Fireside Chat Retreat in Atlanta, GA Tackles Inflation Reduction Act's Adverse Impact on Patient Care

By: Brandon M. Macsata, CEO, ADAP Advocacy & Matt Toresco, Chief Executive Officer, Archo Advocacy LLC

ADAP Advocacy hosted its Health Fireside Chat retreat in Atlanta, Georgia, among key stakeholder groups to discuss the adverse impact on patient care being caused by the Inflation Reduction Act (IRA). The Health Fireside Chat was held from Thursday, September 25th, to Saturday, September 27th. It was a continuation of the conversation surrounding the IRA's drug price controls, which convened earlier this year in Minneapolis, MN. Over two dozen diverse health policy stakeholders attended the event.

Photo Source: Getty Images

The IRA discussion —including its pill penalty provisions, challenges community pharmacies are facing, more restrictive drug formularies increasing, non-medical switching, and patients absorbing greater costs due to shifts from co-pays to co-insurance—was designed to capture key observations, suggestions, and thoughts about how best to address the challenges being discussed at the Health Fireside Chat. The following represents the attendees:

• Guy Anthony, Founder & Executive Director, Black, Gifted & Whole Foundation
• Ninya Bostic,  National Policy & Advocacy Director, Johnson & Johnson
• Richard Brown, Development Manager, Patient Advocate Foundation
• Tori Cooper, Director of Community Engagement, Human Rights Campaign
• Erin Darling, Associate Vice President & Counsel for Federal Policy, Merck
• Nick Garlow, Managing Director, Rational360
• Dusty Garner, Patient Advocate
• Kathie Hiers, President & CEO, AIDS Alabama
• Mark Hobraczk, Director of Public Policy, Ai Arthritis
• Connie Jorstad, Director of Government Relations, ViiV Healthcare
• Amanda Kornegay, Owner, Kornegay Consulting, LLC
• Jen Laws, President & CEO, Community Access National Network
• Darnell Lewis, Paramedic Crew Chief & Patient Advocate
• Brandon M. Mascata, CEO, ADAP Advocacy
• Travis Manint, Director of Communications, Community Access National Network
• Michiel Peters, Head of Advocacy Initiatives, Global Coalition on Aging
• Kalvin Pugh, Director of State Policy, 340B, Community Access National Network
• Stacy Reliford, Alliance Development Director, Pfizer
• Andrew Scott, Director Strategic Alliances and Issue Advocacy, Bristol-Myers Squibb
• Larry Scott-Walker, Patient Advocate
• Ranier Simons, Consultant, ADAP Advocacy
• David Spears, Founder & Director, Magic Box LLC
• Jason Sterne, Director, Policy Advocacy and Alliances, Gilead
• Matt Toresco, CEO, Archo Advocacy
• Monique Whitney, Executive Director, Pharmacists United for Truth and Transparency
• R. Wayne Woodson, Executive Diretor, NEASM

To level set and provide background for discussions, attendees are sent suggested readings in advance. The following are just a few from the thorough list provided for this session:

• The Inflation Reduction Act (IRA): Impact on Medication Pricing, Spending, Affordability, and Access – Analysis by Pioneer Institute
• Alarm Bells are Ringing: Medicare Drug Price Negotiation Program Will Fail Without Changes – Op-Ed by B. Douglas Hoey, RPh, MBA in Drug Topics
• CMS Draft Guidance Creates Regulatory Vacuum in 340B Drug Pricing – Blog by Travis Manint, Community Access National Network
• Is Trump's Executive Order on Most Favored Nations Drug Pricing a Wet Noodle? – Blog by Ranier Simons, ADAP Advocacy
• Three reasons Congress should fix the IRA’s pill penalty – Blog by Brianna Allen, PhRMA
• The Inflation Reduction Act’s Impact Upon Early-Stage Venture Capital Investments – Article in Therapeutic Innovation & Regulatory Science

ADAP Advocacy is pleased to share the following brief recap of the Health Fireside Chat. There were two discussion frameworks:

What Does Effective Advocacy Look Like:

• Defining Effective Advocacy: Data-Guided Strategies for Patient & Policy Impact
• What Works: Cutting Through the Noise in Patient Advocacy
• Shaping Advocacy That Moves Policy
• Building the Blueprint: Effective Advocacy Together

