As we dissect the results of the 2024 elections, one trend is crystal clear: the healthcare needs of rural Americans may have played a more significant though underappreciated role in driving political sentiment. 

In states that prioritized safeguarding the 340B drug discount program—a lifeline for countless small hospitals—Donald Trump’s support grew even in areas already considered strongholds of conservatism.

The 340B program represents an essential policy that keeps rural hospitals operational without burdening taxpayers. But Big Pharma, emboldened by profit margins swollen during the pandemic, has made eliminating this program a top priority. If they succeed, rural hospitals may close, leading to reduced access to care for some of the country’s most vulnerable populations.

In states where Republicans fought for rural access to vital drugs, Trump made some noticeable gains:

What Is the 340B Program?

The 340B program, created in 1992, allows hospitals serving low-income or rural patients to purchase drugs at steep discounts. These savings are reinvested in vital services such as staffing, equipment upkeep, and specialized care like oncology and dental programs. Importantly, the program doesn’t cost taxpayers anything. It’s a win-win model: rural healthcare facilities gain resources to sustain operations, and underserved communities receive critical care.

For rural states like West Virginia, Kansas, and Louisiana, where healthcare facilities are already stretched thin, 340B provides the financial breathing room necessary to serve their communities.

But in Virginia, Republicans have wavered in their support of the program. There, too, results were noticeable.

Virginia’s Missed Opportunity

Virginia offers an instructive case on what happens when 340B protections falter. Despite efforts by the state legislature to safeguard the program, the executive branch weakened its implementation, reportedly in response to lobbying pressure from pharmaceutical industry insiders. 

This move came at the expense of rural hospitals, which rely heavily on 340B to serve their communities.

While Governor Glenn Youngkin’s administration has prioritized numerous conservative policies, it’s vital for the executive branch to better collaborate with legislators to fully protect 340B. The program’s success hinges on unity between lawmakers and the executive to ensure that hospitals serving rural, low-income communities can continue providing life-saving services. Strengthening—not diluting—protections for 340B will better support rural Virginians and align with the values of the conservative base.

Virginia’s 2024 election results tell a cautionary tale. While much of the country shifted further to the right, Virginia trended slightly bluer. This divergence coincided with a perceived weakening of healthcare support, including a failure to robustly back 340B. Republicans aiming to maintain their momentum should consider how bolstering programs like 340B resonates with rural and working-class voters across the nation.

What Is the 340B Program?

The 340B program, created in 1992, allows hospitals serving low-income or rural patients to purchase drugs at steep discounts. These savings are reinvested in vital services such as staffing, equipment upkeep, and specialized care like oncology and dental programs. Importantly, the program doesn’t cost taxpayers anything. It’s a win-win model: rural healthcare facilities gain resources to sustain operations, and underserved communities receive critical care.

For rural states like West Virginia, Kansas, and Louisiana, where healthcare facilities are already stretched thin, 340B provides the financial breathing room necessary to serve their communities.

Big Pharma’s Aggression: A Threat to Rural America

Big Pharma, however, has launched a full-scale assault on 340B, claiming the program is being abused. Their aim? To gut the program and redirect profits to shareholders, regardless of the devastating consequences for rural healthcare. If they succeed, hospitals will face closure, leaving some of the most vulnerable populations without access to care.

Minnesota provides a cautionary example. 

READ MORE: Tim Walz Aspires to Be the 'Rural America' Candidate, But His Policies Will Kill Rural Healthcare

Governor Tim Walz’s administration introduced onerous regulations that burdened small hospitals with costly reporting requirements. These measures, though framed as oversight, disproportionately hurt rural facilities, pushing them closer to financial collapse. Republicans in other states should resist similar approaches, as they harm rural voters and erode the party’s support in critical regions.

Why 340B Is a Conservative Issue

Defending the 340B program is not just good healthcare policy—it’s a demonstration of conservative values. The program enables local institutions to thrive without relying on taxpayer-funded bailouts, embodying the principles of fiscal responsibility and limited government.

If Big Pharma’s lobbying succeeds, taxpayers will be forced to fund hospital bailouts while losing access to affordable care. This outcome would run counter to conservative priorities and alienate the working-class voters who have increasingly turned to the Republican Party.

Political Lessons from the 2024 Election

The election results highlighted a powerful trend: voters rewarded leaders who prioritized rural healthcare. Trump’s growing margins in 340B-protecting states show the political value of championing programs that directly impact the lives of voters.

Virginia’s experience stands out. The state’s slight shift away from Republican dominance coincided with weaker 340B protections. Republicans at every level should take note: defending this vital program isn’t just good policy—it’s politically advantageous.

The Way Forward

For Republicans, the path is clear: defend and strengthen the 340B program. Doing so reinforces the party’s commitment to rural America, preserves access to healthcare, and demonstrates a willingness to stand against powerful corporate interests in favor of everyday citizens.

To safeguard the gains of 2024 and beyond, Republicans must prioritize collaboration—whether in Virginia or across the nation—to ensure that rural hospitals remain open and thriving. Programs like 340B represent not just a policy solution but a moral imperative to support the communities that form the backbone of the conservative movement.