Tag: MHA CEO Report

MHA CEO Report — A Call to Strengthen Healthcare Through Collaboration

Member News, MHA Rounds
MHA Rounds graphic of Brian Peters

MHA Rounds graphic of Brian Peters“If everyone is moving forward together, then success takes care of itself.” – Henry Ford

Our nation’s healthcare system is at a crossroads. Rising costs, workforce shortages and expanding patient needs are placing unprecedented pressure on hospitals and the communities that depend on them. Accepting this strain as status quo is not an option.

The Michigan Health & Hospital Association launched the Always Caring. Always Advancing. campaign as a bold declaration of the shared commitment among Michigan hospitals to build a more affordable, accessible and sustainable healthcare system.

This oath is grounded in a simple but urgent truth: transforming a system shaped by years of uncoordinated and reactive solutions will require collaboration on a much larger scale than what exists within the current healthcare ecosystem, and Michigan hospitals are ready.

As anchor institutions in their communities, hospitals are uniquely positioned to serve as conveners, bringing together policymakers, payers, employers, providers and community leaders to align on solutions that put patients first.

Hospitals are not just adapting to current challenges, they are reimagining what care can be. By working collaboratively, they are advancing new models of care, improving coordination, and ensuring that innovation reaches every patient and every community.

At the same time, the healthcare experience extends far beyond the four walls of a hospital, and no single entity can solve the complex challenges facing our healthcare system alone.

At its heart, Always Caring. Always Advancing. is more than a campaign. It is a commitment to work together in new ways so that Michigan’s healthcare system not only endures but evolves.

Together, this work creates the foundation for a stronger future, one where care is more connected, innovative and affordable, and where every person can access the care they deserve.

If you want to learn more about the work Michigan hospitals are doing to move care forward, I encourage you to visit mihospitals.org.

As always, I welcome your thoughts.

MHA Monday Report May 18, 2026

Member News, Monday Report

House Passes Multiple Healthcare Bills

The Michigan House passed legislation related to third-party litigation financing, Medicaid prescription requirements and surgical smoke plume evacuation during the week of May 11. Lawmakers also introduced legislation related to behavioral health transportation services and …

State House Minority Leader Addresses Legislative Policy Panel

State House Minority Leader Ranjeev Puri (D-Canton) addressed the MHA Legislative Policy Panel May 13 at the MHA Capitol Advocacy Center, providing the panel with a legislative and political update and sharing his commitment to …

2026 Healthcare Leadership Academy Cohort Completes Program

In partnership with Executive Core, the MHA recently celebrated the successful completion of the 2026 Healthcare Leadership Academy, which supports the development of emerging healthcare leaders across Michigan. Through two in-person modules, participants developed skills …

Keystone Quality and Safety Work Highlighted at MICAH QN Meeting

Kristy Shafer, senior manager, MHA Keystone Center, and senior lead quality improvement advisor for Superior Health, presented the Centers for Medicare & Medicaid Services quality improvement program at the Michigan Critical Access Hospital Quality …

MHA Keystone Center to Present During National Caregiver Webinar

The National Alliance for Caregiving will host the webinar “Practical Methods for Integrating Caregivers into Care Delivery” from 1 to 2 p.m. ET May 27, highlighting how hospitals and health systems are embedding caregivers into care models …

Hospitals Help: Memorial Healthcare Prioritizes Infection Control for Long-Term Care Residents

Michigan hospitals have long prioritized infection control and prevention, investing in resources that strengthen safety and quality measures for their patients and staff. The MHA Keystone Center is committed to supporting these efforts. Healthcare teams …

News to Know

  • The MHA Person & Family Engagement Advisory Council met May 14 to examine patient journey mapping, a method used to document and visualize the patient experience across healthcare touchpoints, from recognizing a health need through treatment and ongoing care.
  • Hospitals paid under the Medicare inpatient prospective payment system must submit a calendar year 2025 occupational mix survey to the Medicare Administrative Contractor by June 30.
  • Applicable laboratories, including hospital outreach laboratories, must report private payer data under the Protecting Access to Medicare Act from Jan. 1 through June 30, 2025, during the reporting window open through July 31, 2026.