Measuring What Success Looks Like:

• Redefining Success: Measuring Advocacy Wins for Patients & Policy
• What Counts: Defining Real Success for Patients & Policy
• From Policy to Impact: What Success Really Means & Looks Like in Action
• Measuring The Wins: Success Through Shared Impact

Every major policy fight (IRA, 340B, PDABs) ultimately comes back to protecting the patient–provider relationship and the decisions made within it. Patient advocacy is most effective on these issues through branding and and demonstrating value. To that end, patient advocacy must grow its brand and demonstrate both its current and future impact. Meanwhile, pharmaceutical industry partners need to better communicate the value of advocacy internally across medical, policy, regulatory, commercial, and patient support teams. Building capacity, whether alone or in partnership, is essential.

The group identified numerous policy priorities and the need for better coalition building. Future patient advocacy has to address gaps in access to care and treatment. The IRA weakens Medicare's Six Protected Drug Classes and policymakers need to be reminded why these health conditions were protected in the first place. Advocacy organizations need to focus on clearly describing the impacts of policy issues and helping patients see them, as is being done with educating patients on why reforms are needed to strengthen the 340B Drug Pricing Program.

The ongoing government shutdown also shaped much of the policy discussion, with an agreement that longtime allies in Congress need to be engaged but also potential new voices should be cultivated. The work done by patient advocacy groups and healthcare provider associations working with North Carolina Republican Senator Thom Tillis was cited as a prime example. Sen. Tillis has introduced legislation—"Ensuring Pathways to Innovative Cures (EPIC) Act"—to fix the Inflation Reduction Act's small molecule “pill penalty” to ensure continued R&D investments into small molecule medicines.  The Global Coalition on Aging and the Alliance for Aging Research spearheaded 70+ organizations in sending a letter to congressional leadership urging them to support the EPIC Act.

Photo Source: Government Printing Office

Some recent and upcoming milestones offer patient advocacy organizations additional opportunities to shape the policy conversation. They include:

• September 30, 2025: CMS released final guidance for third cycle (IPAY28) of the MDPNP. CMS released IPAY28 draft guidance in May 2025 for public comment, with the final guidance outlining the process for the third cycle of negotiations.
• October 2025 [Anticipated]: Release of expert report detailing drugs anticipated to be selected in 2026 for the MDPNP. Based on 2024 activities, it is expected that a new white paper or brief will be issued in September 2025 that identifies drugs that are likely to be subject to price negotiation in the third cycle of the MDPNP.
• February 1, 2026: CMS releases the list of drugs selected for negotiation. In 2026, CMS will announce the selection of 15 Part D and Part B drugs for which negotiated prices will go into effect in 2028.
• February 1 – March 1, 2026: Public input period (Information Collection Request, or ICR) following CMS announcement of drugs selected for negotiation. The ICR period is intended to help CMS understand how selected drugs are used and their relative value in clinical practice. Individuals can answer questions across varying respondent types (manufacturers, patients/caregivers, physicians, researchers, and "others"), often with a ~3,000-word limit per question. Question topics include therapeutic alternatives, clinical effectiveness, cost/affordability, unmet needs, patient experiences, and other considerations. 

Aligned stakeholders must use every opportunity to create a public record on the issues related to the Inflation Reduction Act and its impact on chronic health conditions and rare diseases.  No additional Health Fireside Chats are planned for 2025.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

HIV Clusters Spread, as Republicans Seek Deep Cuts to HIV Funding

By: Ranier Simons, ADAP Blog Guest Contributor

In the current political climate, given the government’s health policy landscape, many stakeholders are concerned about the stability of public health. This is undeniably true in the HIV space. Republicans seek deep cuts to HIV prevention and treatment funding, which would destabilize the already tenuous nature of care for people living with HIV/AIDS (PLWHA), especially those in vulnerable populations. Hindering effective HIV response is disconcerting, with trends such as HIV clusters appearing. In recent times, HIV cluster outbreaks have been identified. Fruitful public health support of PLWHA requires an increase in resources, not a reduction.

