September 2023

***MEDIA ADVISORY FOR MONDAY SEPTEMBER 18 AT 11:00 AM ET // 10:00 AM CT***

The CARE for Moms Act Includes Historic Investments to Strengthen Health Care Coverage During and After Pregnancy, Grow and Diversify the Doula Workforce, and Address Underlying Causes of Maternal Mortality

Washington, DC — On Monday, September 18, 2023 at 11 AM ET, U.S. Representative Robin Kelly (D-IL-02) and National Medical Association President Dr. Yolanda Lawson will join Protect Our Care to discuss her new legislation, the CARE for Moms Act, which is a comprehensive plan to combat the U.S. maternal mortality crisis. The bill includes critical steps to save lives, including by investing $35 million in state-based grants to improve perinatal care, mandating Medicaid coverage for new moms one year postpartum, extending Medicaid oral health coverage to pregnant and postpartum women, addressing implicit bias in the health care training, increasing and diversifying the doula workforce, and more. 

During the call, speakers will discuss how the CARE for Moms Act takes a multifaceted approach to promoting the health and safety of new mothers and their babies and the urgent need to stop the worsening maternal mortality crisis. More than 1,000 women die annually due to complications of pregnancy or childbirth, making the U.S. maternal mortality rate three times higher than other wealthy nations. Black and Native women are at significantly greater risk of facing serious complications. Representative Kelly will introduce the CARE for Moms Act on September 19.

PRESS CALL:

WHO:
U.S. Representative Robin Kelly (D-IL-02)
Dr. Yolanda Lawson, President of the National Medical Association
Dr. Phyllis Dennery, Pediatrician-in-Chief at Rhode Island Hospital, Medical Director of Hasbro Children’s Hospital, Vice Chair of March of Dimes Board of Trustees
Sara Jann Heinze, Director of Policy & Advocacy at Maternity Care Coalition
Protect Our Care

WHAT: Virtual Press Conference 

WHERE: Register for the Event Here

WHEN: September 18, 2023 at 11 AM ET

Drug Companies Falsely Claim Innovation Will Suffer As Patients in America Cut Pills and Skip Doses to Make Ends Meet

The Biden administration recently announced the first round of high-cost drugs whose prices will come down as Medicare negotiates with the drug companies. The new program, which is overwhelmingly popular with voters from all parties, will lower costs for certain drugs used to treat conditions like cancer, diabetes, heart disease, and autoimmune disorders – which disproportionately impact women, communities of color, and people in rural areas.

However, big drug companies are suing in the courts to try to stop the Inflation Reduction Act’s core provision of giving Medicare the power to negotiate lower drug prices. They have also started a campaign of lies in an attempt to persuade people that allowing Medicare to negotiate lower prices will prevent drug companies from introducing innovative drugs. But innovation isn’t really what the drug companies are worried about – they just want to protect their profits, continue to line their CEOs’ pockets, and take advantage of patients. In reality, giving Medicare the power to negotiate will save seniors and taxpayers billions while rewarding innovative drugs. 

Legal and health care experts are fighting back against the misinformation campaign. Here’s what they have to say:

Cynthia Ho, Director of the Intellectual Property Program at Loyola University of Chicago School of Law, and Liza Vertinsky, Law Professor at the University of Maryland Francis King Carey School of Law, said: “Once a More Nuanced Approach to Innovation Is Considered, the IRA Might Even Increase Innovation in Higher Public Value Drugs.” “We posit that the current lawsuits and other backlash against the IRA are simply the latest examples of what we refer to as “innovation bullying” by the pharmaceutical industry. And we suggest that this innovation bullying has real costs that can and do deter welfare-improving drug regulation and even valuable innovation.” [Health Affairs, 9/11/23]

Ed Silverman, Pharmalot Columnist and Senior Writer at STAT, said: “If the Pharmaceutical Industry Expects the Public to Heed Its Warnings, It Will Have to Do a Better Job of Explaining Why Swaths of Patients May One Day Lose Out on Treatments.” “Beyond complaining about price controls and unconstitutional mandates, the key message aimed at the American public has been that innovation will suffer. This is a familiar but tiring refrain. When policymakers have attempted to address prescription drug costs in the past, the industry has often rattled this sabre, warning any attempt to rein in pricing would boomerang and some therapies will never be developed.” [STAT, 9/7/23]

The Brookings Schaeffer Initiative on Health Policy’s Richard G. Frank and Caitlin Rowley said: “Despite the Pharma Companies’ Fears, Negotiating Medicare Prices Will Not Lead to a ‘Nuclear Winter.’” “However, such forecasts are unfounded. […] Not only are revenues enough to justify the investment in these particular drugs, they are enough to fund several more generations of pharmaceutical development. Lower negotiated prices are unlikely to deter further investment in similar medications.” [Bloomberg Opinion, 9/5/2023]

The Brookings Schaeffer Initiative on Health Policy’s Richard G. Frank and Ro W. Huang said: “To Date, We Have Found Little Evidence Suggesting a Disruption in Activities and Investments That Will Yield New Pharmaceutical Products in the Years to Come.” “When coupled with optimism expressed in recent large drug company earnings reports, the evidence indicates that the investment environment for drug development remains largely unchanged by the IRA’s drug price negotiation program and is currently not threatened by it.” [Brookings Institution, 08/23/23]

Rachel Sachs, Professor of Law at Washington University, and The Brookings Schaeffer Initiative on Health Policy’s Loren Adler and Richard G. Frank said: “IRA Opponents’ Innovation Concerns Are Overstated and Oversimplified, Overlooking Important Dimensions of Innovation for Patients.” “The oversimplified vision of “innovation” and the IRA’s relationship to it presented by many of the law’s detractors simply do not match the nuanced vision of innovation encompassed either in the IRA or in adjacent policies that the Biden Administration has simultaneously pursued. […] Taken together, it is even possible that these combined changes could increase the development of higher-value drugs, and at the same time reducing costs and increasing patient access.” [Health Affairs Scholar, 6/20/23]