MHA in the News

The MHA received coverage in a May 12 Crain’s Detroit Business story examining insurance contract negotiations with hospitals. In the article, MHA CEO Brian Peters emphasized that reimbursement contracts between hospitals and insurance companies often …

MHA Monday Report May 11, 2026

Member News, Monday Report

 

Medical Residents Highlight Workforce Needs During 2026 GME Capitol Day

The MHA Graduate Medical Education (GME) Capitol Day welcomed nearly 30 physician residents from member hospitals to the MHA Capitol Advocacy Center offices May 6 for a day of meetings with members of the Michigan …

Safe Table to Focus on Medication Safety in Rural Hospitals

The MHA Keystone Center Patient Safety Organization will host an in-person Safe Table on May 28 at Mackinac Straits Hospital in St. Ignace. The session will focus on strategies to prevent medication errors in …

CDC Restores Immunization Schedules After Federal Court Order

The Centers for Disease Control and Prevention (CDC) restored the official U.S. child, adolescent and adult immunization schedules to the July 2, 2025, versions in compliance with the March 16 federal court ruling in American …

MHA Leaders Present at Michigan State of Reform Health Policy Conference

The 2026 Michigan State of Reform Health Policy Conference convened May 5 in East Lansing, MI, to discuss the most pressing challenges across the healthcare continuum. Lauren LaPine-Ray, DrPH, MPH, vice president, policy & rural …

House Passes 2026 Farm Bill with Rural Health Provisions

The U.S. House of Representatives passed H.R. 7567, the Farm, Food and National Security Act of 2026, on April 30, which includes several provisions supporting rural healthcare infrastructure, broadband expansion and behavioral health services. The …

Protect MI Care Coalition Toolkit Available to Hospitals

The Protect MI Care coalition recently shared a toolkit of resources to help coalition partners make their voices heard in support of maintaining state funding for the Michigan Medicaid program. MHA members are encouraged to …

MHA EventsRegistration for MHA Annual Membership Meeting Closes May 22

Registration for the MHA Annual Membership Meeting June 24-26 at the Grand Hotel on Mackinac Island closes May 22. The event is an opportunity to learn, network and celebrate the accomplishments of the program year. …

Final Federal Loan Rule Maintains Narrow Professional Degree Definition

The U.S. Department of Education recently released a final rule implementing changes to federal student loan programs under the Reimagining and Improving Student Education initiative. The final rule includes changes to graduate and professional …

Hospital CEOs Highlight Value of Governance Fellowship

Applications are being accepted for the 2026-27 Excellence in Governance Fellowship, scheduled from October 2026 through June 2027. Chief executive officers who sponsored their board members to participate in the fellowship, as well as program …

MHA Rounds graphic of Brian PetersCEO Report — No One Knows Healthcare Better than Hospitals

Skyrocketing healthcare costs are impacting families and communities across the state. No one is more committed to addressing this problem than those providing care around the clock. Despite being on the frontlines, hospitals are under fire. …

Hospitals Help Us. Here’s How We Can Help Them.

Hospitals show up for Michigan communities around the clock to provide care, support families and strengthen the places we call home. In honor of National Hospital Week, MHA teams asked members across the state to …

Keckley Report

In US Healthcare, It’s Incrementalism before Transformation by Necessity

“This will be a quiet week for healthcare in DC with major hearings, confirmations and legislative votes not scheduled.

Last week was relatively calm as well. The House Ways and Means Committee heard testimony from hospital CEOs of HCA, ECU Health, Common Spirit and NY Presbyterian featuring accusations of price gauging and unnecessary costs. And a study that found an OpenAI model outperformed doctors in diagnostic reasoning stirred attention in the physician and healthcare tech worlds where AI’s a dirty word to some and salvation to others. …

Transformation of the system, and a clear destiny for its future are secondary to self-preservation in US healthcare today. Our investors and lenders expect it, Board compensation committees reward it, and our workforce depends on it.”

Paul Keckley, May 4, 2026

MHA in the News

Bridge Michigan published a story May 7 detailing how federal funding cuts to Medicaid will further exacerbate rural hospitals’ capacity to treat and transport patients requiring more specialized care. Lauren LaPine-Ray, DrPH, MPH, vice president, …

CEO Report — No One Knows Healthcare Better than Hospitals

Member News, MHA Rounds
MHA Rounds image of Brian Peters

“The price of greatness is responsibility.” — Winston Churchill.

