact, he once worked for Gilead, one of the drugmakers most hostile to the 340B program. The fact that even he sees the need for government action should be a wake-up call.

The Political Dilemma: Bailout or Status Quo?

The way this plays out will have significant political consequences, especially for Republicans. The Gang of Six—Senators John Thune (R-SD), Jerry Moran (R-KS), Shelley Moore Capito (R-WV), Tammy Baldwin (D-WI), Debbie Stabenow (D-MI), and Ben Cardin (D-MD)—are tasked with reviewing potential changes to 340B. These senators must now decide whether to side with the pharmaceutical lobby or stand up for rural healthcare providers.

READ MORE: Why Congress’ Quiet 'Gang of Six' Could Threaten Healthcare Access for Rural Communities Nationwide

If lawmakers bow to Big Pharma’s demands, they will almost certainly need to authorize federal funds to rescue rural hospitals. On the other hand, if they leave the 340B program intact, drug companies will have to continue offering discounted drugs to hospitals. This isn't an easy decision, but it should be clear where conservative priorities lie.

For conservatives, this issue is about more than just healthcare policy—it’s about standing against crony capitalism. Why should taxpayers be forced to bail out hospitals because Big Pharma refuses to honor the deal it agreed to years ago? The pharmaceutical industry, which has profited handsomely from taxpayer-funded COVID vaccines and treatments, now wants to avoid doing its part to support rural healthcare.

Many conservatives are likely to ask: Why should we reward a massive industry for walking away from a program that costs them a fraction of their profits? A taxpayer bailout would shift the financial burden from Big Pharma onto working-class Americans in small towns and rural areas. That’s the opposite of what conservative voters want, especially after seeing other industries bailed out in recent years.

Interestingly, Donald Trump himself seems to have shifted his stance on pharmaceutical companies. While he initially worked closely with them during the pandemic, he later grew skeptical of their motives. Many of Trump’s voters, particularly those in rural areas, now view Big Pharma with distrust. They see these companies as putting profits ahead of people—and the 340B debate is yet another example of that.

Even Grogan, once a champion of Big Pharma, seems to recognize that the industry’s agenda is out of step with Trump’s base. If conservative lawmakers ignore this shift and side with drug companies over rural hospitals, they risk alienating key voters in an election year.

The Bottom Line: Keep 340B or Risk a Bailout

The choice facing the Gang of Six is straightforward: Leave the 340B program alone and let it continue supporting rural hospitals, or give in to Big Pharma’s demands and set the stage for a costly, taxpayer-funded bailout. The latter option would not only strain public finances but also hurt the very communities that Republicans claim to champion.

Rural Americans don’t want more government bailouts. They want policies that allow their local institutions to thrive without federal intervention. The 340B program has done exactly that—and it hasn't cost taxpayers a dime. If Big Pharma succeeds in gutting 340B, the only winners will be drug companies, and the losers will be rural patients, hospitals, and taxpayers.

Lawmakers should think long and hard before putting taxpayers on the hook for yet another industry bailout. The better solution is simple: Make Big Pharma stick to the deal they signed up for years ago and allow rural hospitals to keep doing what they do best—serving their communities without federal handouts.