Legal advocacy isn’t just a tactic — it’s a vital force protecting the future of health care. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with Chad Golder, general counsel for the American Hospital Association, about the complex legal landscape hospitals and health systems must navigate to ensure continued care for their communities. From high-profile court cases and threats to funding, to the evolving 340B Drug Pricing Program, the stakes have never been higher for health care.

Tom Haederle

Tina Freese Decker

Hello, and thank you so much for joining us today. I'm Tina Freese Decker. I'm the president and CEO for Corewell Health, and I'm the board chair for the American Hospital Association. A large part of the work that the American Hospital Association does on behalf of all of our members is advocacy. And when many of us think of advocacy, legislation and regulation usually are top of mind.

Tina Freese Decker

But legal advocacy is a key component of the AHA's larger advocacy strategy and is important in so many ways to health care today. Whether it's an extension of the tariff conversation that we had last month or 340B and the many other issues that make their way to the courts, there is a lot of work being done on behalf of our hospitals and our health systems.

Tina Freese Decker

That's why I'm so very pleased to be joined today by Chad Golder, AHA’s general counsel, who is tracking all of these issues on behalf of our field. So, Chad, thank you so much for joining us, for being here with us. I've heard you present on a few of these issues recently and I know that our listeners would so appreciate the insight and updates that you're able to share as it relates to the current legal environment.

Tina Freese Decker

We have seen a lot of legal challenges to various presidential actions in the past several months. Can you give us your thoughts and how should we make sense of all this going on between the administration and the courts and the headlines that we are seeing?

Chad Golder

Absolutely. And thank you for having me, Tina. And thank you for all you do for the AHA. You are certainly right that we have seen a lot of legal challenges over the past few months. There's a website that tracks that. We are now well over 270 legal challenges to administration action. I know that the headlines can be dizzying every day, but whatever paper you're reading, you're seeing some new court decision that did something.

Chad Golder

So really, the way I think about it is this: it's really important to remember that in any lawsuit, the plaintiff, the person who's bringing the challenge, gets to make some important decisions first. The most important at least over the past few months with respect to administration challenges is where to sue. And what we're seeing is a lot of challenges in friendly jurisdictions, places that are friendly to the plaintiffs.

Chad Golder

So the Boston federal court, the Baltimore federal court, where you're going to have a lot of appointees from the Democratic Party who may be more sympathetic to the plaintiffs claims. Now, this is not universally true. There are folks who track this kind of data, and there are plenty of Republican-appointed district court judges striking down administrative actions.

Chad Golder

But I think that is an important feature. So when you see a headline that says court strikes down or a court enjoins this particular administration action, this DOGE cut, this grant condition - what you have to remember first is that the plaintiffs got to choose where they're suing. The second thing to remember is a lot of these challenges involve what's called preliminary relief.

Chad Golder

They're seeking to just halt things in place with a preliminary injunction. And courts are somewhat more willing to grant those here because, you know, they just want to maintain the status quo. They want to say, you know, let's put everything on hold. Let's not let the administration do anything right away until we can sort out all of these legal issues.

Chad Golder

But what comes with that sometimes is what they call a nationwide injunction. Even though the case was brought, say, in Boston by the Massachusetts attorney general, the decision to enjoin doesn't just apply to Massachusetts. It will apply all across the nation. And that raises the third point, which is we really do need to pay attention to what happens as they make their way up the chain towards the Supreme Court.

Chad Golder

As I said earlier, they're filing in friendlier jurisdictions. But over time, as more courts of appeals and the Supreme Court get involved, the win/loss record for the administration will change. Now, the administration's not going to win everything. But overall, I think what we've been seeing is a Supreme Court that's friendlier to this administration, at least in the sense that they are not going to invite a conflict with the Trump administration that they don't have to.

Chad Golder

So hopefully with that framework, folks can think about, you know, the broad range of challenges that have come and we've seen them to everything. You know, it was averaging two challenges a day, basically, whether it's a grant, immigration action, all sorts of stuff.

Tina Freese Decker

But you and your team have been very busy. You know, our current administration appears to be using money that you just mentioned, grants, contracts and other forms of grant funding to really effectuate their policy goals. Is that correct? And what sort of legal issues does that raise?

