Advancing Health Podcast

Episode: How Legal Advocacy Is Shaping the Future of Health Care
Date: June 30, 2025
Host: Tina Friesdecker, President & CEO of Corewell Health, 2025 AHA Board Chair
Guest: Chad Golder, General Counsel, American Hospital Association

Episode Overview

This episode explores how legal advocacy is becoming increasingly crucial in shaping the health care landscape. Host Tina Friesdecker speaks with Chad Golder, AHA’s general counsel, about the shifting legal environment facing hospitals and health systems. The discussion delves into the impact of legal challenges to government actions, the administration’s use of federal funding as a policy lever, regulatory relief efforts, the significance of the Supreme Court’s Chevron decision, and ongoing litigation around the 340B drug pricing program.

Key Discussion Points & Insights

1. Current Legal Landscape: Administrative Challenges and Court Battles

• Volume of Legal Challenges:
  • Over 270 recent legal challenges to administration actions.
  • “It was averaging two challenges a day, basically, whether it's a grant, immigration action, all sorts of stuff.”
    — Chad Golder [03:21]
• Forum Selection by Plaintiffs:
  • Plaintiffs often file in jurisdictions perceived as favorable (e.g., Boston, Baltimore federal courts).
  • Resulting preliminary injunctions can have nationwide application, not just in the jurisdiction where filed.
  • Importance of watching as cases move up to the Supreme Court, which may be less confrontational in the current administration.
  • Quote:
    • “What you have to remember first is that the plaintiff's got to choose where they're suing... the decision to enjoin doesn't just apply to Massachusetts, it will apply all across the nation.”
      — Chad Golder [03:40]

2. Federal Funding, Grants, and Legal Leverage

• Policy Enforcement via Grants and Contracts:
  • The administration uses control over federal funds as leverage to pursue policy goals (e.g., DEI, antisemitism).
  • New broad grant cancellation powers introduced in 2020 let agencies revoke grants if inconsistent with priorities.
  • Legal Challenges:
    • Procedural: Did the government follow required processes?
    • Constitutional: Actions must not violate protections like the First Amendment.
  • Quote:
    • “Federal money is a privilege and it's not a right. The government has significant control over what it does with its money.”
      — Chad Golder [05:37]
• Planning Uncertainty:
  • The volatility of multi-year grant funding creates challenges for hospitals and grantees.
  • Golder empathizes, noting AHA itself faces the same uncertainties as a federal contractor:
    • “I've never felt closer to the GCs of our members than I do now...”
      — Chad Golder [08:21]

3. Regulatory Relief and Reducing Administrative Burden

• AHA Advocacy Efforts:
  • Active engagement with the administration on regulatory relief, responding to RFIs (Requests for Information) from OMB, HHS, DOJ, and FTC.
  • Submission of a comprehensive list of over 100 regulations to target for elimination or streamlining.
  • A special focus on leveling the playing field between hospitals and large commercial health insurers (e.g., United, Aetna).
  • Quote:
    • “The number one regulatory relief priority... should be focusing on those regulations that unfairly advantage commercial insurers...”
      — Chad Golder [10:24]
  • Regulatory relief recommendations and details are available on the AHA website.

4. The Repeal of the Chevron Doctrine and Its Implications

• Chevron Deference:
  • Previously, courts deferred to federal agencies’ interpretations of ambiguous statutes.
  • The Supreme Court’s 2024 Loper Bright decision overruled this doctrine.
• Impact Uncertain:
  • The change mostly affects new notice-and-comment rules.
  • Could hinder the administration’s ability to act aggressively through regulation.
  • AHA closely monitoring; legal advocacy will emphasize statutory authority in future arguments.
  • Quote:
    • “If they take aggressive interpretations of federal statutes, there will no longer be any deference to that agency...”
      — Chad Golder [12:43]

5. 340B Drug Pricing Program: Ongoing Litigation

• Two Key Legal Fronts:
  1. Drug Manufacturer Rebate Policies:
     • Shift by drug companies to deny upfront 340B discounts, replace with post-sale rebates.
     • AHA and HHS opposed this; lawsuit led to a recent court upholding HHS’s rejection of the policy.
     • Further agency review and likely more litigation ahead.
     • Quote:
       • “This kind of shows you how law and policy and federal relations... all the different tools of advocacy come together because we won in the courts... but now we just have to go back to the agency and advocate again...”
         — Chad Golder [15:10]
  2. State Contract Pharmacy Laws:
     • 16-17 states now have laws forbidding drug company restrictions on 340B drug shipments to contract pharmacies.
     • AHA submitting amicus briefs across states, defending hospitals’ rights to participate.
     • “We're filing briefs probably on average one or two a week in all of the new states that are enacting these laws.”
       — Chad Golder [16:24]
• Final Take:
  • 340B issues are highly litigated and require continuous vigilance.
  • “The ultimate lesson is if something touches 340B, it's going to end up in the courts one of these days.”
    — Chad Golder [17:27]

Memorable Quotes

• On the rapid pace of legal cases:

  • “It was averaging two challenges a day, basically, whether it's a grant, immigration action, all sorts of stuff.”
    — Chad Golder [03:21]

• On the power of federal funding:

  • “Federal money is a privilege and it's not a right. The government has significant control over what it does with its money.”
    — Chad Golder [05:37]

• On regulatory inequities:

  • “The number one regulatory relief priority... should be focusing on those regulations that unfairly advantage commercial insurers...”
    — Chad Golder [10:24]

• On Chevron’s repeal:

  • “If they take aggressive interpretations of federal statutes, there will no longer be any deference to that agency...”
    — Chad Golder [12:43]

• On 340B litigation:

  • “The ultimate lesson is if something touches 340B, it's going to end up in the courts one of these days. So we have to be vigilant and active on that front.”
    — Chad Golder [17:27]

Notable Timestamps

• [01:49] — Chad Golder explains the landscape of legal challenges to government action.
• [05:04] — Discussion of the administration’s use of grants as a policy lever and legal issues raised.
• [08:34] — Focus on regulatory burden and AHA’s advocacy for relief.
• [12:03] — Implications of the Supreme Court’s Chevron repeal for health care regulation.
• [14:14] — In-depth discussion of latest legal activity and AHA efforts on the 340B drug pricing program.

Tone and Takeaways

The discussion is pragmatic and detailed, reflecting ongoing legal and regulatory uncertainty in health care. Golder brings a lawyer’s rigor and insider’s empathy, often expressing solidarity with hospital general counsels. The episode strikes a balance of caution and hope—highlighting AHA’s persistent, multi-front advocacy for its members.

This summary captures the episode’s major themes and developments, presents key insights and quotes, and should be valuable for hospital leaders and health policy professionals seeking to understand the evolving legal context of American health care.