Photo Source: Maine.gov

One such cluster of increased HIV transmission is in Penobscot County, Maine, where Bangor is located. A cluster outbreak was first identified there in late 2023 (Budlon, 2025). A cluster is a group of people with related HIV infections. As of September 2025, the number of cases in this cluster has reached 29 (main DHHS). This area of Maine typically sees only two instances of transmission per year (Budlon, 2025). The majority of those involved in this cluster have been experiencing homelessness, injection drug use, or both in the 12 months before their diagnosis (Tusinksi, 2025). These conditions do not cause HIV; however, they do increase the risk of transmission. Housing instability hinders treatment adherence and consistent access to HIV care. Injection drug use can lead to behavior with increased risk, including sharing needles (Arum et al., 2021). Public health officials infer that the number of transmissions is likely higher than 29, given that many have not been tested.

Another cluster seeing a notable increase is in New York. The increase in infections in a reported cluster in Broome County, New York, in early August is higher than the number seen annually over the past four years. Most of those in the cluster are unhoused, have used intravenous drugs, are Caucasian, and between the ages of 30 and 45 (McCarthy, 2025). In addition to those identified in the clusters, the Broome County Health Department estimates there are a couple of dozen more people who have been exposed to HIV that they are not aware of (McCarthy, 2025). Additionally, as of 2023, Broome County has the third-highest rate of new Hepatitis C mortality in New York state (McCarthy, 2025). Hepatitis C, tuberculosis, Hepatitis B, and syphilis are often comorbid with HIV (McCarthy, 2025). HIV transmission has historically been overrepresented in the South; thus, this Northeastern trend is concerning.

Actions by the current administration are in direct opposition to supporting the reversal of these transmission trends. Reductions in HIV-related funding are harmful on many levels. In a July 2025 Executive Order (EO), the President implies defunding harm reduction. Harm reduction includes syringe service programs (SSP) in which evidence-based data shows that they are one of the best ways to prevent HIV and Hepatitis spread among those who inject drugs. Unlike the EO states, SSPs or safe consumption sites do not facilitate or worsen drug use. Two prominent SSPs in Maine have already shut down. The Maine Center for Disease Control and Prevention revoked the Health Equity Alliance’s (HEAL) syringe exchange certification in January 2025 (Bush, 2025). Additionally, due to a zoning issue, SSP Needlepoint Sanctuary was forced to close in July 2025 (Rupertus, 2025).

The language of the EO also paints the unhoused as a criminal group riddled with drug addiction and mental health disease, deserving of involuntary commitment to facilities to restore public safety. The President’s prescription of rounding up people experiencing homelessness and destroying encampments is the same sentiment that resulted in Camp Hope being closed in February of this year. It was the largest homeless encampment in Bangor, Maine (Peters, 2025). Many of those pushed out of the encampment have not been connected to residential situations and remain unhoused. The encampment served as a means for public health providers to reach unhoused PLWHA for treatment and tracing. However, with the residents of the encampments now scattered, any linkage to care that had occurred is destroyed. That is detrimental to PLWHA and the public since HIV prevention is a public issue.

Photo Source: CNN

The House Republican budget proposal slashes federal HIV prevention and treatment funding, seeking almost $2 billion in HIV-related cuts (Ryan, 2025). This is coupled with the large number of HIV related NIH grants that have already been defunded. In a speech, NIH Director Dr. Jay Bhattacharya stated, “We have now in our capacity the ability to actually end the HIV epidemic by 2030, to reduce HIV transmission to very, very low levels. And we just need to figure out how to do it” (Ryan, 2025). It is unclear how this goal can be achieved, given the massive amount of HIV treatment and prevention defunding that the Trump Administration and House Republicans wish to achieve. 

Regardless of the current destabilization in the HIV-related public health space, monitoring for transmission trends and cluster outbreaks is imperative. A challenging aspect of monitoring is HIV molecular surveillance. HIV molecular surveillance involves the collection and tracking of virus sequences from specific genetic strains of HIV. HIV transmission reporting is required by law for public health purposes. When a person tests positive for HIV, additional genetic bloodwork is done to determine the specific strain of HIV for epidemiological and cluster tracking purposes. 

In theory, meaningful data analysis is achieved by collecting this information. However, there are no proper safeguards in place to ensure the privacy of the PLWHA from whom this data is collected. Privacy breaches could result in harm, including economic and physical safety concerns. There are safer means of acquiring tracking data, such as tracking HIV through comprehensive case surveillance, behavioral and clinical monitoring, and analysis of pharmaceutical data (CDC, 2025). ADAP Advocacy is strongly opposed to HIV molecular surveillance being used to combat HIV clusters and has routinely supported the Center for HIV Law and Policy in its advocacy in this space.