Skyrocketing healthcare costs are impacting families and communities across the state. No one is more committed to addressing this problem than those providing care around the clock.MHA Rounds image of Brian Peters

Despite being on the frontlines, hospitals are under fire. What’s worse is that conversations around healthcare affordability often involve those who don’t understand how policy decisions will play out in practice. When legislators listen to hospital voices, they gain firsthand insight on the needs of Michigan communities while better understanding the barriers that providers face.

Addressing healthcare affordability starts with taking a closer look at the largest cost drivers, many of which are beyond hospitals’ control. While they are often blamed, hospitals do not manufacture or determine drug prices. Similarly, reimbursement rates are ultimately determined by public and private insurers. Although the figures are often taken out of context, hospitals only collect a fraction of what is listed on publicly posted pricing files.

At the end of the day, nobody sees the impact of rising costs quite like hospitals do. Their teams deliver care 24/7 to anyone who walks through their doors, regardless of their ability to pay. They do this while facing acute workforce shortages, rising labor costs, mounting regulatory pressures, cybersecurity threats and more.

Our MHA affordability webpage does a great job outlining cost drivers, visualizing hospital spending and proposing meaningful solutions.

In order to keep putting communities first, hospitals need our state and federal leaders to confront the external pressures dictating how much cost they can realistically absorb. We applaud Senate Majority Leader Winnie Brinks and Sen. Hertel for bringing forth legislation last month focused on expanding coverage options, strengthening continuity of care and addressing costs drivers. Passing this bill package would be an important step toward lowering costs, but it must be part of an ongoing commitment from our lawmakers to collaborate with hospitals on strategies that keep patients at the center of every solution.

During National Hospital Week, we’re asking lawmakers who are serious about addressing healthcare affordability to give local hospitals a seat at the table to help inform decisions, identify solutions and avoid outcomes that ultimately harm Michigan patients and communities.

As always, I welcome your thoughts.

MHA CEO Report — Violence Is Not Part of the Job

Member News, MHA Rounds
MHA Rounds graphic of Brian Peters

“Fear is not a good motivator.” — Edgar Schein

MHA Rounds graphic of Brian PetersHealthcare workers accept extraordinary responsibility in their role as caregivers for their community, but fearing for their own safety is never something they should have to accept as part of the job.

During Workplace Violence Prevention Month, we must be clear in our conviction that ensuring the safety of healthcare workers is not optional.

Violence against healthcare workers is rising at a concerning rate. According to a 2025 American Hospital Association report, up to 76% of healthcare workers have reported experiencing violence. Hospitals refuse to accept this as the status quo. Across the state, our members are investing in security enhancements, strengthening de‑escalation training and reinforcing the message that hospitals are places of healing.

But hospitals cannot solve this growing crisis on our own.

Without intentional policy solutions, efforts to reduce violence against healthcare workers will not meet the scope and severity of the problem. Healthcare workers deserve the same legal and workplace safeguards afforded to others who serve the public, like flight attendants and first responders. The MHA continues to advocate for legislation that will cement the expectation that assaulting healthcare workers will not be tolerated into law.

A fragmented approach to addressing workplace violence isn’t sustainable, which is why our members remain actively engaged in coordinated statewide mitigation efforts. Just last month, hospital HR leaders gathered at our annual HR conference and participated in a workplace violence reduction panel discussion. This October, our Safety & Quality Symposium will continue that focus with programming centered on worker safety. The MHA Keystone Center, a certified patient safety organization, supports this work year‑round by facilitating a member‑led workplace safety collaborative and offering educational opportunities, security risk assessments and trainings in partnership with MHA‑endorsed business partner Tarian.

Healthcare workers are there for us during our most vulnerable moments. It is our responsibility to be there for them as well by building cultures of safety that extend not only to patients, but to those supporting and providing care.

During Workplace Violence Prevention Month, and every month thereafter, we must reaffirm our commitment to prioritizing safety and advancing comprehensive solutions that support staff well-being. Protecting healthcare workers is not only fundamental to our values, but also to our ability to deliver the care our communities deserve.

As always, I welcome your thoughts.