Former U.S. Representative Henry A. Waxman, Chairman of Waxman Strategies, said: “Above All, An Innovative Drug Doesn’t Help Anyone If It Is Unaffordable.” “The reality is there is currently no correlation between a drug’s list price and its R&D costs. The price of insulin has skyrocketed by 64 percent since 2014 not because of innovation, but because the drug companies could get away with it. […] The manufacturer AbbVie doubled Humira’s price from about $19,000 per year to $38,000 per year for Americans. But in Europe, the company cut the drug’s price by 80 percent and is still not losing money.” [Health Affairs, 12/10/19]

Michael A. Carrier, Professor of Law at Rutgers University School of Law, and Genevieve Tung, Associate Director for Educational Programs at the Biddle Law Library, said “Drug Companies Play Games.” “Big Pharma has cried Innovation Wolf every time Congress seeks to address its shenanigans. And the legislators keep coming to defend it. That has to stop. It is past time for the industry to be called to account on using its get-out-of-jail-free innovation card to avoid reasonable legislation.” [STAT, 9/26/19]

Larry Levitt, Executive Vice President for Health Policy at KFF, said: “The Issues Raised by Critics Can Be Complex and Nuanced, Involving Trade-Offs Not Always Easily Condensed Into Sound Bites.” “One of the big reasons any effects on innovation may be muted is that drugs are shielded from government negotiation for quite a while: until nine years after Food and Drug Administration approval for small-molecule drugs like pills and 13 years for injectable biological products. Drugmakers can continue to set their own prices and reap substantial profits before having to submit to negotiation.” [New York Times, 9/6/23]

Today, the federal government will be filing a judgment motion in Merck v. Becerra et al. Merck is one of several drug companies suing the federal government to stop Medicare from negotiating lower prescription drug prices on behalf of millions of seniors. Merck’s Januvia was recently announced as one of the 10 drugs selected for negotiation. This comes just after Merck announced it raked in $15 billion last quarter – a $450 million increase over last year. While they make billions, Americans pay exorbitantly high prices for prescription drugs. 

By The Numbers

• Merck has reported nearly $51 billion in global sales for Januvia since it launched in 2006. 
• Januvia is responsible for over $28 billion in gross Medicare spending as of 2021. 
• Merck has issued over $200 billion in stock buybacks since launching Januvia.
• Merck has spent over $115 million on lobbying since launching Januvia.
• Merck has been on the market without competition for over 17 years. 
• In 2022, 885,000 Medicare enrollees took Januvia. 
• Januvia costs the average Medicare enrollee without a subsidy over $500 per year out-of-pocket.
• Merck reported $15 billion in earnings for Q2 2023, a 3% increase from Q2 2022. 
• Merck initiated over $300 million in stock buybacks in Q2 2023. 
• Merck’s stock price has increased 24% over the past year. 

Merck Has Made Billions From Januvia At The Expense of Seniors. Merck has reported nearly $51 billion ($50,897,600,000) in global sales for Januvia since it launched in 2006. Januvia is responsible for $28 billion in gross Medicare spending. Merck has issued over $200 billion in stock buybacks since launching Januvia and spent over $115 million on lobbying. In 2022, 885,000 Medicare enrollees took Januvia. Januvia costs the average Medicare enrollee without a subsidy over $500 per year out-of-pocket.

Merck Has Gamed The Patent System To Protect Billions In Revenue. Merck has been on the market without competition for over 17 years, and Merck has gamed the patent system to thwart competition for an additional 3.3 years, protecting $3.5 billion in revenue.

Instead Of Spending On Research & Development, Merck Has Spent Lavishly On Stock Buybacks To Boost The Company’s Value and Reward Shareholders. Rather than pricing Januvia at an affordable and accessible price, Merck has spent hundreds of billions on stock buybacks to boost its investors and reward its executives. While the company rakes in billions, U.S. drug prices for Januvia are up to nine times higher than prices in other high-income countries like Australia.

Merck’s stock price has increased 24% over the past year after the company initiated $300 million in stock buybacks in Q2 2023. On Aug 1, CFO Caroline Litchfield touted the company’s “very strong growth of 14%” and said they expect that to continue: “As we look out to 2024 and beyond, we continue to expect strong growth including the impact of additional approvals.” Merck also acquired Prometheus Biosciences for $10.8 billion in June.

Read more about why Medicare needs the power to negotiate lower drug costs and the five drugs that tell the story, including Januvia, here.

The Biden administration announced the first round of high-cost drugs whose prices will be lowered as Medicare begins to negotiate with drug companies. The new program created by the Inflation Reduction Act will lower costs for some of the highest-priced prescription drugs on the market used to treat conditions like cancer, diabetes, and autoimmune disorders – conditions that disproportionately impact women, communities of color, and people in rural areas.

President Biden and Democrats in Congress stood up to big drug companies and won a decades-long battle to lower the cost of prescription drugs for millions of Americans  . Negotiating lower prices is overwhelmingly popular across the country, yet big drug companies are suing the federal government to protect their massive profits by halting the program, and Republicans are attempting to repeal the Inflation Reduction Act entirely. Read more about the first 10 drugs here.

ALABAMA

Alabama Political Reporter: How Alabamians Will Be Affected by the Medicare Drug Price Negotiation Program. “According to Protect Our Care, a non-profit organization dedicated to affordable health care, approximately 166,000 Alabamians will see lower drug prices as a result of the negotiations…Founder and president of Protect Our Care, Leslie Dach, released a statement discussing the importance of the price negotiations. ‘Americans deserve financial security and some peace of mind when they go to sleep at night,”  But, too many are forced to choose between being able to afford their medicines or paying for food or housing. Prescription medicines cannot work if people cannot afford to take them, and high drug prices are keeping too many Americans from the health care they need. Patients should not be paying out-of-control prices for medicines they need when all it’s doing is increasing drug company profits and footing the bill for outrageous CEO salaries. President Biden and Democrats in Congress stood up to big drug companies and won a decades-long battle to lower the cost of prescription drugs by giving Medicare the power to negotiate lower prices. The Biden administration is laser-focused on making medications affordable for families and ending the era of drug companies’ unchecked power and greed.’” [Alabama Political Reporter, 9/8/23]

