Opinions
Hospitals are abusing this drug discount program
Congress must step in to help low-income patients
Hospital chains are unfairly profiting off a program meant to help low-income patients afford their medicines. If policymakers don’t reform this system soon, I worry that many of the marginalized patients I’ve devoted my career to protecting won’t be able to access the care they need.
The program, known as 340B, gives drug discounts to hospitals in underprivileged areas so that they can better serve their communities. Yet, with little oversight, the hospitals can divert the savings to their own bottom lines.
A recent report from the Drug Channels Institute exposed just how big the problem is.
The analysis found that under 340B, hospitals took discounts worth $52.3 billion in 2022 with scant evidence that those savings went to help low-income patients. The report also found that the 340B program continued its exponential growth during the pandemic, swelling by 22% between 2021 to 2022.
In short, money intended to help marginalized communities is instead being funneled into hospital profits in ever-greater amounts. Having spent much of my career helping Black men with HIV, I find this gravely concerning. But the impact of the exploitation extends far beyond my own work, to all communities grappling with chronic disease and unaffordable health care. The solution is for Congress to bring some much-needed oversight and regulation to the 340B program.
It all started three decades ago when lawmakers launched a seemingly benevolent plan: In order to help non-profit “safety net” hospitals in poor communities, 340B required pharmaceutical companies to sell them drugs at big discounts. The idea was that this would lower drug prices for low-income patients and also help the hospitals, so that they could reinvest in facilities, equipment, and staff to serve disadvantaged patients.
Unfortunately, the 1992 law failed to codify any rules about what hospitals should do with the savings, so no proof of reinvestment is required. Soon enough, even hospitals serving prosperous communities realized they could use the law’s loopholes to turn 340B into a profit center.
Many hospitals have multiple locations. Under current regulations, a hospital can use its facility in an underserved community to qualify for the 340B Program, take millions of dollars in drug discounts, then resell the drugs in more affluent neighborhoods.
Consider the Cleveland Clinic, known as one of the best hospitals in the country. It uses satellite “rural referral centers” to qualify for discounted drugs under 340B, then sells them at full price through its Cleveland-based flagship hospital.
The profit from such maneuvers can be substantial. For instance, 340B hospitals sell top oncology drugs at a median of 4.9 times their discounted price, according to a report from the Community Oncology Alliance.
It’s no wonder that 44% of U.S. hospitals now report that the 340B program is a substantial revenue source. It may have also contributed to industry consolidation in recent years, encouraging hospitals to merge in order to acquire qualifying facilities.
Despite the program’s rapid expansion, there’s little evidence that it’s benefiting marginalized patients. A study in the New England Journal of Medicine found that the “financial gains for hospitals have not been associated with clear evidence of expanded care or lower mortality among low-income patients.” Another study, in the journal Health Services Research, concluded that when new hospitals join 340B, it doesn’t lead to any change in the amount of uncompensated care they provide.
In fact, 340B may actually increase healthcare costs for low-income patients. Because hospitals benefit from the difference between the discounted drug price and the sale price, they are incentivized to prescribe more expensive drugs, which yield higher profit margins than lower-cost generic alternatives.
This appears to be happening with the PrEP drugs that prevent transmission of HIV. A report from the American Action Forum, a think tank, found that 340B likely incentivizes hospitals to prescribe more expensive brand-name PrEP over generic versions. This means some patients are paying more than they should for this lifesaving medicine.
Hospitals chains’ continued abuse of 340B also takes critical resources away from the healthcare facilities the program is meant to help. For instance, Ryan White HIV/AIDS providers help low-income people living with HIV access medications and support services. But letting hospitals exploit loopholes in 340B could leave fewer discounted drugs for Ryan White and similar safety net programs.
Congress needs to reform the bloated and unaccountable 340B program as soon as possible. Democrats and Republicans should be able to agree that eligibility standards must be tightened and reporting requirements improved. Hospitals must use 340B profits to help our most vulnerable patients.
