While large hospitals and pharmaceutical manufacturers battle over drug costs, Missouri community health centers see themselves as collateral damage.

Section 340B of the 1992 Public Health Service Act, allows small community health centers and hospitals to buy pharmaceuticals at highly discounted prices.

Colleen Meiman, national policy adviser for the State Association of Community Health Centers, said the centers use the savings to support other community support services like dental, behavioral health or opioid treatment programs, all without taxpayer dollars.

"We don't have any negotiating power. We're stuck having to pay full price because we've got this tiny little nonprofit community entity up against a giant drug company," Meiman pointed out. "The law was meant to equalize that a little bit and then enable us to get the drugs at a discount."

Drug manufacturers are concerned about the misuse and fast expansion of the 340B program. Hospital and pharmacy drug provider sites increased from 8,100 to 50,000 between 2000 and 2020. An August 2022 report by the Health Resources and Services Administration found discount drug purchases through 340B increased 16% between 2021 and 2022 to $44 billion.

Meiman noted 340B can be helpful in Missouri where she lives, but added current restrictions limit the number of contract pharmacies in a given area of the state, which can create hardships for patients.

"In Missouri it can be hard to get around in the wintertime," Meiman explained. "If suddenly you have to drive a really long distance to get your medications, either because that's the only way you can get them discounted enough to afford them, because you're low income uninsured, or because you were trying to support your health center."

Meiman added health centers across the country have been forced to reduce staff or curtail services because they have lost access to 340B savings.


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Changes could be coming for Arkansans who are on Medicaid.

Gov. Sarah Huckabee Sanders is proposing to add work requirements for some Medicaid recipients. Similar rules were imposed in the state in 2018 but later struck down by the Biden administration.

Neil Sealy, senior organizer for Arkansas Community Organizations, said more than 18,000 people lost coverage seven years ago although they were working or had been granted exemptions.

"We reached out to people to speak with them about their experience," Sealy explained. "There was a reporting requirement, and if after three months if you had not reported, then you would be taken off. "

He noted some recipients were unaware they did not have coverage until they tried to go to the doctor. Sanders is hopeful the requirements will remain in place under the new Trump administration.

According to a report in Forbes Magazine, Arkansas is the fourth-least healthy state in the country. Around 820,000 Arkansans are on Medicaid.

Specific details about Sanders' proposal have not been released but she said she wants a broader requirement to cover able-bodied adults. Sealy noted their volunteers are already mobilizing.

"We get ready," Sealy emphasized. "We are reaching out to people in the community. We are going to be on the doors, talking in churches, getting ready. We don't sit down and take it. "

A Harvard study showed in 2018 the work requirements did not decrease unemployment and red tape and paperwork created serious hurdles for people who were eligible for coverage.


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A new study from Wayne State University showed breathing in air pollution, especially benzene, can raise the risk of developing type 2 diabetes.

Benzene is a pollutant found in common emissions such as car exhaust and tobacco smoke. The report found a strong link between benzene exposure and insulin resistance.

Marianna Sadagurski, associate professor of environmental health sciences at Wayne State University and the study's lead author, investigated how air pollution affects metabolism. She explained how long it takes for sugar levels to rise after being exposed to benzene.

"Within seven days you already have changes in blood glucose levels," Sadagurski reported. "It does not mean that you already developed type 2 diabetes immediately. But that indicates that your blood glucose levels continue to higher than normal. "

In mice, test results showed after exposure, male mice showed changes in energy balance, brain activity, insulin function and immune responses, which caused their blood sugar levels to rise.

The researchers also discovered even short-term exposure to benzene affects how the brain handles insulin and causes inflammation in certain brain cells. The inflammation is connected to a specific pathway in the body. When they blocked the process in the brain cells, it helped fix the metabolism problems caused by benzene in the mice.

Sadagurski emphasized the study was far-reaching.

"All the studies, not just from the U.S., all across China and Mexico and so on," Sadagurski outlined. "All the studies that were done, we collected."

Sadagurski explained they analyzed data from different groups of people, including young adults and the elderly.

The Episcopal Health Foundation wants Texas lawmakers to make health a priority during this legislative session.

The nonprofit focuses on the nonmedical drivers of a person's overall health, such as economic status, health behaviors and safe neighborhoods where people can exercise.

Ann Barnes, president and CEO of the foundation, said they would like to see legislation on maternal health, food security and diabetes prevention.

"These are health conditions that affect low-income populations and communities of color," Barnes pointed out. "We are looking for opportunities to support legislation that improves those outcomes."

Barnes noted during the last legislative session, lawmakers passed bills that approved Medicaid screenings for nonmedical factors that influence health and for doulas to serve as case managers for pregnant people. She looks forward to having those bills implemented.

A recent survey by the foundation found nearly half of adults in Texas say they live in a household experiencing diabetes or prediabetes.

Barnes argued not addressing the problem puts an economic strain on the entire state.

"Between $6 billion and $8 billion, that's billion with a B, is spent on the treatment of diabetes through the Medicaid program," Barnes emphasized. "That is about a quarter of all dollars spent on adults on Medicaid."

She added health care only affects about 20% of a person's overall health. The other 80% is determined by their environment.