ARIZONA

ABC15 Arizona: Valley Seniors Hope Negotiating Prescription Drug Prices Will Help Save Money. “‘The number one reason why seniors skip or ration their medications is because they cannot afford it. So, this will save millions of Arizonans a lot of money on their prescription drug costs,’ said Dana Kennedy, State Director for AARP. Medications to treat heart disease, diabetes, and Crohn’s disease are among the most expensive prescriptions in Medicare Part D.” (ABC15, 9/4/23)

ARKANSAS 

KARK Little Rock: Biden Administration Names 10 Drugs for Price Negotiation. “The drugs on the list announced Tuesday accounted for $3.4 billion in out-of-pocket costs for Medicare patients last year. The Medicare program paid more than $50 billion for the drugs between June 1, 2022, and May 31, according to the Centers for Medicare and Medicaid Services, or CMS. The announcement Tuesday is another significant step toward taming drug pricing under the Inflation Reduction Act, which was signed by Biden last year. The law also calls for a $2,000 annual cap on how much people with Medicare have to pay out of pocket for drugs starting in 2025. In addition, the law already caps out-of-pocket costs for insulin at $35 a month for Medicare patients.” [KARK Little Rock, 8/29/23]

CALIFORNIA

Noozhawk Santa Barbara: 5 Things to Know About the New Medicare Price Negotiation Rule. “Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market. Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care. The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients). Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices ‘will embolden and arm private sector negotiators to seek that lower price for those they cover.’” [Noozhawk Santa Barbara, 5/2/23]

COLORADO

KOAA News5 Colorado: More Than 100,000 Coloradans Could See Price Cuts in Ten Medicare Prescriptions. “More than 100,000 Coloradans could see cuts to their costly medications. Ten are up for negotiation, which includes treatment to life-threatening conditions like cancer, heart failure, and diabetes.” (KOAA, 9/5/23)

GEORGIA

11 Alive Georgia: Patients Excitedly Welcome Price Negotiation for Expensive Drugs. “The Biden Administration revealed the first 10 prescription drugs Medicare will negotiate under the Inflation Reduction Act meaning patients could soon pay less to get life-saving care. Diane Loupe, 66, of Decatur, takes Xarelto. She ended up with the prescription after thinking that she just had bad varicose veins. The luxury of life comes with a hefty price. Loupe said her prescription went from $10 a month to $85 a month. She has Medicare, but without insurance, pharmacies say blood thinners like hers can cost way more. 11Alive talked to a few local pharmacies. Most of the medications on the list can cost over $600. Several pharmacies say they don’t even keep them in stock because they’re so expensive. However, White House Press Secretary Karine Jean-Pierre said that’s about to change. ‘These 10 drugs, in last year, in 2022 cost Americans $3.4 billion, about $6,000 out-of-pocket expenses – just for one drug,’ Jean-Pierre said.” [11 Alive Georgia, 8/29/23]

HAWAII

Hawaii Tribune-Herald: Biden’s Medicare Drug Pricing Plan is Good Medicine for Americans. “The VA takes care of veterans, Medicaid (whose costs are shared with states and localities) is coverage for the poor and Medicare is health insurance for seniors and people with disabilities. The VA and Medicaid can, and do, negotiate with suppliers on drug prices, just like they negotiate payment levels for other health services. Yet Medicare, which sets the reimbursement rates for doctors and hospitals, is barred by federal law from negotiating on drugs. That’s the doing of the well-heeled pharmaceutical lobby. It took a long time, but the change finally came last year with President Joe Biden’s… Inflation Reduction Act. The law, signed a year ago this month, permitted Uncle Sam (meaning Secretary of Health and Human Services Xavier Becerra) to haggle over the prices of medications. Biden has now announced the first 10 drugs. The negotiations, by the Centers for Medicare &Medicaid Services, will take years and the lower prices for consumers will begin in 2026. There will be another 50 drugs over the next four years up for negotiations and after that, 20 a year. And Big Pharma is fighting all the way, already in court to stop it. One of the drugs on the list, Imbruvica, for blood cancer, runs $17,000 a month, or $204,000 a year. Whatever the reason [for the price], it can be addressed during the talks now permitted between Medicare and the supplier, a joint product of AbbVie and Johnson & Johnson.” [Hawaii Tribune-Herald, 9/2/23]

ILLINOIS

Chicago Tribune (Commentary): Big Pharma is Wrong, Medicare Price Negotiation Won’t Hinder Innovation. “Big Pharma is pulling out all the stops to avoid lowering drug prices for seniors. Their legal strategy is tantamount to ‘throwing the kitchen sink at the government,’ as one expert described it, with various lawsuits arguing violations to the First, Fifth, and Eighth amendments. The pharmaceutical industry has argued that negotiating Medicare prices with the federal government will force them to pull back on developing groundbreaking new treatments. The argument relies on a central falsehood: that the government does not subsidize investments in pharmaceutical innovation. But evidence shows that public sector investments in basic and applied biomedical research — primarily from the National Institutes of Health — contribute substantively to the emergence of new drugs and drug-related patents. Amazingly, given the pervasiveness of the industry’s argument, a recent study found that NIH funding contributed to nearly all (99.4%) of FDA-approved drugs from 2010 to 2019, and the magnitude of NIH investment in new drugs is comparable with that of the industry. These findings clearly suggest that the public deserves a more equitable return on its investment relative to the pharmaceutical industry’s investment.” [Chicago Tribune (Commentary), 9/3/23]

WGEM Quincy Illinois: Medicare Will Now Be Able to Negotiate Prices for 10 Drugs. “Some seniors have had to make tough choices between their medication and other necessities. Under a new policy announced last week, Medicare will negotiate the price of ten of the most costly prescription drugs on the market with manufacturers. Rob Ritchey, the Administrative Director of Pharmacy with Blessing said drug prices are based on how much money the government pays for the medication. He said last year the government spent $50 billion on prescription drugs. Mary Crawford, the West Central Illinois Area Agency on Aging Grant and Program Manager said seniors commonly use the drugs on the list, and those drugs really eat away at their budgets. She said its an important first step to have Medicare play a role in negotiating drug prices. She said for seniors who need assistance, programs to help them pay for their medication exist. Crawford said the current steps the federal government has taken; such as capping the price of insulin and will soon expand the extra help benefits which will reduce what people pay for premiums, deductibles, and co-pays. She says steps like these make her hopeful for other actions down the road.” [WGEM Quincy Illinois, 9/5/23]

