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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A bill just introduced in Congress would raise public awareness of issues surrounding the end of life, including palliative care, and hospice.

The Compassionate Care Act would establish guidelines for advance care planning between health providers and patients.

Lisa Pahl, a licensed clinical social worker from Torrance, guides families through hospice.

"We live in a culture that is very avoidant of conversations on death and dying," Pahl observed. "Public education around the importance of planning ahead will improve access, so that everyday Americans know to ask for hospice and palliative care."

The bill would direct the government to develop education resources for providers, expand telehealth options and facilitate a study of a national advance care planning registry, which would allow patients to transfer their advance directives from state to state.

Pahl encouraged people to spell out what they want at the end of life so their relatives do not have to make expensive and painful decisions.

"Unless we have these conversations, we won't know," Pahl pointed out. "Health care providers typically will err on the side of doing it all, rather than going with comfort measures."

The bill is co-sponsored by Rep. Nanette Barragán, D-Calif., and Sen. Richard Blumenthal, D-Conn. A similar bill stalled in the House of Representatives in 2020 and never got a vote.


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The National Association of Community Health Centers is meeting in Atlanta this weekend to address the issues affecting the health care system as more people seek essential services.

In Georgia alone, about 400 centers serve more than 700,000 patients each year. With underfunded primary care, workforce shortages and rising drug costs, doctors said the need for the centers is increasing.

Kyu Rhee, president and CEO of the association, said community health centers have seen an increase of almost 3 million patients in the last four years.

"Community health centers have served as the employer, provider and partner of choice across our nation since 1965 nearly six decades," Rhee pointed out. "And now serve one in 10 people across our nation, or over 32-and-a-half million people"

Despite the growth, Rhee believes the demand for community health centers is even greater and they should be reaching one in three people based on national health needs. Gov. Brian Kemp and Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, are slated to speak at the conference.

Rhee noted 90% of those served at the centers live below of the federal poverty level, meaning access to care can often be hindered by various barriers. He emphasized a key strength of these centers is the ability to meet patients where they are, extending care beyond the exam room and financial status.

"If you think about other parts of the health system, in general, you have to have a certain type of insurance you have to pay before you're seen," Rhee observed. "The beauty of what community health centers deliver is that we serve everyone, regardless of their ability to pay."

As the conference delves into health care issues, Rhee stressed the importance of examining the roles of other providers and the pharmaceutical industry, both crucial in supporting the mission of community health centers and the populations they serve.


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Wildfires are becoming bigger and more frequent in Colorado and across the Mountain West, and health experts are offering tips to breathe easy even during bad air-quality days.

Dr. Anuj Mehta, pulmonary and critical-care physician at Denver Health said pregnant women, infants, children, older adults and people with heart or lung disease are most at risk.

"Wildfire smoke has a lot of particulate matter. So really, really small microscopic particles that can cause inflammation in the lungs. Just breathing in that particulate matter, that inflammation may not just stay in your lungs. It can really cause inflammation around your body," Mehta said.

Exposure to smoke from wildfires has been linked to an increased risk of heart attack, stroke, lung cancer and a decline in cognitive function. Using air purifiers with HEPA filters and high MERV rated air conditioning filters can improve indoor air quality. Limiting strenuous activities is also a good idea, because when your breathing rate goes up, you inhale more particulates.

Workers and others who need to be outdoors can get air-quality updates on particulate matter and ozone pollution levels online at colorado.gov/airquality. Mehta says N-95 masks and respirators can also help, if worn correctly.

"If you can be indoors, that's going to be really good. If you have to be outdoors, and you are somebody with underlying breathing problems, wearing the mask actually can reduce the amount of particulate matter that you are going to breathe in," Mehta continued.

Colorado has already seen six wildfires that have burned more than 1,000 acres since May, and as humans continue to burn fossil fuels, wildfire risks are widely expected to increase into the foreseeable future. Mehta said it's important to understand the risks, and to be prepared.

"So every summer we're going to be dealing with bad air quality days. And so people, especially people with underlying health concerns, should be discussing with their medical teams about a bad air-quality plan," Mehta continued.


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