One of Washington’s most powerful health care lobbies has repeatedly positioned itself in opposition to President Donald Trump’s ambitious health care agenda: the American Hospital Association (AHA).
“In effect, the AHA [has] functioned as an auxiliary of the Democratic National Committee,” a GOP source told the Washington Reporter.
Long a dominant force in health policy debates, the AHA has emerged as a counterweight to several of the administration’s reforms.
Recently, the AHA turned to the courts after the Trump administration moved to impose basic accountability on the fraud-ridden 340B drug-pricing program — a system that provides hospitals steep discounts on prescription drugs intended for low-income patients, but which has repeatedly been linked to misuse and lack of transparency.
In July, the Department of Health and Human Services (HHS) announced a voluntary, limited, and data-driven pilot program to test a rebate-based model for 340B discounts. The AHA promptly sued to stop the program.
In that lawsuit, the AHA dismissed the reform effort as “a solution in search of a problem” — a claim that raised eyebrows across the health policy community. The AHA did not respond to request for comment. The AHA’s battle with the Trump administration comes on the heels of research showing that hospitals are most responsible for driving up the price of health care.
Terry Wilcox, the chief executive officer of Patients Rising, told the Reporter that the AHA’s claims about 340B reform don’t add up. “Calling 340B reform ‘a solution in search of a problem’ ignores years of evidence showing that discounts meant for patients are being converted into massive hospital margins,” Wilcox said. “Transparency threatens that business model, which explains the lawsuits.”
Just weeks earlier, Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Sen. Bill Cassidy (R., La.) released findings from a years-long investigation citing “transparency and oversight concerns that prevent 340B discounts from translating to better access or lower costs for patients.”
Cassidy has explained to the Reporter in multiple interviews that one of his top priorities as chair of the HELP Committee is to cut waste in America’s health care system.
The AHA’s resistance to the Trump administration has extended to basic data collection. The AHA objected last month to Centers for Medicare & Medicaid Services (CMS) asking hospitals that participate in federal drug programs to complete routine surveys on drug acquisition costs.
“Our members have serious concerns about the burdens imposed by the drug acquisition cost survey,” the association wrote, arguing that the burdens justified refusing to complete a non-mandatory questionnaire.
One possible reason for that reluctance is what the data might reveal. According to a recent Milliman report, hospital margins on certain 340B drugs used to treat autoimmune diseases can reach 409 percent, 610 percent, 3,610 percent, and in some cases more than 108,000 percent.
During debate over Trump’s signature One Big Beautiful Bill (OBBB), the AHA spent millions on television advertising warning that reforms targeting waste, fraud, and abuse in federal health programs would be a “devastating blow” to underserved communities. The group also attacked the bill’s tax provisions as “disproportionately benefiting high-income individuals” — a notable talking point coming from a hospital trade association.
A former Senate staffer told the Reporter that “the AHA, to its credit, ran effective ads proclaiming that the OBBB would devastate hospitals and Medicaid but it just wasn’t true. The cuts — to the extent there were any — were to waste, fraud, and abuse, and they don’t even come into play for years. It was extremely annoying as we were whipping votes and trying to get Senators Murkowski and Cassidy comfortable with getting to yes.”
The staffer added to the Reporter that the AHA “had Tillis convinced that Medicaid was going to end. AHA really was super annoying during OBBB. They almost killed it.”
During that battle, the AHA’s messaging featured emotionally charged campaigns highlighting the “faces of Medicaid,” including children, people with disabilities, seniors, and nursing-home residents — populations that were not targeted by the reforms at issue.
This pattern is not new. In 2020, when Trump sought to enforce a widely popular rule requiring hospitals to publicly disclose negotiated prices for health services, the AHA sued to block it.
“A consistent theme runs through the AHA’s opposition to the Trump health care agenda: resistance to transparency,” a health care expert told the Reporter. “Transparency in the prices hospitals charge patients. Transparency in how drug-discount benefits are used. Transparency in what hospitals actually pay for drugs.”
“For institutions that enjoy tax-exempt status and receive substantial taxpayer subsidies, that resistance deserves scrutiny,” the expert continued. “President Trump is right to shine a light on these inequities and lawmakers in Washington would be wise to help him do it.”