IOWA

Iowa Public Radio: Understanding the Historic Plan for Medicare Drug Price Negotiations. “The Biden Administration announced that ten prescription drugs have been selected for Medicare price negotiations for the first time. The power to negotiate the prices comes from the Inflation Reduction Act, passed last year.” [Iowa Public Radio, 9/8/23]

KGAN Iowa: Biden’s Inflation Reduction Act to Lower Prices of Key Drugs for Iowans: A Relief for Millions. “President Biden announced the first 10 drugs to have lower prices under the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. The new program requires big drug companies to negotiate lower pricing for the high-cost drugs used for treating conditions like cancer, diabetes, and heart disease. Lower Pricing will help millions across the country and Iowa.” [KGAN Iowa, 9/7/23]

The Gazette: Over 36,000 Iowans Will Be Affected by Price Negotiation Rule. “Roughly 36,000 Iowans on Medicare pay an average of $650 each year to take the blood thinner Eliquis, according to federal data, but that copay could fall in future years under a new federal law being celebrated by President Joe Biden’s administration and Iowa Democrats. The measure, part of the so-called Inflation Reduction Act, allows the federal government to negotiate prices with prescription drugmakers. This week, the Biden administration highlighted potential cost savings for the first 10 drugs whose prices the administration plans to negotiate in the coming years. However, any lower prices won’t take effect for three years, and the path forward could be further complicated by litigation from drugmakers and heavy criticism from Republicans. In addition to the 36,000 Iowans on Medicare who paid an average of $650 in 2022 on Eliquis, 15,000 paid an average of roughly $640 for another blood thinner, Xarelto, according to federal data. And 12,000 paid roughly $470 for the diabetes treatment medication Jardiance. Iowa’s average out-of-pocket costs for those three most commonly used drugs are among the highest in the country, according to the federal data. In 2022, Iowa had the fifth-highest average annual out-of-pocket cost for Eliquis, Xarelto and Jardiance. In a statement, Iowa Democratic Party Chair Rita Hart called on Republican presidential candidates who have been campaigning in Iowa to make clear their position on the legislation and the measure that allows the federal government to negotiate Medicare drug prices.” [The Gazette, 8/31/23]

LOUISIANA

The Times Picayune NOLA: How Medicare Price Negotiation Will Help Louisiana Medicare Enrollees. “It was the biggest news of the week — or at least the news with the most fanfare — and its success could mean that many of the roughly 883,000 Louisiana seniors on Medicare would no longer have to choose between buying medication or food, says AARP Louisiana. The White House announced Tuesday that the Centers for Medicare & Medicaid Services would commence negotiating lower prices with the major drug manufacturers, often known as Big Pharma, for 10 drugs frequently prescribed to seniors. CMS got authority to negotiate prices for the first time under the Inflation Reduction Act, passed last August. CMS calculates at least 151,000 Louisiana seniors on Medicare take one or more of the 10 initial drugs on the list. Mean annual out-of-pocket expenses cost those seniors between $93 for Novolog and $4,500 for Imbruvica. About 55,000 Louisiana Medicare enrollees have been prescribed the heavily advertised Eliquis to treat blood clots and have to personally pay an average of $372 after Medicare pays its portion. For those who take Jardiance for diabetes, that’s another $237 out of pocket. U.S. Rep. Troy Carter of New Orleans, the only Democrat Louisiana voters have sent to the House, said: ‘This will lower prescription drug costs for seniors in Louisiana and around the country.’” [The Times Picayune NOLA, 9/1/23]

MAINE

The Press Herald Maine: Biden’s Big Deal on Drug Prices. “President Biden announced the first price negotiations over 10 super-expensive Medicare drugs last week through the Inflation Reduction Act as if it were a big deal. It is. In fact, it’s the first time since the program’s creation under Lyndon Johnson in 1965 that Democrats have struck a major blow toward reducing the program’s costs for taxpayers. The drugs on the Biden administration’s list cost, on average, three times what other nations pay: 300% more. That explodes the drug company argument that such prices are necessary to avoid stifling innovation. Why should Americans, alone, pay through the nose so Germany, France and Sweden can get steep discounts on the very same pills? [Price negotiation is] a start, and if it becomes a trend, it could finally mark a new direction is the dismal course of the American health care system, which becomes more corporatized and bureaucratized, more remote from the people it’s supposed to serve with each passing year.” [The Press Herald Maine, 9/7/23]

News Center Maine: How Mainers Will Benefit From Medicare Price Negotiations. “President Joe Biden has revealed a plan to lower the cost of 10 prescription drugs for seniors by allowing Medicare to negotiate the price with drug companies. The drugs include those that treat diabetes, heart disease, and cancer. Dr. Karen Saylor works at Coastal Maine Direct Care in Falmouth. She said her patients sometimes have to choose between paying large amounts of money for important medications or not taking them at all. But that might change. Some of those medications are among 10 drugs that could have their prices slashed in negotiations between the government and drug manufacturers, which was authorized by the Inflation Reduction Act passed by Congress last year. The effects of this change are expected to be wide-reaching in Maine. Medicare enrollees taking the medications here in the state paid out-of-pocket costs of up to nearly $5,000 in 2022. Savings for the 10 drugs won’t come until 2026, but for Saylor’s patients, she said it will be worth the wait.” [News Center Maine, 9/1/23]

MASSACHUSETTS 

Boston Globe (Opinion): Medicare Drug Price Talks Are Lauded by Americans. “[W]e the people are winners as we begin reining in excessive prescription drug prices. Skyrocketing prices lead to higher health care premiums, higher taxes to pay for Medicare and Medicaid, and higher costs at the pharmacy counter. According to the state Center for Health Information and Analysis, prescription drug spending increases outpace other health care spending in Massachusetts. Spending on prescription drugs grew 7.7 percent in 2020, more than twice the 3.1 percent state benchmark for increases in overall health care spending. President Biden’s plan to allow Medicare and Medicaid to negotiate prices for some prescription drugs unraveled an absurd prohibition the pharmaceutical industry pushed through Congress 20 years ago. Negotiation is crucial as drug companies keep US prices inflated by blocking generic competitors through patent-extending tactics. Unsurprisingly, the pharmaceutical industry opposes the plan. The rest of us are all in. We’ll need more reforms for a fairer medication marketplace, but this is a great start.” [Boston Globe (Opinion), 9/4/23]

