If national polls are right and just a third of the people signing up for a plan under Obamacare were actually uninsured last year, the reform has made only a tiny dent in Tennessee’s 866,700 uninsured population. How could a program carrying a $1.8 trillion price tag fail this miserably to deliver on its promise to dramatically expand coverage in its first year?
Perhaps the problem is that Obamacare is simply another federal experiment, which are notorious for being largely inadequate at solving long-term problems and equally infamous for the money they drain from taxpayers’ pockets. Sadly, the issues these programs are meant to address are real for many Americans and they deserve real solutions — particularly in the quest to cure our nation’s broken healthcare system.
Case in point: The 22-year-old federal prescription drug discount program that started as a small, targeted effort designed to lower drug costs for the uninsured. That’s obviously a noble goal. But it has since morphed into a multi-billion dollar corporate welfare scheme for hospitals and big retail pharmacies.
Called “340B,” after the section of the law that created it, this program requires drug manufacturers to sell drugs at deep discounts to hospitals and clinics that largely care for low-income and uninsured patients.
Yet, 340B never actually required those savings to get passed on to patients, and the rules governing which hospitals were eligible for the discounted drugs are relatively vague. A report to Congress dating as far back as 2007 found, for example, “a weak relationship” between one of the criteria used and the actual number of uninsured patients treated at hospitals.
And while the discounts are only intended for eligible outpatients of a hospital or clinic, another 2007 government report found that the definition of a “patient” wasn’t clear either, letting providers interpret the definition “too broadly.”
It didn’t take long for hospitals to realize that this program could be exploited to fatten their bottom lines. Not surprisingly, the number of hospitals participating in 340B tripled between 2005 and 2011. Today, nearly a third of all hospitals can buy drugs at a discount using 340B provisions, and then keep the profits they are able to generate from the program.
A Government Accountability Office (GAO) report found that hospitals providing “a small amount of care to low-income individuals” could nevertheless “claim 340B discounts.” Furthermore, a March study from Avalere Health found that most hospitals getting these discounts provide less charity care than the national industry average – here in Tennessee, two-thirds of 340B hospitals’ charity care is less than the national average of 3.3 percent. At a quarter of 340B hospitals nationally, charity care is just one percent of their patient costs. That means hospitals that never intended to participate in the program are reaping some huge rewards.
A report published in the North Carolina News & Observer found that for certain 340B drugs, hospitals “routinely mark up prices … two to 10 times or more over cost,” and often sold them to insured patients. The New York Times reported last year that 340B had become “a big revenue-capture game” for hospitals. An investigation spearheaded by Iowa’s Senator Charles Grassley found that Duke University hospital boosted its net income by $50 million in 2012 by manipulating the program.
Yet, rather than fix these problems and bring the focus back to the original intent of 340B, the federal Health Resources and Services Administration blindly expanded 340B in 1996 — removing the requirement that hospitals dispense discounted drugs in-house — instead allowing them to contract with outside pharmacies.
In 2009, the passage of Obamacare expanded 340B, and in 2010, federal officials expanded 340B yet again.