Guy Anthony is president and CEO of Black, Gifted & Whole.
Opinions
Not all trans people are the same
Media, activists need to do more to challenge stereotypes
It’s interesting how the mainstream media, especially the conservative part of it, likes to write about transgender subculture when they should speak up about trans people.
How often do you see mentions of blue or purple hair, Marxism, specific clothing styles and ecology when you see a mention of a trans person?
It happens more often than it should. It looks like the mainstream media, even the ones that don’t demonise us, sincerely believe that being trans means sharing a whole bunch of characteristics that have nothing to do with having a gender identity different from the one that was assigned at birth.
Here are four reasons why it may create problems, and what to do about them.
1. A subculture idea
The assumption that being trans is part of a subculture creates a very specific kind of discrimination, because the mainstream audience who read those stories sincerely believes that being trans is a personal choice or a trend in the same way as being a K-pop fan, a goth, or a metalhead. It basically means that being trans is nothing more than a trend, and trends, as we all know, can change. People who believe in this idea are more likely to speak about “gender ideology” and “propaganda trends” and less likely to listen to scientists and studies around trans issues, or to different experiences of what it means to be trans.
Even if trans people made a choice to be trans, they shouldn’t be discriminated against. In a democratic, free country, no one should be punished for choosing what to do with their body. And hate for subcultures is a real thing that leads to violence. But the problem is that, despite there being a trans subculture, most trans people are statistically not part of it. But where are they in activism?
2. Misleading about goals
Let’s be honest. We are partly to blame for this stereotype. And before you stop reading, let’s just think about the topics most people discuss before the average protest or radical Pride event. Or let’s imagine trans-friendly events. They are mostly leftist, and people at these events share the exact same interests, hobbies, and political positions.
At my last protest about the new draconian Equality and Human Rights Commission guidelines in the U.K. that say trans people can only use public places according to the sex assigned to them at birth, we were speaking about anything else. For example, some speeches were about abolishing “bourgeois democracy,” speaking up for socialist revolution, and saying some other things I definitely couldn’t support.
I’m not against socialism, but I’m against the idea that all trans people are socialists. That is inherently misleading, at best, and harmful, at worst. I support universal basic income and free healthcare, but not revolution or Marxist reform. If I were a cis person who generally supported trans rights but knew too well about the Russian Revolution of 1917 and how it ended for indigenous people and queer people, if I were a bystander, I wouldn’t stop at a protest like that. I probably wouldn’t even believe that the situation is as bad as they are saying.
There is nothing bad about inviting a socialist speaker. The problem begins when all trans events become socialist events. Those protests don’t look like protests for trans rights – they look like protests for socialist revolution or just like a rebel teens gathering.
3. Self-fulfilling prophecy
At the protest I mentioned and at other similar protests, including the ones from the U.S. I saw online, there weren’t a lot of “traditionally” trans people — the ones you may have been able to see in old TV programs about trans experiences, where trans people were presented to be more gender-conforming.
Most activists are young, white, poor but not extremely poor, citizens of the country where they are living, gender-non-conforming, leftist, and non-religious. They like trans horror, drag queen shows, drawing and reading MfM romantasy. And despite the fact that I just finished writing my own trans horror novel, I wonder — where are the other trans people? With different hobbies and lifestyles?
Where are all those “traditional” trans women from old TV shows who like make-up and want to give birth to kids if only it was possible, and trans men who like to spend their time drinking beer in pubs and going to the gym with their bros? I think we need them more than we think. They may give new ideas and perspectives. And they need us.
Why don’t we see them? Why do we see so few trans refugees who came from Middle Eastern, Asian, and African countries? May they be triggered by the world then because the U.S. had the worst dictatorship on the planet, or that the U.K. is a fascist country when they saw something worse than the British government or even MAGA? For some trans person who survived Bashar al-Assad in the Syrian government or fled Eastern Turkestan, such slogans would feel like gaslighting — and I knew because I met many refugees.