NORTH DAKOTA

Public News Service: North Dakotans See Light at the End of the Tunnel on Prescription Costs. “Older North Dakotans and a key advocacy group are hopeful that seniors will see relief from the heavy burden of prescription drug costs – and they’re hailing a big step announced this week. The Biden administration unveiled the first 10 medications that will be subject to price negotiations under the Medicare program. The action is part of the Inflation Reduction Act approved by Congress. Bismarck resident Bob Entringer has used one of the medications on the list since 2017. When he retired and switched to Medicare, he found out the blood thinner would be almost $500 for a 90-day prescription. Policy experts note that other IRA provisions are already helping beneficiaries. Josh Askvig, AARP North Dakota state director, [said] that for too long, drug makers have prioritized profits over the people who desperately need some of these medications. ‘We know the number one reason seniors skip or ration their prescriptions is because they can’t afford them,’ he said, ‘and this must stop, and this is an important step in that direction.’” [Public News Service, 9/1/23]

PENNSYLVANIA

Lehigh Valley News: U.S. Rep. Susan Wild: Start of Medicare Drug Negotiations Is Cause for Celebration. “Niebell’s cardiologist had prescribed her two of the 10, the blood thinners Xeralto and Eliquis, as they searched for critical medication to which she wouldn’t have an allergic reaction. […] “These prices never should have been this high,” Niebell said, using a hot pink cane to keep her balance at the podium. “We, as seniors, we have enough to worry about, and the doctor shouldn’t have to listen to me whine about the cost every time he sees me.” [Lehigh Valley News, 9/5/23]

The Morning Call: ‘These Prices Never Should Have Been So High’: Susan Wild, Advocates Tout Savings From Medicare Drug Price Negotiations. “The savings primarily will benefit the 65 million people enrolled in Medicare. Enrollees in the government health insurance program paid $3.4 billion out-of-pocket last year for the 10 aforementioned prescription drugs — a number that will likely be slashed thanks to price negotiations. The United States has historically been behind countries like Canada, Mexico and many European countries that allow price negotiations and tend to have more affordable prescription drugs.” [The Morning Call, 9/5/23]

The Philadelphia Tribune (Commentary): Medicare Price Negotiations Will Give Pennsylvania Seniors Relief at the Pharmacy Counter. “On Aug. 29, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, announced more federal action to increase access and affordability for Medicare recipients. Medicare will now be able to negotiate the price of prescription drugs, starting with 10 medications covered under Medicare Part D, thanks to the Inflation Reduction Act. I applaud President Joe Biden’s continued efforts to improve health equity for elder Americans. Citizens of all ages, not just here in Philadelphia but across the state and country, struggle to afford critical, lifesaving medications to help manage their chronic conditions. Sen. Bob Casey, a vocal supporter of lowering drug prices and providing more access to life-saving treatment, is providing additional support at the federal level. I am proud to see the Affordable Prescriptions for Patients Act introduced in Washington. That legislation would prohibit the pharmaceutical industry from using anticompetitive practices that block competition and keep drug prices high. These critical steps at the federal and state level are necessary and long overdue to help solve our drug pricing crisis while increasing access and affordability. Together, we can help everyone see relief at the pharmacy counter.” [The Philadelphia Tribune, 9/5/23]

VIRGINIA

Loudoun Times-Mirror: HHS Secretary Touts New Drug Price Negotiation Rule at Clinic in Virginia. “Becerra compared Medicare not being able to negotiate to a car buyer who has to pay the sticker price on a vehicle in a car lot. He noted the U.S. Department of Veterans Affairs negotiates on drug prices, as do many governments in other industrialized nations. Becerra added that the 10 drugs account for 20% of all annual Medicare spending for prescription drugs. Under the IRA, the results of negotiations for an additional 15 drugs take effect in 2027. Another 15 take effect in 2028. Becerra said the number rises to 20 drugs annually beginning in 2029. In a brief interview after the event, Becerra vowed to ‘vigorously defend’ the IRA in court. ‘We feel very confident that what Congress passed, they took into account all the different factors in making it possible for us to negotiate,’ he said. ‘We feel like the law is on our side and we are going to be vigorous in defending this new law because we know that tens of millions of Americans are counting on it.’” [Loudoun Times-Mirror, 9/5/23]

***MEDIA ADVISORY FOR WEDNESDAY, SEPTEMBER 6 AT 12:15 PM MST // 3:15 PM EDT***

The Biden Administration Announced the First 10 Drugs That Arizonans Will Save Money on Thanks to the Inflation Reduction Act

Phoenix, AZ  — On Wednesday, September 6 at 12:15 PM MST // 3:15 PM EDT, Senator Mark Kelly will join Protect Our Care Arizona to discuss how Medicare negotiations will lower prescription drug costs for Arizonans. The Biden administration recently announced the first 10 drugs that will have lower prices negotiated by Medicare under the Inflation Reduction Act, which was passed by Democrats last year. Prescription medicines cannot work if people cannot afford to take them, and high drug prices are keeping too many Americans from the health care they need. Speakers will discuss what these efforts mean for Arizonans and how lowering the cost of health care and prescription drugs remains central to the Inflation Reduction Act’s popularity.

This event comes as Republicans and drug companies attack the Inflation Reduction Act by trying to derail health care policies that will bring down costs. Big drug companies are suing the federal government to protect their massive profits by halting the measure passed in the Inflation Reduction Act that empowers Medicare to negotiate drug prices while Republicans are attempting to repeal it. President Biden and Democrats in Congress are already working to expand these cost savings to more Americans, no matter what age they are or how they get their health insurance. The Biden administration is laser-focused on making medications affordable for families and ending the era of drug companies’ unchecked power and greed.