Member Resource Available – Workplace Safety Posters

The MHA developed workplace safety posters for members to display throughout their facilities communicating the consequences of committing physical harm toward healthcare workers or hospital property. The informational posters are geared toward patients, families and visitors, with a couple of creative options available in two sizes. With the help of MHA Endorsed Business Partner AMN Healthcare Language Services, Spanish and Arabic versions are also available. Complimentary copies of the materials are available to MHA members by request through an online order form. Non-members may purchase materials at cost. Questions about materials may be directed to the MHA.

MHA CEO Report — Sustaining Hospital Funding is Key to Meaningful Reform

Member News, MHA Rounds
MHA Rounds image of Brian Peters

“We can’t become what we need to be by remaining what we are.”  — Oprah Winfrey

Michiganders heard a clear message from our state and federal leaders last week: healthcare is too expensive and the system is flawed. We agree. Michigan hospitals are deeply invested in providing timely and accessible care, reducing unnecessary administrative burden and improving transparency.MHA Rounds graphic of Brian Peters

The healthcare landscape in our country is incredibly complex, so it’s imperative to recognize no single action or one-size-fits all approach will create the substantial change we need. For decades, good-faith, reactive polices have attempted to manufacture financial stability for patients and providers by addressing immediate cost pressures, but this approach has only delayed the inevitable conversations we must have about healthcare affordability and sustainability.

Michigan hospitals continue to experience reimbursement rates that fall far below the cost of providing care and our patient population is simultaneously growing older and sicker. Hospitals are continually being asked to do more with less, but even their most innovative efficiency efforts cannot overcome reimbursement that lags far behind the growing cost and complexity of patient care. For example, general inflation rose by 14.1% from 2022 to 2024, while Medicare net inpatient payment rates increased by only 5.1% during the same time period. Access to important healthcare services is at risk when providers are reimbursed at less than the cost of care.

We’re eager to discuss long-term solutions with employers, lawmakers and other healthcare stakeholders, but we cannot address these systemic issues from our back foot. Labor, drug and supply costs are forcing hospitals, especially those in rural areas of the state, to limit services. Maintaining healthcare funding is about protecting access to care in communities across Michigan and not about preserving the status quo.

To create a more affordable system, we need one that is strong enough to withstand change. If we can pair reform and sustainability actions, we can strengthen care and lower costs for everyone long-term.

As always, I welcome your thoughts.

MHA CEO Report — The Reality Behind a Hospital Ribbon-Cutting

Member News, MHA Rounds
MHA Rounds graphic of Brian Peters

MHA Rounds graphic of Brian Peters

Hospital ribbon-cutting ceremonies tend to spotlight the new and modern elements of a hospital expansion: bright windows, sleek patient rooms or advanced diagnostic technology. But what you don’t see is often more important than what you do.

Behind nearly every new facility is a story of aging infrastructure, outdated equipment and community needs that have outgrown what a hospital’s existing buildings can provide. Many hospitals operate buildings that are decades old – some built long before today’s medical technology, infection control standards or patient-centered design principles even existed.

Aging facilities often have electrical systems that can’t support modern equipment, rooms that limit the physical safety and efficiency of frontline workers, HVAC systems not suitable for infection control, or layouts that slow down emergency response or patient flow. Hospitals replace facilities because community needs can no longer be met with outdated structures, not because they want something new.

Expansion of facilities or technology, also referred to as capital projects, are funded through a mix of sources. These often include donors and philanthropic gifts, grants from foundations or government programs, bond financing, occasional state or federal appropriations and hospital capital budgets, which are built from small operating margins over the course of multiple years. These new facilities are not paid for directly from patient bills.

Even in years when hospitals have positive margins, these average margins are typically around only one to three percent and are reinvested directly back into patient care, safety improvements and facility upgrades. These reinvestments in new construction are about preserving access and modernizing care; not profit.

New buildings or service lines often emerge because patients travel long distances for essential care, equipment is too outdated to repair, demand for services like cancer care, imaging or behavioral health has grown, or because safety standards require major updates. A hospital that upgrades its cancer center or brings 3D digital mammography closer to home is reducing travel burdens, improving outcomes and keeping care local.

Behind Every Ribbon are Years of Work and Analysis

Before any groundbreaking, hospitals spend years evaluating whether renovation is possible or if replacement is more cost-effective. Hospitals also consider how to minimize disruption to patient care and what community health data shows about long-term needs. Finally, with all those factors considered, hospitals and health systems then determine how to secure funding without burdening patients.

