Meanwhile, McKinley has also changed his negotiation tactics to get his bill into the mix. He and his cosponsors had originally wanted it passed before the HHS cuts took effect on Jan. 1. Now he is pushing E&C Chair Greg Walden (R-Ore.) to convene a meeting with all the policymakers who want to change the program and hammer out a path forward that includes ratcheting back the 340B program.
"It's expanded too much," McKinley said. "It was a good program that went through all the loopholes and quadrupled or it's five times the size. At the very least we've got to freeze the program until we get a better grip on how it can be used. But the idea of cutting it back this way is too punitive."
Besides the moratorium, McKinley would also consider a slow phase-in of the Medicare reimbursement formula change implemented by HHS on Jan. 1 with little warning. This, he said, was "too draconian."
He also is wary of reporting requirements as he said paperwork is already too burdensome for small providers. But he is willing to compromise.
"I have room to negotiate on this, and so I am trying to get a hearing," he added. "I am trying to get Greg (Walden) to work with me on this and see if we can't work something out."
On Pharma's push against the program, McKinley said he understands their position. That the original 340B statute requires pharmaceutical companies to pay for uncompensated care doesn't make clear sense to him, he said. But he is adamant that lawmakers shouldn't change that now.
"That's the law, and let's make it work," he said. "I think (Pharma lobbyists) see this opportunity as a way to extricate themselves from issue. I don't think we should do that unless we have another funding source. Let's clean it up and work on it."
As policy discussions fluctuate on Capitol Hill, some 340B hospitals are also getting more vocal about their willingness to look at program changes.
Thomas Worthy, vice president of government affairs for the Piedmont Hospital system in Georgia, wrote a letter to Walden in late December stating disagreement with the American Hospital Association's opposition to proposed changes to 340B. Piedmont, Worthy wrote, "eagerly stands by ready to partner with you and your Committee to develop common-sense and meaningful reforms and assess any impact they may have on healthcare delivery in the United States."
In an interview, Worthy said the letter shouldn't be read as a split in the hospital community. He, like other hospital officials who have spoken to Modern Healthcare, is concerned about the "patient definition" proposal especially and vehemently opposes the HHS cuts.
"But we believe in transparency, and it has become clear with us that the legislators, especially in the House, believe transparency is important too," Worthy said. "We wrote the letter to help the committee understand that Piedmont's systems use the program as intended and these cuts affect services that can put patients at risk."
In the meantime, Weinstein and his group aren't letting up. They are planning a "major demonstration" at Peters' district office for Feb. 22 and next week will run a new ad in San Diego.
Weinstein has the constitutional right to run these ads, Peters said. "But it creates a lot of work for us, a lot of clarification. The people know where I'm coming from. What my district demands is someone who is willing to get in the middle of these things and work on them. If you're in the middle of the road they'll shoot you from both sides."