PRESS EVENT:

WHO:
United States Senator Mark Kelly
Linda Somo, President, Arizona Alliance for Retired Americans
Allison LeFebvre, Arizona patient & health care advocate
Kathy Saulsberry, Arizona patient & health care advocate

WHAT: Virtual Press Conference

WHERE: Register to join the Zoom event (Registration required)

WHEN: Wednesday, September 6 at 12:15 PM MST // 3:15 PM EDT

This week we highlight the 60th anniversary of the March on Washington and the announcement of the first round of high-cost drugs whose prices will come down as Medicare negotiates with the drug companies, as well as new maternal health and teen pregnancy prevention grants being provided with a focus on reduced health disparities and the shift in biotechnology investment towards accelerating health equity efforts across the country. Even so, from new National Academies of Science, Engineering, and Medicine report findings to climate change to insurer care-delay tactics to an increasing maternal health crisis, there is much work to be done to ensure that systematically marginalized groups benefit from the initiatives highlighted this week and other essential programs to improve health outcomes.

Protect Our Care is dedicated to making high-quality, affordable, and equitable health care a right, and not a privilege, for everyone in America. We advocate for policies that lower health care costs and strengthen coverage, which are critical to expanding access to quality health care and, ultimately, achieving better health outcomes, particularly for people of color, rural Americans, LGBTQI+ individuals, people with disabilities, and more. Our strategies are driven by a broader commitment to tackling systemic inequities that persist due to racism and discrimination and the reality that multi-sector policies are needed to address basic conditions that affect health and related outcomes, particularly for marginalized communities.

INITIATIVES

Washington Post (Opinion: Joe Biden): We Must Keep Marching Forward Towards Dr. King’s Dream. “Sixty years ago, the Rev. Martin Luther King Jr. and hundreds of thousands of fellow Americans marched on Washington for jobs and freedom. While we’ve never fully lived up to that promise as a nation, we have never fully walked away from it, either. Each day of the Biden-Harris administration, we continue the march forward. That includes a fundamental break with trickle-down economics that promised prosperity but failed America, especially Black Americans, over the past several decades. Vice President Harris and I came into office determined to change the economic direction of the country and grow the economy from the middle out and bottom up, not the top down. Black unemployment fell to a historic low this spring and remains near that level. More Black small businesses are starting up than we’ve seen in over 25 years. More Black families have health insurance. We cut Black child poverty in half in my first year in office. We’re taking the most significant action on climate ever, which is reducing pollution and creating jobs for Black Americans in the clean energy future. For generations, Black Americans haven’t always been fully included in our democracy or our economy, but by pure courage and heart, they have never given up pursuing the American Dream. On this day of remembrance, let us keep showing that racial equity isn’t just an aspiration. Let us reject the cramped view that America is a zero-sum game that holds that for one to succeed, another must fail. Let us remember America is big enough for everyone to do well and reach their God-given potential.” [Washington Post (Opinion: Joe Biden), 8/27/23]

Pittsburgh Post-Gazette: How Medicare’s Price Negotiation Will Affect People and Equity Efforts. “After months of speculation, the Centers for Medicare and Medicaid Services (known as CMS) has finally released the list of medicines that will be subject to the agency’s new price-negotiating powers. The list should give the public hope that — assuming legal challenges from drugmakers are defeated — the program could yield significant savings and more equitable healthcare access. Studies show that the more expensive drugs are, the less likely patients are to adhere to them. That’s been particularly true of several classes of drugs — diabetes and blood thinners — targeted by this list. Moreover, research also reveals significant racial disparities in the use of several of the medications on this first list, says Utibe Essien, a physician at the David Geffen School of Medicine at UCLA who studies health equity. He found that Black patients, including those on Medicare, were 25% less likely to take newer classes of blood thinners for a type of abnormal heartbeat called atrial fibrillation. Beyond improving equitable access, making these medicines more affordable could lead to healthcare savings, says Essien, by making patients healthier. Patients who take their blood thinners consistently can avoid worse health problems, like strokes or kidney disease.” [Pittsburgh Post-Gazette, 8/31/23]

Department of Health and Human Services: HHS Awards $23 Million to Support Teen Pregnancy Prevention Programs. “The U.S. Department of Health and Human Services (HHS), through the Office of Population Affairs (OPA), is announcing approximately $23 million in funding to foster innovation, provide new research, and expand the evidence to support and advance equity in the Teen Pregnancy Prevention (TPP) program. Through the TPP program, HHS seeks to advance equity in adolescent health by supporting projects that create, identify, and scale effective approaches in communities and populations with the greatest needs and facing significant disparities across the country to improve adolescent health and well-being. Collectively, these 18 new Tier 2 projects, along with the 53 new Tier 1 projects OPA announced in June 2023, demonstrate how OPA’s TPP Program is responsive to the needs of youth, their families, and communities. The TPP Tier 2 Rigorous Evaluation cooperative agreements will support 12 projects that will implement and rigorously evaluate a wide diversity of promising interventions. The new interventions include those for youth in foster care, youth in juvenile justice, rural youth, expectant and parenting teens, younger adolescents in middle school, as well as intervention geared for parents, and clinical providers. The projects will also evaluate interventions that use newer modalities including videos, video games, and virtual implementation. These awards are for five-year project periods beginning September 15, 2023.” [Department of Health and Human Services, 8/25/23]

Boston Globe: Governor Awards $1.5 Million in Grants to Promote Maternal Health Equity. “Attorney General Andrea Campbell Tuesday announced $1.5 million in grants to 11 organizations that provide maternal care in Massachusetts as part of her office’s efforts to combat rising maternal health inequities in the state. Campbell hosted the recipients of the Maternal Health Equity Grant for a roundtable discussion about how to reduce negative pregnancy and postpartum outcomes across the state, particularly for Black women, who continue to face the highest rates of pregnancy complications and deaths. First announced by Campbell’s office in April, the grant aims to reduce these racial and ethnic inequities by increasing access to prenatal care, behavioral health support, and breastfeeding support that meets the needs of the state’s diverse population. The Whittier Street Health Center, which serves a large population of low-income individuals and immigrants who receive services in languages other than English, will use the funding to hire bilingual staff and conduct community outreach initiatives to better serve those at highest risk of receiving poor maternal care. The grant also aims to increase access to care from doulas, non-medical professionals trained to offer emotional and informational support to families during and after pregnancy, and support a more robust and diverse workforce.” [Boston Globe, 8/15/23]