Photo Source: Center for HIV Law & Policy

Data shows that some HIV transmission statistics are trending in the wrong direction. Now is not the time to destabilize the fragile infrastructure that is the status quo. If massive defunding ultimately becomes a permanent reality, HIV clusters will increase, and many preventable transmissions will occur. That outcome will result in a significantly higher level of societal and governmental spending compared to the savings the administration professes to achieve from its proposed fiscal cuts.

[1] Arum, C., Fraser, H., Artenie, A. A., Bivegete, S., Trickey, A., Alary, M., Astemborski, J., Iversen, J., Lim, A. G., MacGregor, L., Morris, M., Ong, J. J., Platt, L., Sack-Davis, R., van Santen, D. K., Solomon, S. S., Sypsa, V., Valencia, J., Van Den Boom, W., Walker, J. G., … Homelessness, HIV, and HCV Review Collaborative Group (2021). Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet. Public health, 6(5), e309–e323. https://doi.org/10.1016/S2468-2667(21)00013-X. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8097637

[2] Budlon, K. (2025, July 11). Penobscot County HIV outbreak continues to grow; providers say the rest of Maine is at risk. Retrieved from https://www.mainepublic.org/health/2025-07-11/penobscot-county-hiv-outbreak-continues-to-grow-providers-say-the-rest-of-maine-is-at-risk

[3] Bush, B. (2025, January). Maine CDC change to syringe-exchange program in Bangor displaces need for services. Retrieved from https://www.newscentermaine.com/article/news/health/health-equity-alliance-syringe-needle-exchange-program-revoked-maine-cdc/97-f5132e6d-2c9f-405c-b034-cae05cd6de1c

[4] Centers for Disease Control and Prevention. (2025, February 7).About HIV Surveillance and Monitoring. Retrieved from https://www.cdc.gov/hiv-data/about/index.html#:~:text=Medical%20Monitoring%20Project%20(MMP):,outlets%20in%20the%20United%20States. 

[5] McCarthy, J. (2025, September 17). HIV cases have increased in Broome County cluster. Why there is still a 'big unknown'? Retrieved from https://www.pressconnects.com/story/news/public-safety/2025/09/17/hiv-cases-rise-in-ny-cluster-while-health-leaders-grapple-with-containment/86181140007/

[6] Peters, D. (2025, February 28). 'It's family here': Bangor officially closes city's largest homeless encampment. Retrieved from https://www.newscentermaine.com/article/news/local/bangor/bangor-closes-homeless-encampment-camp-hope-maine/97-00f3028d-4739-4ce9-b5fc-9287ab30e6ff#:~:text=Boyd%20Kronholm%2C%20executive%20director%20of%20the%20Bangor,approach%2D%2Drather%20than%20an%20immediate%20sweep%2D%2Dis%20more%20effective.

[7] Rupertus, A. (2025, July 28). Bangor syringe exchange service shuts down shortly after opening. Retrieved from https://www.bangordailynews.com/2025/07/28/bangor/bangor-health/needlepoint-sanctuary-shut-down-shortly-after-opening-n6hjn1me0n/

[8] Ryan, B. (2025, September 29). Republicans seek deep cuts to HIV prevention and treatment funding. Retrieved from https://www.msn.com/en-us/news/other/republicans-seek-deep-cuts-to-hiv-prevention-and-treatment-funding/ar-AA1NGD63?ocid=socialshare

[9] Tusinski, D. (2025, July 23). How a ‘cluster’ of HIV cases in Penobscot County became one of Maine’s largest outbreaks. Retrieved from https://www.pressherald.com/2025/07/23/how-a-cluster-of-hiv-cases-in-penobscot-county-became-one-of-maines-largest-outbreaks/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.    