The result may look like a brand-new facility, but it represents years of planning, prudent budgeting and community-focused decision-making.

In an era when headlines move fast, communities may question why hospitals announce expansions at the same time they face workforce shortages or reimbursement challenges. The answer is simple: capital investments and operational budgets are not the same.

A hospital can be financially strained day to day while still needing to replace unsafe or outdated infrastructure. So next time you see your local hospital celebrating the grand opening or ribbon cutting of a new facility or technology, you can join in the celebration by knowing that your community, family and friends are receiving high-quality, modern care for decades to come, all close to home.

As always, I welcome your thoughts.

MHA Monday Report Jan. 12, 2026

Member News, Monday Report

MHA Healthcare Leadership Academy Applications Due Feb. 6

The enrollment deadline for the MHA Healthcare Leadership Academy is Feb. 6. The cohort meets Feb. 25-27 and May 7-8 at the MHA headquarters in Okemos. HCLA, in partnership with Executive Core, has been …

MHA Joins Coalition Letter Opposing Federal Redefinition of Professional Degrees

The MHA joined a statewide coalition in signing a letter to Michigan’s congressional delegation expressing concern about a proposed federal change that would remove several health professions, including nursing and behavioral health fields, from the …

Webinar to Highlight Effective Cyber Incident Response

MHA Endorsed Business Partner CyberForce|Q is hosting the webinar Proactive Cyber Risk Measures from 11 a.m. to noon ET on Jan. 29. The session will feature speakers from Trinity Health, the Michigan State Cyber …

MHA Rounds image of Brian PetersMHA CEO Report — 2026, A Pivotal Year for Healthcare

As we look toward the year ahead, one thing is clear: healthcare will remain at the forefront of public debate. We’ve seen time and again how healthcare delivery is shaped by policy decisions. …

Keckley Report

Healthcare 2026: Three Realities

“Congress returns to DC this week to debate the merits of extending the advanced premium tax credits that enable coverage for 4 million in a climate of high anxiety about U.S. intervention in Venezuela and heightened tension with Russia and China.

Each sector in healthcare—hospitals, physician services, long-term care, insurers, life science manufacturers, enablers and advisors—is vulnerable. None welcomes unflattering attention and all spend heavily on messaging and advocacy to protect themselves.  All recognize the elephant in the room—large employers that have patiently funded the system’s profitability and value protective regulation that limit disruption. And in all, implementation of AI solutions that lower operating costs and streamline performance is THE immediate priority.

The realities of 2026 for healthcare are foreboding: business as usual is not an option.”

Paul Keckley, Jan. 4, 2026

MHA in the News

The MHA received media coverage during the week of Jan. 5, covering the increasing rate of flu-related hospitalizations in Michigan. Both Bridge and Michigan Public published stories during the week based on interviews with Jim …

MHA CEO Report — Dedicated to Care Every Day of the Year

Member News, MHA Rounds
MHA Rounds image of Brian Peters

MHA Rounds image of Brian Peters“Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.” — Dalai Lama

During the holiday season, we look forward to annual traditions and time spent with loved ones. While many of us gather around our tables this season, we are all aware of individuals who sacrifice this special time with cherished company to keep the places of healing in our communities open.

Hospitals don’t close for the holidays. They are open 24 hours a day, 7 days a week, 365 days a year. Emergencies don’t check the calendar, and neither do the people who dedicate their lives to responding to them.

Every hospital in Michigan can provide round-the-clock service because of the remarkable network of professionals working there. There are teams of highly skilled clinicians ready at the bedside, but there is also a deep bench of essential staff working diligently behind the scenes. Nurses, physicians, medical assistants and countless other care providers are able to deliver comfort and support when it matters most thanks to the help of many colleagues whose work often goes unseen.

There are environmental services teams who ensure every room is safe and clean, maintenance workers who manage essential systems for heat, power and water, food service workers making meals for staff and patients, and lab technicians providing fast, accurate, results. Our hospitals employ accountants, attorneys, communications and IT professionals, and so many more.

And these individuals aren’t strangers. They are our neighbors, our friends and our family members. They are the people we see at the grocery store, at school events or in line for our morning coffee.

Their commitment means that when a baby spikes a fever or a parent slips on ice, help is always there. Their presence brings reassurance to every family in our community: no matter the hour or the day, hospitals stand ready.