Chad Golder

That is a great insight, Tina. What I think this administration has found is that money is a powerful lever, and they are able to effectuate their policy goals without making a judgment about those policy goals, whether it's, you know, DEI or something related to anti-Semitism. They're able to effectuate those policy goals by using the threat of money or withdrawal of money.

Chad Golder

Now, this raises a bunch of different legal issues. But the way I generally think about this is, federal grants, federal money is a privilege and it's not a right. The government has a significant amount of control over what it does with its money. There's a great Washington Post article from early in the administration in March. Folks should look at it.

Chad Golder

Chad Golder

And that's very broad language. That lets them cancel a grant for basically anything they want. So that leaves you with two sets of legal challenges to any cancellation. They have the power to do this. They just have to do it the right way. So one is procedural. Did they go through the right processes? Did they give the right notice and comment?

Chad Golder

Some grants require that. Some monetary action require you to follow a particular process. Just the other day, for example, a district judge struck down some cancellation to AmeriCorps funding because they didn't go through the proper process. The other basis to do it, to challenge it is the Constitution. You know, even though there are rules on the books, if the Constitution says you can't do something, then you can't do something.

Chad Golder

And we've seen that in the examples of like Harvard or the law firms, where if there is a claim that the administration has done something in violation of, say, the First Amendment, they're discriminating against you because of your viewpoint or your political position. We've seen a lot of challenges to that. Now, those are all working their way through the courts.

Chad Golder

Some have decisions, some don't yet. But I think that will be an important area to watch in the coming weeks and months to see the scope of the executive branch power to cancel grants for based on political preferences and things like that.

Tina Freese Decker

It's still quite hard to do planning, especially when you have a grant that is three, four or five years, or programs that are that long. And so it is still challenging to do it, but it helps, you know, the different processes that that could go.

Chad Golder

I have said, you know, I've never felt closer to the GCs of our members than I do now because we at the AHA are a federal contractor. I'm dealing with the same issues and uncertainty that you guys are now. So it is a challenge.

Tina Freese Decker

So we both know that hospitals and health systems are subject to a complex web of federal regulations, many of which do increase class and drive inefficiencies in our operations. And some are some are very good too. What is the administration been doing in the regulatory relief space, and how has the AHA been engaged in that work?

Chad Golder

This is a really big priority of the second Trump administration. We have seen RFIs requests for information from a number of different agencies: OMB, HHS and others asking for lists or recommendations of regulations that are wasteful, that can go away. And the AHA has been extremely active on this front. This is one of the areas where we think we're working extremely well with the administration.

Chad Golder

For the first set of these RFIs with OMB and with HHS, we sent over a list of 100 regulations or regulatory areas that the administration can and should take a hard look at. And they, you know, they run the gamut of all the kinds of regulations in that complex web that you mentioned, Tina, of regulations that they should be looking at to either get rid of or alter or streamline to make it easier for hospitals to function.

Chad Golder

You know, these go to things that they did in during COVID, waivers during COVID that worked very well then, why can't we have them now? These are all on our website AHA.org/regulatory relief. Then there is a second wave that we and the legal department here at AHA were particularly focused on. There were RFIs from DOJ and the Federal Trade Commission specifically asking for regulations that were anti-competitive, that inhibited competition, that were presenting potential antitrust problems.

Chad Golder

And we wrote a pretty lengthy letter -a 20 single spaced page letter - to these agencies, not only reiterating the 100 regulations that we had sent on, but really focusing on how the regulatory environment has become so uneven that the playing field is so unfair to hospitals as compared to large commercial health insurers. It is our belief that the number one regulatory relief priority, at least as it relates to competition, should be focusing on those regulations that unfairly advantage commercial insurers like United and Aetna.

Chad Golder

And we offered a range of those, whether it's medical loss ratio requirements or various Stark and anti-kickback provisions that allow them to purchase physician practices. All of those things are regulations that shape the real world but do so in unfair ways. So again, those are all available on the AHA website. Take a look,

Chad Golder

and we hope to continue advancing this regulatory relief agenda as we move forward.

