Just a couple months ago, we all watched as registered nurses took to the picket lines outside several hospitals in New York, demanding better nurse-to-patient ratios, higher-quality healthcare for their patients, and the wages they deserve. On strike for more than a month, these nurses exposed a truth that we often don’t like to admit: Our healthcare system could be falling apart and it is on us to fight for it.
Part of that fight is a program that you may not have heard about, but Black communities will feel the impact first and hardest. It centers on the 340B Drug Pricing Program. Not flashy or easy to explain to the person sitting next to you on the subway, this program has quietly helped keep hospitals and clinics in our community open and serving patients who rely on them the most.
The program was created to do one simple thing: Make drugs more affordable for hospitals and clinics that serve poor and disabled patients. It requires pharmaceutical companies to offer discounts on outpatient medications. Hospitals then use those savings to stretch limited resources — covering the cost of care for patients who can’t pay, expanding services, and keeping clinics open in communities that need them most.
That matters, because in too many Black communities, access to care is already a fragile thing.
Hospitals like NYC Health + Hospitals/Harlem aren’t just healthcare providers for us; they are community anchors. We know the nurses and respiratory therapists who work there, and we call all names a friend, family member, or neighbor who benefited from the hospital’s care. They treat higher numbers of Black patients, more Medicaid patients, and more people dealing with chronic illness and financial hardship. They are where people go when there is nowhere else to turn.
The data backs that up. A 2019 report from L&M Policy Research found that hospitals participating in the 340B Program treat significantly more Black patients, more disabled patients, and more people eligible for both Medicare and Medicaid than other providers. These are the patients who need consistent, affordable access to medication — not policy experiments.
Right now, though, the system that supports that care is being squeezed.
On one side, you have rising healthcare costs and ongoing staffing shortages. Hospitals across the country are struggling to hire and retain nurses and frontline workers. That’s not theoretical. It’s happening in real time.
On the other side, Medicaid — the largest payer for many of these hospitals — is under pressure. Cuts from the Trump administration have led to eligibility changes, low reimbursement rates, and hospitals getting paid less for the same patients. Now, layered on top of that, there are efforts to reshape the 340B program itself.
Some pharmaceutical companies have already moved to limit how hospitals can get access to discounted drugs, particularly through contract pharmacies. Others are pushing for structural changes that would require hospitals to pay full price for medications upfront and then apply for rebates later. That might sound like a bureaucratic tweak. It’s not.
For hospitals operating on thin margins, that shift could mean millions of dollars in upfront costs they simply don’t have. It could mean hiring more administrative staff just to navigate the system — resources that would otherwise go toward patient care. For smaller or underfunded providers, it could mean cutting services altogether and potentially leading to hospital closures.
That is why some states are pushing back. Arkansas and Louisiana were among the first to pass laws protecting hospitals’ access to 340B discounts, and a growing number of states have followed their lead. This isn’t happening by accident. It’s happening because lawmakers on the ground see what’s at stake.
What’s at stake is access. Access to HIV/AIDS medicine. Access to insulin. Access to cancer treatment. Access to medications that keep chronic conditions under control, such as diabetes and high cholesterol.
For Black communities, this is not an abstract policy debate. It’s about whether the systems that have long filled the gaps in our healthcare infrastructure will continue to exist in a meaningful way.
When resources shrink, when systems get strained, when policy decisions prioritize efficiency over equity, our communities feel it first. Longer wait times. Fewer services. Harder choices between paying for medication and paying for rent, so when you hear people in Washington talk about “reforming” 340B, ask a simple question: reform for whom? If reform means shifting more cost and more burden onto hospitals already stretched thin, and onto patients already navigating barriers to care, then it’s not reform — it’s retreat.
In a healthcare system where access is already uneven and inequitable, retreat is not an option.
The truth is, programs like 340B are not perfect — but they are essential. They are part of the patchwork that keeps care within reach for millions of people who would otherwise fall through the cracks.
Richard Fowler is an American storyteller, a contributing writer at Forbes, a contributor at Fox News, and an adjunct professor of journalism at Georgetown University.