Catholic healthcare was not started nor inspired from profit and loss statements or a desire to drive more shareholder value. Instead, through acts of mercy, women religious crossed oceans on rudimentary vessels and traveled along dirt roads by horse-drawn carriage, overcoming religious discrimination and language barriers to care for those who otherwise would have gone without. In the Franciscan tradition, this ministry has always been guided by what is oftentimes viewed as radical commitment to poverty, humility, solidarity with the poor and joyful service. These values, rooted in the Gospel, have been lived out in rural and underserved communities for centuries.
In my humble opinion, the 340B Drug Pricing Program is a clear embodiment of those values in today’s healthcare system.
A program aligned with Catholic Social Teaching
Catholic Social Teaching rests on four pillars that are especially relevant to healthcare: the dignity of the human person, the preferential option for the poor, solidarity and subsidiarity. The Catholic Health Association has long taught that healthcare is not merely a service, but a moral responsibility, and institutions must be judged by whether they enhance or threaten human dignity.
340B aligns squarely with these principles:
- Human dignity: By ensuring access to life-saving medications for people who are uninsured, underinsured or geographically isolated
- Preferential option for the poor: By directing resources to providers that care for patients with the fewest choices
- Solidarity: By requiring profitable pharmaceutical manufacturers share responsibility for the common good
- Subsidiarity: By allowing local hospitals, clinics and community partners to determine how best to meet the needs of their own communities rather than imposing disconnected, one-size-fits-all solutions
What 340B means in rural and Franciscan ministry
For rural hospitals and Catholic systems, 340B is not a financial strategy; it is a service line enabler.
Chris Thomas, president and CEO of Community Hospital in Grand Junction, Colo., leads a 60-bed hospital serving a vast rural region. In his public advocacy, he describes what many Catholic rural leaders know firsthand: without 340B, essential services such as oncology infusion, behavioral health and charity care would simply not survive.
That same reality was voiced by Mahomed Ouedraogo, CEO of Chicago-based Access Community Health Network. During 340B Action Day, he spoke about how 340B is a lifeline that allows providers to accompany patients beyond the clinic walls through contract pharmacies that bring medications closer to home. Mr. Ouedraogo has urged Illinois legislators to pass HB 2371 SA2, to protect patient access from arbitrary manufacturer restrictions.
This is subsidiarity in action: care delivered as close as possible to the patient, by people who know their community and walk with them through their time of need. When patients are forced to travel long distances for care, they are often separated from their families, parishes and support systems that are essential to healing. These barriers can lead to care disruption, resulting in poorer health outcomes in our communities with the fewest resources.
The moral problem with pharma’s campaign against 340B
Pharmaceutical manufacturers argue that 340B has “strayed from its purpose.” Yet the actions they propose reveal a different motivation.
Industry-aligned advocacy groups, including ADAP Advocacy, have sought to shift the debate toward hospital CEO compensation — an argument that distracts the central issue and is not supported by federal oversight findings. And amid manufacturers’ calls for 340B reform, core realities are left unaddressed: the program does not set drug prices, does not increase premiums and is not funded by taxpayers. It makes one wonder why every call for reform from pharma seems to turn a blind eye to these fundamental facts.
What 340B does is limit the ability of manufacturers to extract maximum profit from safety-net care. From a Franciscan perspective, this is not merely an economic dispute. It is a question of whether markets exist to serve people, or if people exist to serve markets — a question Catholic Social Teaching has always answered unambiguously.
Integrity, oversight and truth
Claims of widespread abuse within 340B are not substantiated by the facts. The American Hospital Association and 340B Health have consistently shared research indicating 340B hospitals are more compliant with program rules than drug manufacturers assert.
It is a point John Adams even understood in the 1700s when he reportedly said, “facts are stubborn things.”
In contrast, manufacturers have increasingly attempted to unilaterally change how the 340B program operates — most recently by proposing rebate models that replace statutory upfront discounts with delayed reimbursement. These models force hospitals to pay full price upfront, and then wait for reimbursement, undermining their ability to stretch limited resources and continue serving patients with the greatest financial need. In addition, these rebate approaches often lack clear enforcement guidelines, including defined payment timelines and transparent criteria for resolving claim disputes. Without these protections, hospitals face uncertainty around reimbursement and administrative burdens that further threaten their ability to provide affordable care to the communities they serve.
Recognizing the gravity of these changes, the American Hospital Association and others have filed suit to block them, and federal courts have already halted portions of these efforts. Further underscoring the stakes, the Health Resources and Services Administration announced in February that it would extend the public comment deadline to April 20, acknowledging the need for careful discernment rather than rushed policy shifts.
In Catholic terms, this is a moment for prudence and moral clarity, not capitulation to corporate pressure or financing political campaigns.
A Franciscan witness in health policy
Saint Francis of Assisi taught that we must walk with the poor, not speak for them from a distance. Catholic healthcare has lived that witness for generations — particularly in rural America, where hospitals and systems like my own are often the last remaining anchor institution.
Weakening 340B would not lower drug prices. It would not improve access. It would simply shift financial burden onto rural hospitals, Catholic ministries and the patients least able to absorb it, ultimately threatening the availability of care in the very communities that depend on it most.
Protecting 340B is not about defending an institution. It is about defending a moral imperative.
A society is ultimately judged, as the church teaches, by how it treats its most vulnerable. By that measure, the 340B program is not a problem to be solved, but a promise to be kept and secured.
Damond W. Boatwright is president and CEO of Hospital Sisters Health System, a Catholic nonprofit with 13 hospitals and 130 care sites in Illinois and Wisconsin.
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