Maintaining access to affordable and quality Pennsylvania healthcare is a multi-faceted problem, encompassing more than just the financial burden of our citizens.

Just as Pennsylvanians are experiencing the upward spiral of healthcare costs, so too are the many in-state facilities that provide those services. In particular, rural hospitals in the Keystone state have been significantly impacted due in part to the older, less healthy, and underinsured populations they typically serve.

In the decade preceding the Covid-19 pandemic nearly 200 rural hospitals have closed, including five here in Pennsylvania. In the past eighteen months alone and in a quite unexpected scenario, even Chester County, one of the highest-earning counties in the state, realized the closure of two local hospitals.  

Now, even more hospitals in Pennsylvania are teetering on financial tightropes, including the sixteen rural hospitals in Pennsylvania that are experiencing multiyear losses on patient services. A variety of factors have contributed to these concerning developments and must be addressed, because unless something changes soon, additional closures are possible.

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The scope of Medicare, Medicaid, and insurance coverage of healthcare services continue to decrease, and reimbursements to hospitals often fall short of the actual cost of treatment. This has added another layer of financial responsibility to the already stressed patient and medical facility. As a result, medical facilities now face the choice of having to balance the cost of keeping the lights on against providing quality daily care to patients. These are not choices that should be thrust upon Pennsylvania healthcare providers.  

At the same time, the current Federal Trade Commission (FTC) is creating unnecessary obstacles that impede hospitals’ ability to consolidate, limiting a key approach that financially struggling Pennsylvania healthcare facilities have used to harness market forces to cover operating expenses and serve patients in a cost-efficient way.

The Biden Administration has argued that mergers have led to hospital closures and impede market competition, but this is incorrect. Years of research have instead shown that rural hospital mergers have resulted in an increase in the quality of patient care and a decrease in mortality rates. Regulators in Washington should rethink their stance.  

Congressional meddling in a key program that benefits rural hospitals, known as 340B, may also make things worse. This vital program, which provides discounted drugs to safety-net hospitals and the vulnerable patients they serve, has been a key part of expanding healthcare access in Pennsylvania — as well as America more broadly — for over three decades.  

This program is as important now as it has ever been. Due to the skyrocketing cost of prescription drugs, 22 percent of Pennsylvanians have cut pills in half, skipped doses of medicine, or did not fill a prescription due to cost. Furthermore, given the fact that 681,000 residents of Pennsylvania are uninsured, the charity care for under and uninsured patients the 340B program funds has become a critical service.

Despite the fact that the 340B program helps millions of patients each year at no cost to the taxpayers and gives hospitals and healthcare centers the financial support necessary to provide more comprehensive services, Congress may be gearing up actions that could jeopardize the program.

…unless something changes soon, additional closures are possible.

H.R. 198, the so-called Drug Pricing Transparency and Accountability Act, was recently introduced for consideration. This legislation, while carrying a relatively benign name, would be devastating to the 340B Program and the safety-net hospitals it supports.

The bill establishes a two-year moratorium on allowing new, non-rural hospitals and associated children’s hospitals to participate in the 340B program. During this time, a multitude of crippling regulations would also be issued as well as onerous reporting requirements related to program participation, eligibility, and costs. 

While the merits of this legislation may be well-intentioned, such bureaucratic administrative burdens placed on already struggling healthcare facilities could result in financial failure and closure. This would, in effect, deny low-income and uninsured citizens access to the treatment they need. 

Congress should instead limit any 340B reforms to those that root out waste, fraud, and abuse, rather than stifling a beneficial program with cumbersome regulations. They may also better use their time by focusing on legislation such as H.R. 2559, the Strengthening Community Care Act of 2023, which would reauthorize funding for community health centers through 2028. A recent subcommittee hearing was held regarding this bill and enacting such legislation would be positive action by the 118th Congress.  

There are many legislative and regulatory fixes that policymakers in Washington can adopt to address challenges to accessing healthcare, but they must ensure they are focused on eliminating roadblocks in the existing system as opposed to creating new ones. This would be the best way they could serve vulnerable patients both in the Keystone State and nationally.

Becky Corbin is a former member of the Pennsylvania House of Representatives. During her time in office, she served on the Health Committee.

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