Why, finally, do so many trans activists have similar clothing styles, similar interests, and similar experiences?
Because it’s a self-fulfilling prophecy. When trans activists create this kind of culture, they accidentally gatekeep all other trans people who may feel less comfortable within a subculture that has its own rules, style, and ideology, even if none of those things have anything to do with being trans.
4. Media misrepresentation
When the media — conservative and not very conservative — sees the same thing, it doesn’t matter if we are speaking about a trans man who is traditionally masculine and wants a traditional family, or if we are speaking about soft, nice gay boys who happen to promote socialist revolution like many modern stereotypical trans activists. It is equally misleading.
I hate the idea that we need to pretend to be more convenient and normal in order to be accepted by society, because society has never worked that way. But pretending to be accepted by the community is no better.
Trans people are different — and sometimes problematic — and despite the core of activist trans culture, we can have some distinctions when we speak with the media. We should never try to tell people that all trans people are similar.
Now, when trans rights are under attack, it is more important than ever to show that all trans people are just people. We are different, like everyone else. We have our rights, even if we are wrong. Even if we are ugly. Or struggle with inner transphobia. Or some of us internalise traditional roles, or; the opposite, too weird for any culture and subculture. We can make mistakes. But we are not a political party or a monolithic group. Being trans is not a lifestyle, because we have different lifestyles.
Trans kids need to see that they can be whoever they are and still be true, real trans people. And the media should always be questioned when they try to push all trans people into the frame of a subculture.
But to do so, we need to look at our activism and at the representation we are creating.
Opinions
Black Educated Lesbians: A movement rooted in community
Organization’s annual conference is part of a much larger mission
When people hear the word “conference,” they often imagine a weekend event that begins on Friday and ends on Sunday. For Black Educated Lesbians (BEL), our annual conference is only one part of a much larger mission.
BEL was founded because Black lesbians deserve spaces intentionally created with us in mind. Too often, we are overlooked in conversations about health, leadership, philanthropy, education, and community. We exist at the intersection of multiple identities, yet organizations and institutions frequently assume our needs are being met by broader groups. Our lived experiences tell a different story.
BEL is a national nonprofit organization dedicated to creating opportunities for Black lesbians and Black queer women through leadership development, wellness programming, research, education, and community building. While our conference has become one of the few events in the country centered specifically on Black lesbians, our work continues year-round.
Throughout the year, BEL hosts virtual wellness sessions, leadership development opportunities, financial education workshops, community discussions, and mentorship programs designed to help our members thrive personally and professionally. We are also investing in the next generation through our EmpowerHER initiative, connecting Black queer youth with mentors, resources, and leadership opportunities.
Research is another critical part of our work. We are committed to ensuring Black lesbian voices are included in conversations about healthcare, mental health, economic opportunity, and overall well-being. Data drives policy, funding, and services. If our experiences are absent from the research, our needs often remain invisible.
Our annual conference, taking place Sept. 18–20 in Hapeville, Ga., brings this mission to life. Attendees will participate in conversations about physical and mental health, healthy relationships, financial literacy, entrepreneurship, leadership, aging, women’s health, and sexual wellness. The conference also creates opportunities to build meaningful relationships, support Black-owned businesses, and connect with professionals and organizations that understand our community.
Creating spaces like this is not easy. As a small nonprofit, every workshop, meal, scholarship, and resource requires fundraising, partnerships, and countless volunteer hours. Yet we continue because our community deserves spaces where they can simply exist, learn, heal, and grow without explanation.
What makes BEL unique is not simply that we serve Black lesbians. It is that Black lesbians lead every aspect of our organization. We understand the importance of creating programs that reflect our lived experiences rather than asking our community to fit into spaces never designed for them.
Community is not built during moments of crisis. It is built through consistent investment, authentic relationships, and showing up year after year. That is the work BEL is committed to doing.