Health Affairs: Biotech Industries Are Transitioning Towards a Model of Funding Health Equity Programs. “The biotech story for the rest of 2023 will be neither entirely turmoil nor entirely growth. Instead, it will be a fundamental reset—an industry realignment born of the broader macroeconomic conditions and of the painful lessons learned from the global pandemic that brought us to this moment. As the realignment begins to take shape, one of its most prominent features is already becoming clear: Health equity will be a central focus in biotech. For instance, last year, UCLA Health launched an innovation accelerator to help scale up health equity-focused startups. Johnson & Johnson awarded seed funding to 14 entrepreneurs and organizations with the potential to advance health equity as part of its Health Equity Innovation Challenge. And an increasing number of health-focused private companies are hiring “Chief Health Equity Officers,” as commercial entities awake to longstanding shortfalls. The trend is also reflected in the regulatory landscape, as accrediting bodies and trade associations are increasingly prioritizing key health equity initiatives. Recently, the Institute for Healthcare Improvement and the American Medical Association launched a new National Coalition for Equity in Healthcare. There’s even been major governmental action, including the Biden administration’s 2021 formation of the Office of Climate Change and Health Equity.” [Health Affairs, 8/11/23]

WJTV: Mississippi Community Organization to Receive $6 Million Dollar Grant to Support Health Equity Efforts. “A national bio-tech company, Genentech, announced that a Mississippi based community organization is among 10 chosen to share a $6 million grant. Jackson-based Southern Echo will begin by reaching out to southern states interested in the conversation of health organizing. From there, they will build out a curriculum to better help address issues that can be presented to policy makers. Rachel Mayes, the executive director of Southern Echo, said health plays out in the lives of everyone on a daily basis. She said the grant from Genentech will allow Southern Echo to do what they have in the past. They support organizations in the south in civic engagement, community organizing, the importance of the census, redistricting and voting. This time, the focus is on health equity. Advancing health equity is the purpose behind Genentech’s Community Health Justice Fund, which supports nonprofits.” [WJTV, 8/3/23]

CHALLENGES

Stat: New Report Says Ending Health Disparities Will Require a Permanent Federal Regulatory Body. “In its many recommendations, the committee that wrote the report called for Congress to create a scorecard to assess how new federal legislation might affect health equity; urged all federal agencies to conduct an equity audit of current policies; asked the Centers for Disease Control and Prevention to create and facilitate the widespread use of measurements of social determinants of health, including racism; and urged the Office of Management and Budget to oversee efforts to improve the poor and sporadic collection of data about the nation’s racial and ethnic groups. The report’s authors stressed that improving health equity cannot be accomplished by the government’s health agencies alone. Education, income, transportation issues, and the quality of neighborhoods, the report noted, all play a role in harming or helping people’s health. While programs like Medicaid and the Children’s Health Insurance Program have proven to be the most effective policies to reduce health disparities, the report found policies that increase the federal minimum wage or close gaps in education spending have also promoted better health. The report details the nation’s many racial and ethnic disparities, including the fact that maternal mortality rates are two to three times higher in Black and Native American populations, and notes that in 2019, Black Americans lived more than four years less than white people and Native Americans lived more than five years less than those who are white. Because income is so closely tied to health and because past policies, such as redlining neighborhoods, have led to the massive loss of generational wealth for many Black Americans, the report urged the adoption of policies to boost income and housing security. These include providing more housing vouchers for low-income people; offering government-subsidized savings accounts for children; promoting fairer financial services that offer lower-cost credit for people with low incomes; and expanding social benefit programs to many who have been left out, including immigrants, people who have been incarcerated, and adults who do not have children.” [Stat, 7/27/23]

NPR: Heatwaves are Increasing Disparities in Health Across the Country. “Within the past five years, Dr. Sameed Khatana says, many of his patients in Philadelphia have realized how climate change hurts them, as they fared poorly with each wave of record heat. Record heat scorching the country is especially dangerous for the many, many people with common conditions like diabetes, obesity and heart disease. And within cities, many vulnerable communities face greater exposure to heat, fewer resources to address it or escape it, and higher rates of the diseases that make heat more dangerous for people. Heat stroke happens when the body’s core temperature rises so fast and high it rapidly becomes lethal. The heart pumps blood away from vital organs to dissipate heat. That can overload weakened hearts or lungs. Many of his patients also have obesity or diabetes, which can affect circulation and nerve function. That also affects the ability to adapt to heat. In addition, common medications his patients take for heart disease — beta blockers and diuretics — can make heat symptoms worse. Just as seen in other public health concerns like obesity or COVID-19, the elderly, communities of color, and people with lower socioeconomic status bear the highest risk. Those most in danger live in the Deep South and across the Midwest — where heat, older populations and rates of complicating disease run highest.” [NPR, 8/10/23]

Capitol News (Opinion): Insurer Tactics to Delay Care Makes Achieving Health Equity More Difficult. “Long plagued by racism and discrimination, communities of color lag on many healthcare measures. Eliminating disparities requires increasing access to care and improving outcomes. Unfortunately, some insurance companies are erecting extraordinary barriers that will actually delay necessary treatment for patients — and exacerbate inequities. UnitedHealthcare (UHC) just rolled out a nebulous new Advance Notification Program for all commercial plans that will require doctors to gather data at a granular level to order most gastrointestinal (GI) colonoscopy and endoscopy procedures for their patients — an arduous process that will be used to create a “Gold Card” prior authorization program in early 2024. Prior authorization, a process through which insurance companies can overrule doctors’ expertise and deny coverage for medically necessary care, will seriously disrupt patients’ ability to receive life-saving colonoscopies and endoscopies that can detect pre-cancers and cancers in the esophagus, stomach, small intestines, and colon. Unfortunately, any delay in treatment, by definition, prolongs patients’ pain and anxiety. And, even worse—since some forms of gastrointestinal cancers progress quite rapidly, it is not a stretch to say that these prior authorization requirements could cost lives. That is especially true for communities of color, which suffer higher burdens of colorectal cancer and which, due to a range of existing social determinants of health, also face significant access barriers to the procedures necessary to diagnose and monitor disease development. According to the American Cancer Society (ACS), colorectal cancer is the second-most common cause of cancer death in the country, with incidence and mortality rates highest among American Indian, Alaska Native, and non-Hispanic Black individuals. The racial disparities in incidence and mortality rates for colorectal cancer are largely driven by differences in risk factors and access to care, including screening and cancer treatment.” [Capitol Weekly (Opinion), 7/31/23]

