Democrats refused to pass funding bills over a dozen times this fall, grinding government to a halt for 43 days. Their demand: extend expiring Affordable Care Act subsidies. Senator Amy Klobuchar went on national television, warning about “75% premium increases.” Senator Elissa Slotkin called healthcare costs “the most personal” issue families face.
Democrats positioned themselves as defenders of healthcare affordability. They warned about costs spiraling out of control. They made it their signature issue.
But there’s a program that keeps healthcare costs low for rural Americans, one that costs taxpayers nothing, that some of these same Democrats helped pharmaceutical companies try to dismantle.
It’s called the 340B Drug Pricing Program. Three Democratic senators spent early 2024 collaborating with Republicans and the pharmaceutical industry to “reform” 340B in ways that could devastate rural hospitals across the country. Then they spent late 2025 fighting a shutdown over healthcare costs.
What 340B Actually Does
Congress created the 340B program in 1992 as a bipartisan deal. Pharmaceutical companies, as a condition of selling drugs through Medicare and Medicaid, must offer discounted prices to safety-net hospitals serving low-income and rural patients. The discounts run 25-50% off wholesale.
Hospitals use the savings to fund services for vulnerable communities. The program costs taxpayers zero dollars. Drug manufacturers fund it entirely.
In 2022, 340B hospitals provided nearly $100 billion in community benefits. Financial assistance for patients who can’t pay. Medicaid shortfalls that hospitals absorb. Health professions education. Community health programs. Those benefits came from $46.5 billion in drug discounts—3% of pharmaceutical companies’ global revenues.
For rural America, 340B determines whether hospital doors stay open.
Rural America’s Crisis
More than 400 rural hospitals nationwide are in danger of closing. Since 2010, 89 rural hospitals have closed, with another 65 undergoing “converted closures," which means reducing services, changing locations, and eliminating facilities. Texas alone has lost 26 rural hospitals since 2010.
Hospital administrators consistently cite the same threats: Medicare Advantage plans that reimburse 8-10% less than traditional Medicare, declining rural populations, and pharmaceutical companies squeezing the 340B program. But the program keeps many of these hospitals alive. Take Our Lady of the Lake Regional Medical Center in my home state of Louisiana, which generates $120 million annually from 340B.
Those money funds:
Uninsured patients pay $7.77 for retail prescriptions instead of $78.13, and $48.05 for specialty medications instead of $3,937.10
Free medication delivery to low-income neighborhoods
Emergency department case managers who pushed follow-up compliance from 23% to 76%
Mobile immunization clinics serving community centers and schools
Geaux Get Healthy program teaching families to shop and cook nutritious meals on a budget
Without 340B, these programs disappear. When rural hospitals close, they don’t come back.
The Bailout Nobody’s Talking About
Here’s what happens when the Republicans and Democrats work together to gut 340B: Rural hospitals lose their financial lifeline. Many close. Communities lose emergency rooms, maternity wards, and any nearby healthcare.
Then the federal government steps in with a taxpayer-funded bailout.
Joe Grogan, a former Trump official with pharmaceutical industry ties (he worked for Gilead, one of the drugmakers most hostile to 340B), admitted at a healthcare summit that if 340B is dismantled, hospitals “are going to be under pressure” and the federal government “doesn’t have the money to shore up the community hospitals.”
Even Big Pharma’s own people see the bailout coming.
The 340B program costs taxpayers nothing right now. Drug manufacturers fund it—companies that made record profits during the pandemic. These companies agreed to provide these discounts in exchange for Medicare and Medicaid access. They signed up for this deal.
Now they want out. If they succeed, working-class taxpayers across rural America get stuck with the bill.
Big Pharma wants to walk away from commitments that cost it 3% of global revenues. And taxpayers will bail out the hospitals they leave behind.
States Are Fighting Back
Multiple states have passed laws protecting 340B. In August 2023, Louisiana became one of the first states to prohibit drug manufacturers from restricting contract pharmacy access. Some drug companies backed off.
Courts have consistently sided with states against drugmaker challenges. Arkansas, Maryland, Mississippi, West Virginia, Minnesota, Kansas, Missouri, and Louisiana have all passed similar protections.
The pharmaceutical industry keeps appealing. They’re pushing a “rebate model” to convert 340B’s upfront discounts into back-end rebates—starving hospitals of immediate cash flow. If drug companies deny every rebate claim and extend payment cycles by months, rural hospitals can’t survive. They need working capital now to pay nurses, buy equipment, keep doors open.
End 340B through financial starvation. That’s the strategy.
Look at What They Do, Not What They Say
Democrats shut down the government for more than a month over healthcare costs. They warned millions of Americans would face 75% premium increases. Senator Baldwin tried to force a vote on ACA subsidy extensions.
Senator Slotkin said healthcare costs are more personal than any other expense. She’s right.
But earlier that year, three Democratic senators worked with Republicans on 340B reforms. The program keeps drug costs low for vulnerable Americans. It funds community health programs. It lets rural hospitals serve patients regardless of their ability to pay. It costs taxpayers nothing.
The reforms they proposed (user fees, new restrictions, enhanced bureaucracy) line up with what pharmaceutical companies have been demanding for years. You can care about healthcare costs while working to undermine programs that control them. But you shouldn’t.
The Real Issue
Healthcare costs matter. Democrats spent 43 days shutting down the government over that issue, warning about premium increases.
If they actually care about healthcare costs, they'll defend 340B. But the reforms some Democrats helped craft in early 2024 would impose new fees and restrictions on struggling rural hospitals. That drives costs up, not down. And Republicans can't claim to oppose bailouts while supporting reforms that guarantee taxpayer-funded hospital rescues.
Senators can't take pharmaceutical industry money while gutting the program that keeps rural hospitals open.
Editor’s Note: After more than 40 days of screwing Americans, a few Dems have finally caved. The Schumer Shutdown was never about principle—just inflicting pain for political points.Please help us report the truth about the Schumer Shutdown. Use promo code POTUS47 to get 74% off your VIP membership.
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