Whether someone joins us as an attendee, sponsor, volunteer, donor, or community partner, they become part of something much larger than a conference. They become part of a movement dedicated to ensuring Black lesbians are seen, heard, valued, and supported.
As we prepare to welcome attendees from across the country this September, we invite readers to learn more about BEL, support our mission, and help us continue building spaces where Black lesbians don’t just survive, they thrive.
LaJoya Johnson is founder and executive director of Black Educated Lesbians, a national nonprofit dedicated to advancing leadership, wellness, and education for Black lesbians and Black queer women.
Opinions
I respect AOC, even though I often disagree with her
She should work toward House leadership role and skip presidential run
There is a column in the New York Times asking, “Is Ocasio-Cortez ready for the glass cliff?” The author thinks it’s a great idea for her to run for president. I believe it’s a bad idea for her personally, and a disastrous idea for the Democratic Party. However, that is not the only column written recently about Ocasio-Cortez, discussing her options and private life. I think it is cringeworthy what social media, and even some mainstream media, are focusing on these days.
Politicians have become fodder for what were once just stories about Hollywood, and loud showmen like the felon in the White House. Now, like the showman, those like AOC, can’t claim they aren’t asking for it by striving for the biggest online following possible. They obviously see that as a way to validate themselves; politicians use it as a way to raise money, become influencers, and get their message out.
But they also open themselves up to even more intrusion into their private lives. Those who do that also open the door for all politicians to have their private lives made public. Running for president, which the column suggests AOC should do, and which she herself has said she isn’t ruling out, is a great way to grab a headline, and leads to reporters digging to find every little fact about her. AOC is trying to get ahead of the curve by talking about a breakup, and then about harvesting her eggs — topics once considered private that should stay that way. There was once just the National Enquirer, but today every news outlet incorporates what the Enquirer did, as it makes for great clickbait.
I feel for her, thinking all this has to be public, when a single woman wants to run for higher office. We have seen married women, including Geraldine Ferraro, Sarah Palin, Hillary Clinton, and Kamala Harris, run and be subjected to dealing with questions about their husbands, their former boyfriends, and in some cases, more reporting about those things than what they stood for. Maybe for AOC, that would be a good thing, as the country is far from ready for a candidate who up until now, proudly represents the Democratic Socialists of America (DSA). Yes, she is trying to step away from them a little, but I don’t think that is possible, which is why I feel it is a disaster for her to run, both for herself, and the Democratic Party. She could decide to run for the Senate if Chuck Schumer (D-N.Y.) understands it is time for him to retire. Even that could be a difficult race. She might win a primary, which another progressive representative, Bella S. Abzug (D-N.Y.), tried and lost in 1976, if she gets a big enough New York City vote. Should she try, we would see how much change there has actually been.
Back when JFK had women in and out of the White House, Ronald Reagan got Nancy pregnant before they married, and George H.W. Bush allegedly had a mistress traveling with him, those were not the headlines. I think we were all better off. Gary Hart asked for it when he told the press to follow him, and they caught him with a woman not his wife. Again, he asked for that. Then we got to the Clinton era and the right wing, actually David Brock, got the information on Paula Jones, and it all exploded, eventually cascading down to harm Hillary. They tried to find anything they could on Jimmy Carter, George W. Bush, and Barack Obama, but couldn’t find the salacious bits they were looking for. But I bet they will find some things that sound salacious on AOC, even if they have to make them up. She appears to be a normal, highly intelligent, motivated, single woman.
Recent primaries in Michigan and Wisconsin, and general election results, will clearly impact what she decides to do. DSA candidates are not an easy sell to most Democrats, let alone the general electorate. We will find out how Dr. El-Sayed does in the general election. While I didn’t support him in the primary, I do in the general election. Those results, and looking back at other women who have run, may give AOC second thoughts about giving up working toward seniority in the House. I predict she could be much more impactful than one of her idols, Bernie Sanders, has been. He has been there for 40 years and accomplished nothing. I think AOC could accomplish a lot.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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