U.S. News: One in Five Mothers Report Mistreatment in Maternity Care. “One-fifth of U.S. mothers say they have experienced mistreatment by their health care provider during their pregnancy and delivery care and 29% say they have faced discrimination, according to new research from the Centers for Disease Control and Prevention, with higher rates of such incidents reported among women of color. Approximately 20% of more than 2,400 women surveyed in a CDC Vital Signs report released Tuesday said they experienced some form of physical neglect or verbal abuse during their maternal care. The report’s findings were based on a survey conducted from April 24 through April 30 by public relations firm Porter Novelli. Higher rates of mistreatment were reported by mothers who identify with a racial and ethnic minority group, including 30% of Black women, 29% of Hispanic women and 27% of multiracial women during their pregnancy care, compared to 19% of white women and 15% of Asian mothers. Nearly 30% of women who were uninsured and 26% of those covered by Medicaid reported mistreatment during their maternity care compared to 16% of women with private insurance, according to the analysis. In addition, 29% of women surveyed said they experienced at least one form of discrimination during their pregnancy care, with 40% of Black women, 39% of multiracial women, and 37% of Hispanic women reporting such incidents, compared to 26% of white women and 23% of Asian women. The most common reasons for discrimination reported included issues concerning age, weight and income.” [U.S. News, 8/23/23]

PR Newswire: New Report Shows Maternity Care is Worsening for Millions of Americans. “March of Dimes today released Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, a new collection of reports that shows more than 5.6 million women live in counties with no or limited access to maternity care services, forcing families to find new ways to get the care they need. The new research from March of Dimes shows that for millions of women in the United States, it is more difficult to access maternity care.  One of the largest analyses on maternity care access, the report offers insight into the factors that impact pregnancies in all 50 states, Washington, D.C., and Puerto Rico. More than one third (36%) of U.S. counties are considered maternity care deserts, which are defined as counties without a hospital or birth center offering obstetric care and without any obstetric providers. The loss of obstetric units in hospitals was responsible for decreased maternity care access in 369 counties since the 2018 report, nearly 1-in-10 counties across the U.S. 70 additional counties have been classified as maternity care deserts due to a loss of obstetric providers and obstetric units in hospitals, since the initial report in 2018. More than 32 million reproductive-age women are vulnerable to poor health outcomes due to a lack of access to reproductive healthcare services, like family planning clinics and skilled birth attendants. States with the highest rates of maternity care deserts include North Dakota, South Dakota, Alaska, Oklahoma and Nebraska, states with more rural populations.” [March of Dimes Press Release, 8/1/23]

KFF Health News: Dangers and Deaths Around Black Pregnancy a Completely Preventable Health Crisis. “Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates. In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. The counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants. No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.” [KFF Health News, 8/24/23]

NPR: Abortion Bans Are Leading to an Influx of High-Risk Patients in Illinois Hospitals. “Since the Dobbs decision overturned Roe v. Wade on June 24, 2022, who can get an abortion and where has been complicated by medically ambiguous language in new state laws that ban or restrict abortion. Doctors in those states fear they could lose their medical licenses or wind up in jail. Amid these changes, physicians in abortion havens like Illinois are stepping up to fill the void and provide care to as many patients as they can. But getting each medically-complex patient connected to a doctor and a hospital has been logistically complicated. In response to the growing demand, Illinois Governor JB Pritzker recently launched a state program to help. The goal is to get patients who show up at clinics, yet need a higher level of abortion care, connected more quickly with Illinois hospitals. Providers will call a hotline to reach nurses who will handle the logistics. There is little concrete data on how many more patients are traveling to other states for abortions at hospitals. Hospitals are a “black box” for abortion-related data, according to Rachel Jones, a longtime researcher at the nonprofit Guttmacher Institute. Even before Roe fell, it was hard to get through the bureaucracy of hospitals to understand more comprehensively how abortion care was provided, Jones said. Guttmacher has tracked hospital-based abortions in the past, but doesn’t have updated figures since Dobbs. WeCount, widely considered a reliable tracker of shifts in abortion care over the past year, doesn’t break out hospital data separately. WeCount co-chair Ushma Upadhyay said the data would have gaps anyway. She said it’s been difficult to get providers in banned states to report what’s happening.” [NPR, 8/23/23]

Missouri Independent: One-Third of Rural Hospitals in Missouri At Risk of Closure. “A July report from the Center for Healthcare Quality and Payment Reform, a national policy group, found that 19 of Missouri’s 57 rural hospitals are at risk of shuttering because of ‘serious financial problems.’ Many of those hospitals at risk of closure could sustain themselves financially for six to seven years, according to the report.  Eight rural hospitals, however, are in particularly dire straits, according to the report, and are at risk of ‘immediate closure’ — meaning they are at risk of closing in the next two to three years. That is up from only two rural hospitals at risk of immediate closure in the previous year’s report. The state’s 57 rural hospitals are providers located outside the 34 counties that make up Missouri’s metropolitan statistical areas. Ten rural hospitals in Missouri have closed since 2012. Those that remain open, but are faltering, often consider cutting services in an attempt to remain afloat — gradually chipping away at care as the prospect of closure looms. Cox Monett Hospital, in Southwest Missouri, announced earlier this year its plan to close its inpatient labor and delivery this summer, citing difficulty recruiting doctors. Some patients would need to travel upwards of 45 minutes from Monett to Springfield to access obstetric care, KY3 reported. In 2020, almost half of rural community hospitals nationally did not offer obstetric care, according to the American Hospital Association. Studies have found a higher risk of complications for those giving birth in rural areas. The last year of inflation and a tight labor market, along with the end of COVID federal grants, contributed to hospital losses increasing, Miller said. Many rural hospitals lost more money in 2022 than in pre-pandemic years, he said.” [Missouri Independent, 8/1/23]