Rural Health Transformation Program Offers Opportunity

By: Ranier Simons, ADAP Blog Guest Contributor

Budget reconciliation legislation, H.R. 1, also known as the "One Big Beautiful Bill Act," was signed into law in July of this year. The bill slashes overall Medicaid spending by $911 billion over ten years. This funding reduction would decrease Medicaid spending in rural areas by over $119 billion over the next ten years (Saunders, Burns, & Levinson, 2025). Medicaid covers one in four adults in rural areas, where 20% of the U.S. population resides. In response to the significant fiscal damage to rural areas resulting from H.R. 1, the bill includes a $50 billion fund known as the Rural Health Transformation Program (RHT). The $50 billion RHT is temporary, time-limited funding that does not remedy the over $119 million in cuts from H.R.1. However, it presents as an option to obtain a modicum of assistance to bolster rural programs.

Photo Source: CMS

To receive RHT funding, states must apply for a grant by submitting a Rural Health Transformation Plan. The RHT will distribute $10 billion annually from 2026 through 2030. Half of the funds will be distributed equally among the states that obtain approval of their transformation plans, and the remainder will be left to the discretion of CMS. The due date for applications is November 5, 2025, with a statutory deadline of December 31, 2025, for CMS to issue rewards (Howard et al., 2025). 

According to the Rural Health Transformation Program website, the program was created to “empower states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem. In essence, the program is designed to stabilize and transform rural health systems nationwide by supporting infrastructure, workforce development, and innovative care delivery models. All comprehensive rural health transformation plans submitted with the funding application must include proposals that invest in at least three of the following areas (Karl et al.):

• Prevention and Chronic Disease: Implementing evidence-based, measurable interventions to improve prevention and chronic disease management. 
• Provider Payments: Supporting payments to providers for delivering healthcare services that fill a gap in care coverage (e.g., uncompensated care). 
• Consumer Technology Solutions: Expanding consumer-facing, technology-driven tools for chronic disease prevention and management.
• Training and Technical Assistance: Building capacity for adoption of technology-enabled solutions in rural hospitals. 
• Workforce: Recruiting and retaining clinicians in rural areas, with a minimum five-year service commitment. 
• IT Advances: Upgrading information technology at rural health facilities to improve efficiency and health outcomes. 
• Right-Sizing Care Availability: Helping rural communities align healthcare service lines (preventive, ambulatory, emergency, inpatient, post-acute) with community needs. 
• Behavioral Health: Expanding access to opioid-use disorder treatment, other substance-use disorder services, and mental healthcare. 
• Innovative Care Models: Supporting value-based care, alternative payment models, and other innovative delivery arrangements. 
• Capital Expenditures and Infrastructure: Investing in facility upgrades, minor renovations, and equipment to ensure sustainable operations. 
• Community Collaboration: Fostering partnerships between rural facilities and other providers to strengthen quality, financial stability, and access.

Photo Source: Shulkin Blog

Presently, numerous states are actively seeking public input on what projects and priorities they should consider in creating programs with which to utilize the funds they apply for. The following link indicates which states are presently receiving comments, as well as the official guidance on how to submit suggestions: Tracking State Preparation for the Rural Health Transformation Program. One state example is Louisiana, which created a landing page for its Request for Information (RFI). Notably, among the rural health challenges that need to be addressed, the Louisiana Department of Health directly highlighted HIV. The site specifies that 56% of new HIV cases are from outside of New Orleans and Baton Rouge. Georgia is another state that could benefit from funding for programs to address the needs of its rural population that is living with HIV. The results from a recently published paper indicate that significant disparities in HIV care access and support exist when comparing rural Georgians to those living in urban areas (Purcell et al., 2025).

As states create application proposals, it is imperative that they research all the fine details of what can and cannot be included. Prohibited uses of funds include support for new construction and building expansions, clinician salaries or wages at facilities with non-compete agreements, expenditures associated with financing the non-federal share of program costs, and requirements related to documenting citizenship (Karl et al., 2025). Given the current political climate, it is essential to navigate the application process with discernment while ensuring that a submitted plan aligns with all organizational goals.

As states submit plans, it would be very encouraging to see elements included that align with the Ending the HIV Epidemic (EHE) Initiative, increase capacity for HIV linkage to care in rural areas, and ways to improve rural PrEP access. Some rural hospitals have already closed, and the massive cuts in Medicaid spending threaten to close more. The RHT is a band-aid on a large wound that is more appropriate for stitches. However, in the status quo of rural healthcare, every dollar counts.

