NATIONAL GRANGE NEWS
The National Grange Challenges Congressional Candicates: Protect Rural Healthcare and Fix 340B
Rural hospitals are closing while the program built to save them keeps growing - and keeps missing the communities it was meant to serve. The National Grange is putting every congressional candidate on notice: rural Americans are paying the price for a broken 340B system, and it's time for Washington to fix it.
What is 340B and why it matters for Rural America:
The Problem
Rural America is watching a program intended to help fund and save its hospitals do the opposite. In the spring of 2026, the National Grange launched an investigation into why access to care continues declining even as the federal government's investment in the 340B Drug Pricing Program soars - and what we found demands action.
340B Drug Pricing Program was created for one reason: to give safety-net providers the revenue they need to deliver affordable medicines to low-income and uninsured patients, and to keep rural hospitals' doors open for the families who depend on them. Instead, a lack of program transparency and accountability has opened a loophole that lets large urban hospitals siphon this critical funding meant for rural communities. While 340B spending has ballooned from just over $6.5 billion in 2010 to $100 billion in 2025, rural hospitals are shutting their doors at an alarming rate.
That raises the question every Congressional candidate should have to answer: Is 340B working as Congress intended for the patients and communities it was created to serve?
The Evidence
The National Grange commissioned two independent analyses this year. Both point in the same direction: resources meant for rural safety-net hospitals, serving the country’s most vulnerable citizens, are being captured elsewhere through structural and policy mechanics most rural Americans never see.
Report #1 - The 340B Program Impact on Rural Hospitals:
This analysis by Avalere Health, commissioned by the National Grange, reveals stark disparities between rural and non-rural hospitals - and makes clear that true rural hospitals aren't driving the growth in 340B spending.
Key Findings:
Despite representing 41% of 340B hospitals, rural facilities account for less than 3% of total Medicare 340B drug claims.
Report #2 - Hospital Dual Classification
Compiled by Magnolia Market Access, this report exposes how urban hospitals reclassify as rural to tap into 340B funding meant for rural safety-net providers - then reclassify again as urban to collect higher wage-index payments.
Key Findings:
Dual classification jumped from 168 hospitals in 2018 to 593 in 2023, following a patchwork of court decisions and CMS policy changes.
Key Findings:
Despite representing 41% of 340B hospitals, rural facilities account for less than 3% of total Medicare 340B drug claims.
The Response
For nearly 160 years, the National Grange has been the trusted voice of rural America - and we're using that voice now. We're calling on every candidate for Congress to close the dual-classification loophole, demand greater transparency, and hold 340B accountable to the patients and communities it was built to serve.
In the News
April 2026 - DAILY YONDER: Research: Urban Hospitals Use a Dual-Classification Loophole to Exploit Aid Programs for Rural Hospitals
April 2026 - REALCLEARHEALTH: Rural America Is Paying the Price for Medicare Loophole, Op-Ed by Christine Hamp
April 2026 - WBAL NEWS RADIO: Jerry Rogers Health Decoded: Chris Hamp
Rural Americans should not have to question whether the federal programs created to protect their healthcare access are actually working for them. Every dollar matters when a rural hospital is struggling to keep its doors open, a pharmacy is disappearing from a small town, or a family must drive hours for care."
“We don't just represent rural America - we are rural America! One of our most urgent priorities is the health and well-being of the people we serve, and we're calling on policymakers to reform the 340B program, close loopholes, and restore accountability to the federal 340B Drug Pricing Program.”
Project Inquiries
To partner on this initiative, share information, or ask a question, contact ruralhealth@grange.org