To all those working this holiday season, thank you. You are there when we need you most, and our communities are stronger because of you.

As always, I welcome your thoughts.

MHA Monday Report Nov. 10, 2025

Member News, Monday Report

Congressman Bergman Co-Sponsors Critical Access Hospital Relief Act

U.S. Rep. Jack Bergman (R-MI) recently co-sponsored HR. 538, the Critical Access Hospital Relief Act of 2025, which would remove the 96-hour physician certification requirement for inpatient services at critical access hospitals. The bill, introduced in January 2025, would amend …

State and Medical Partners Urge Michiganders to Get the COVID-19 Vaccine

To help ensure access to the COVID-19 vaccine for all residents, the Michigan Department of Health and Human Services, Department of Licensing and Regulatory Affairs and Department of Insurance and Financial Services …

MMMS and FIMR Aligned Recommendations to Improve Maternal and Infant Health

The Michigan Maternal Mortality Surveillance (MMMS) and Fetal Infant Mortality Review (FIMR) programs recently released aligned recommendations at improving outcomes across the maternal and infant health continuum. MMMS reviews cases of maternal deaths that occur …

Honoring Veterans Through Improved Access & Care Coordination

When observing Veterans Day, it’s important to recognize how healthcare organizations can meaningfully work together to improve health outcomes and address the unique needs of service members and their families. …

Key Findings from the Michigan Interpreter Needs Assessment Report

Understanding the critical role interpreters play in hospitals, the MHA Health Foundation recently contributed funding to support the Michigan Department of Licensing and Regulatory Affairs in conducting a needs assessment of Michigan’s interpreter landscape. …

MHA Rounds graphic of Brian PetersMHA CEO Report — Streamlining Medicaid Work Requirements

As states work toward establishing Medicaid work requirements that are a core element of H.R. 1, it’s more important than ever that we reduce the administrative burden associated with verification for beneficiaries. …

Keckley Report

The Structural Flaws that Must be Fixed to Transform the U.S. Health System

“Such is the case for health insurance coverage for millions in the U.S. as the federal government shutdown enters Week 6. Democrats are holding out for continuation of Affordable Care Act (ACA) insurance subsidies that enable 22 million to “buy” insurance cheaper, and Republicans are holding out for federal spending cuts reflected in the One Big Beautiful Act (July 2025) that included almost a trillion reduction in Medicaid appropriations thru 2036.

ACA subsidies at the heart of the shutdown successfully expanded coverage in tandem with Medicaid expansion but added to its costs and set in motion corporatization and consolidation in every sector of the health system. The pandemic exposed the structural divide between public health programs and local health systems, and insurance premium increases and prior authorization protocols precipitated hostility toward insurers and blame games between hospitals, insurers and drug companies for perpetual cost increases. …

Sixteen years later, healthcare is once again the eye of the economic storm. Insiders blame inconsistent regulatory enforcement and lack of adequate funding as root causes. Outsiders blame lack of cost controls. consolidation and disregard for affordability. Thus, while attention to subsidized insurance coverage and SNAP benefits might temporarily calm public waters, they’re not the solution. …

Healthcare’s the same. Outside forces seen or not will impact its future dramatically. Plans have to be made though Black Swans like the pandemic are inevitable.  But long-term planning built on plausible bets are necessary to every healthcare organization’s future.”

Paul Keckley, Nov. 2, 2025

New to KnowNews to Know

  • MHA offices will be closed and no formal meetings will be scheduled Nov. 11 in honor of Veterans Day.
  • The MHA will host a virtual member forum from 8:30 to 9:30 a.m. Nov. 7 to outline the MHA 2025-26 Strategic Action Plan approved by the MHA Board of Trustees.
  • Amy Brown, chief nursing officer, MHA, recently joined MHA Endorsed Business Partner (EBP) AMN Healthcare on the episode “Empowering Nurses Through Advocacy and Innovation” of the Elevate Care Podcast.
  • MHA EBP SunRx is continuing a webinar series about 340B Rebate Model Briefings on Nov. 13 and Nov. 20.

MHA in the News

Bridge published a story Nov. 5 sharing five reasons why health insurance rates are rising at increasing rates in the state, which included workforce challenges, expiring enhanced premium tax credits, inflation and drug prices. …