House Bill Expands Telehealth Access

More than a third of Americans live in an area with a shortage of healthcare professionals. For these 122 million people, that shortage can mean longer wait times and delayed access to essential care. For patients living in rural areas, attending in-person health appointments can also require them to pay steep travel costs while sacrificing time that could be better spent working or with family.

Fortunately, telehealth, in which appointments take place online or over the phone, provides an opportunity for these millions of rural Americans to receive care without visiting a health clinic. During the COVID-19 pandemic, telehealth became a lifeline, allowing patients and doctors to interact safely, flexibly, and quickly. Before the pandemic, approximately 840,000 encounters per year between doctors and consumers on Medicare employed telehealth. One year later, amid the national health emergency, 52.7 million appointments relied upon telehealth infrastructure, an increase of 6,300 percent. 

While the pandemic, and thus the need for telehealth, might not be nearly as urgent as it was during height of the pandemic, lawmakers in Washington have taken to heart telehealth’s importance. The House of Representatives recently passed the Advancing Telehealth Beyond COVID-19 Act, which extends COVID-era provisions and exceptions related to Medicare telehealth up until the end of 2024. While a companion bill has yet to be introduced in the Senate, the House version passed 416-12, indicating broad bipartisan support.

The initial COVID waivers that this bill extends expanded the narrow circumstances under which Medicare coverage could apply to telehealth. Before the waiver, only a small subset of those living in rural areas had any chance of receiving covered virtual healthcare. Now, for all Medicare users, coverage applies equally to telehealth and in-person visits.

While the House bill takes the first step to guarantee telehealth’s continued viability, its two-year timeframe means it will be, at best, a temporary fix. To ensure that those in rural areas continue to get the care they need, while simultaneously increasing the speed of access for all Medicare users, Congress should make this temporary extension permanent.

Before the pandemic, the longstanding fear that telehealth would undermine the quality of care prevented it from becoming broadly used. In 2015, for example, 75 percent of patients said they would not trust a diagnosis made remotely. Five years later, those statistics have turned completely on their head. A vast majority, over 75 percent of patients, report being “very satisfied” with their telehealth experiences. Less than 10 percent listed some level of dissatisfaction. The complete reversal of public opinion emphasizes the necessity of ensuring open access to telehealth.

Indeed, more Americans now prefer telehealth to traditional in-person visits for routine checkups. Across all age groups, an average of 40 percent of Americans favored telehealth, compared to only 28 percent of patients who said they would prefer in-person meetings. The reasons underlying these changes in preferences vary from patient to patient, but the most frequently cited factors include needing to take less time off work, cut transportation costs, and avoiding exposure to COVID-19.  

In addition to continuing Medicaid coverage for general telehealth, the bill extends a 2020 provision that allows coverage to apply to audio-only telehealth appointments. For those with less access to technology or slower Internet connections, these audio appointments are more feasible than video appointments. Among both the elderly and minorities, lower availability of high-speed broadband connection can make video software challenging or almost impossible to use. Without access to audio-only appointments, these individuals would be denied access to telehealth or forced to use a more inconvenient and more expensive method of receiving healthcare.

After Congress initially included audio-only appointments as an option under Medicare coverage, telehealth usage by elderly consumers and minorities increased. These marginalized communities were granted the opportunity to receive more care without any drop-off in quality. Failing to extend the audio-only alternative might mean patients, particularly those in marginalized communities, are denied the opportunity to benefit from remote healthcare. The overwhelming consumer support for telehealth emphasizes its continued post-pandemic importance to patients across the US. Telehealth has thus far succeeded in connecting medical professionals with those who need them, granting consumers flexibility with the time and place of their appointments. To take a major step toward America’s medical future and protect rural consumers, all lawmakers have to do is ensure that telehealth can continue to thrive without imposing stifling legislation that would hinder its continued integration into everyday healthcare.

Jean-Luc Belloncle is a policy intern at the American Consumer Institute.

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