Tina Freese Decker

Tina Freese Decker

What impacts do you see, from the repeal of the Chevron standard in this new administration?

Chad Golder

Chad Golder

the agency could move forward with its action. The last year, in the Loper Bright decision the Supreme Court overturned that. But what we really have not seen a ton of just yet, and the full gamut of regulations have not come out yet. But when this administration starts issuing notice and comment rules, whether it's you know, the IPPS rule, the OPPS rule, rules related to Medicaid, all those things. If they take aggressive interpretations of federal statutes, there will no longer be any deference to that agency so long as Congress didn't

Chad Golder

grant them deference. And I think there was a lot of speculation at the start of the administration that this movement against Chevron, which was really done by conservatives and folks who are opposed to the administration state, may end up biting the Trump administration if they want to take aggressive regulatory action. So it's something we are paying close attention to.

Chad Golder

It is certainly as you said, at the top of this, Tina, legal advocacy is always a weapon in our toolkit. And we will be making robust arguments about statutory authority if the proposed rules exceed the bounds of federal statute.

Tina Freese Decker

So, Chad, I have one final question for you, and I know it's one of your biggest passion areas. It's that you spend so much time on 340B issues and so do many of us. So the 340B drug pricing program has provided financial help to hospitals serving vulnerable communities to manage rising prescription drug costs. Can you give us an update on these efforts and what is going on right now?

Chad Golder

Absolutely. Passion is definitely one word for it, Tina. I consider myself, you know, almost a fulltime 340B lawyer. There are really two major areas right now in the courts where the 340B program is being litigated. The first is the rebate policies that the drug companies implemented maybe ten months ago last summer. And, you know - just as a bit of background for those who weren't following it as closely - effectively, what the drug companies did was they said rather than paying hospitals their 340B discounts upfront right at the time of sale, they were going to issue rebates.

Chad Golder

They were going to say, pay us the full price now. We'll take a look at whether you deserve these rebates, and then we'll pay you back at some point. We were very active, the AHA, in working with HHS to explain why this was unlawful and a really bad policy idea. And HHS said they agreed with us and they said the drug companies couldn't do this.

Chad Golder

So what happened? It's what happens always in 340B, someone sues. And in this case, it was the drug companies saying that the denial or the rejection of the rebate policy was unlawful. So that that litigation unfolded throughout the winter. And just a few weeks ago, one district court judge in Washington, D.C., upheld HHS's rejection of the drug company rebate policy.

Chad Golder

So what does that mean? I call it kind of an incremental victory. What it means now is that the drug companies will get a chance to make their case to HHS, and say you should allow us to move forward with these rebate policies. These kind of shows you how law and policy and federal relations, all the things you talked about, all the different tools of advocacy come together because, you know, we won in the courts or we won this incremental victory in the courts, but now we just have to go back to the agency and advocate again using other tools.

Chad Golder

And regardless of what the agency does, whether they approve it or reject it going forward, it'll be back in the courts again. The other area that we're extremely active in is the various state contract pharmacy laws. States across the country - we're now up to 16 or 17 states - have enacted laws saying drug companies cannot impose restrictive policies that prevent of 340B drugs to contract pharmacies, for dispensing to patients closer to where they live.

Chad Golder

And these states of, you know, fill the void that the federal government has left, when other federal courts have held that the federal government, HRSA, can't enforce similar laws. So as new states come into play, as new states enact these laws, the AHA and our allied association partners are active in filing amicus briefs explaining why these are lawful; this litigation will go on for a while now. We're filing briefs probably on average, 1 or 2 a week in all of the new states that are enacting these laws.

Chad Golder

So that is another active area. But, you know, you are right, Tina. The ultimate blessing 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.

Tina Freese Decker

You have just been a delight to talk to today, even though there's so many different things that are happening. We appreciate all of your work and your team's work for the legal advocacy. It's so critical, as you've described today, the importance of it. And so thank you very much for all the work that you do on behalf of our field.

Tina Freese Decker

And thank you to all of our viewers and listeners for finding the time to tune in today. We'll be back next month for another Leadership Dialogue conversation.

Tom Haederle

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