[1] Howard, H, Lopez, R., McLean, J, SHVS. (2025, September 18). Tracking State Preparation for the Rural Health Transformation Program. Retrieved from https://shvs.org/tracking-state-preparation-for-the-rural-health-transformation-program/

[2] Karl, A., Herring, A., Osius, L., Rains, J., Mannatt Health. (2025, September 17). CMS Releases Rural Health Transformation Funding Opportunity. Retrieved from https://shvs.org/wp-content/uploads/2025/09/CMS-Releases-Rural-Health-Transformation-Funding-Opportunity_SHVS.pdf

[3] Purcell, D. J., Standifer, M., Martin, E., Rivera, M., & Hopkins, J. (2025). Disparities in HIV Care: A Rural-Urban Analysis of Healthcare Access and Treatment Adherence in Georgia. Healthcare (Basel, Switzerland), 13(12), 1374. https://doi.org/10.3390/healthcare13121374

[4] Saunders, H., Burns, A., Levinson, Z. (2025, Jun 27). How Might the House-Passed Reconciliation Bill’s Medicaid Cuts Affect Rural Areas? Retrieved from https://www.kff.org/medicaid/how-might-the-reconciliation-bills-medicaid-cuts-affect-rural-areas/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.   

When is 'Enough' Going to Be Enough for Hospital CEOs?

By: Marcus J. Hopkins, ADAP 340B Consultant

Did you know?

Almost all but two of the ten highest-paying professions in the United States are in the medical field. The two professions that are not inherently medical in nature are airline pilots and Chief Executives. On the U.S. News list of the top ten jobs, Chief Executive salaries rank 10th, with a median annual salary of $206,680 (U.S. News, 2025).

Photo Source: Lown Institute

Apparently, U.S. News hasn’t met very many hospital CEOs. In particular, CEOs running the hospitals raking in millions of dollars from the lucrative 340B Drug Pricing Program—which is designed to help poor patients.

Hospitals are vital services filled with people who literally save lives every day, and at the top of the pile sits the Chief Executive Officer, ostensibly responsible for ensuring their hospital can keep the lights on and the patients alive and well. It’s a critical job that requires expertise and understanding of not only the healthcare space, but of business, management, finance, and publicity.

Of the 63 hospitals that ADAP Advocacy has audited since 2023, not a single CEO earned a salary so little as $206,680. Instead, across all 63 hospitals, the average CEO compensation package was $3,378,461—just a bit higher than the figure on the U.S. News list.

Now, obviously, U.S. News’ report considers all CEO positions across all sectors, but it raises the question of whether U.S. News needs to adjust its methodology.

It’s no secret that CEO pay at hospitals has long outpaced the incomes of the people working in those hospitals—people who often work significantly more extended hours and hold in their hands the literal lives of other human beings. In fact, a 2023 report from the North Carolina State Health Plan for Teachers and State Employees found that the CEO pay of just 11 of North Carolina’s non-profit hospitals was the equivalent of what those same hospitals would pay to hire 572 nurses (North Carolina State Health Plan for Teachers and State Employees, 2023).

The NC State Health Plan report highlights just how severe those pay gaps are, particularly at a time when wage growth for non-physician roles is slowing due to hospital system consolidation (Prager & Schmitt, 2021). More damning was that, during the COVID-19 pandemic, hospital CEOs gladly accepted exponential pay raises at these hospitals. In contrast, hospital staff—the individuals responsible for saving lives—were instructed to make do with insufficient supplies and personal protective equipment (Shabad, 2020).

Photo Source: North Carolina State Health Plan for Teachers and State Employees

The issue with CEO compensation, in general, is that CEOs tend to demand high compensation packages, particularly for companies and organizations that generate billions of dollars in revenue annually, and boards of directors often feel compelled to accept those demands. If they don’t want to pay that much, the candidate can simply walk away and find it elsewhere.

The non-physician employees who provide the bulk of care in hospitals don’t have that luxury.

Imagine if nurses and other hospital support staff demanded starting salaries of just $100,000 a year. They would be laughed out of the room, their demands would be rejected, and they would be accused of putting money ahead of patients. In fact, it wasn’t until 1974 that non-profit hospitals were allowed to form labor unions (National Labor Relations Board, n.d.), and even then, they could only do so if they agreed not to strike. 

When nurses strike, as with teachers, the argument is made that they are being selfish for striking. The criticism reflects: How DARE they put the lives of patients at risk?! Never mind that there have been critical nursing shortages for most of the past decade, and that shortage is expected to get considerably worse by 2030 (University of St. Augustine for Health Sciences, 2024). These shortages are driven by several factors, including (but not limited to):

• A rapidly expanding aging population, which grew from 41 million people in 2011 to 71 million in 2019 (a 73% increase; Paavola, 2020)
• An aging Registered Nurse (RN) population that is starting to retire, with more than 25% of all RNs saying in 2022 that they would leave or retire from the field within five years (Rosseter, 2024)
• Nurses not being located where the shortages are greatest
• Job stress, fatigue, and burnout (University of St. Augustine for Health Sciences, 2024)

Meanwhile, the CEO HCA Healthcare—the largest health system in the United States—gladly accepted a compensation package totaling $23,799,137, while the median HCA employee earns $60,082 (Brusie, 2025). This new compensation package increases the HCA CEO-to-worker pay ratio from 356 to 1 in 2023 to a staggering 391 to 1.

Photo Source: Vecteezy

The reality is that, while hospital CEOs have important jobs, they should never have become the stars of the show. Unfortunately, there are no data available that can demonstrate whether or not revenues received from the 340B Drug Pricing Program—a program created to ensure that poor patients were able to access low-cost medications and healthcare services by reinvesting those revenues into increasing access and affordability for those patients—have been used to increase the compensation packages of CEOs or other executives.

We argue that 340B dollars, regardless of the covered entity eligible to receive them, should be directly tied to improving access and affordability for patients. One way to improve services, for example, would be to use those funds to hire more nurses. Or increase the pay of the existing nurses. Or keep rural hospitals open instead of closing them and consolidating them.

There are a lot of moving parts in this debate, but the reality is that we’ve allowed CEO pay at 340B-eligible hospitals to get entirely out of hand. And if we don’t get a handle on the problem, soon, the companies that foot the bill—pharmaceutical companies—are going to refuse to participate.

References:

Brusie, C. (2025, May 05). HCA CEO pay gap widens in 2024; The eye-popping compensation of high-paid hospital CEOs. Bellevue, WA: Nurse.org: News. https://nurse.org/news/hospital-ceo-pay/

National Labor Relations Board. (n.d.). 1974 Health Care Amendments. Washington, DC: National Labor Relations Board: About NLRB: Who We Are: Out History. https://www.nlrb.gov/about-nlrb/who-we-are/our-history/1974-health-care-amendments

North Carolina State Health Plan for Teachers and State Employees. (2023, February 14). Hospital executive compensation: A decade of growing wage inequity across nonprofit hospitals. Raleigh, NC: North Carolina State Health Plan for Teachers and State Employees. https://www.shpnc.gov/nonprofit-hospital-executive-pay-report/open

Paavola, A. (2020, April 07). 266 hospitals furloughing workers in response to COVID-19. Chicago, IL: Becker’s Hospital Review: Finance. https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19/

Prager, E. & Schmitt, M. (2021). Employer consolidation and wages: Evidence from hospitals. American Economic Review, 111(2), 397-427. http://dx.doi.org/10.1257/aer.20190690

Rosseter, R. (2024, April). Nursing Workforce Fact Sheet. Washington, DC: American Association of Colleges of Nursing: News & Data: Fact Sheets. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet

Shabad, A. (2020, May 04). North Carolina is low or completely out of certain critical supplies of PPE. WNCN Charlotte: Articles: News: Health: Coronavirus. https://www.wcnc.com/article/news/health/coronavirus/north-carolina-low-completely-out-critical-supplies-ppe/275-560d5b3e-172c-4e07-bf1d-f0e4524a5190

U.S. News. (2025). Best-Paying Jobs. Washington, DC: U.S. News: Money: Careers: Best Jobs: Best-Paying Jobs. https://money.usnews.com/careers/best-jobs/rankings/best-paying-jobs

University of St. Augustine for Health Sciences. (2024, December 30). Nursing shortage: A 2024 data study reveals key insights. St. Augustine, FL: University of St. Augustine for Health Sciences: Blog. https://www.usa.edu/blog/nursing-shortage/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.