It takes my brother four hours to get to an in-person doctor’s appointment. He has Duchenne’s muscular dystrophy, is in a wheelchair, and uses a feeding tube to eat and a ventilator to breathe. To get to the doctor’s office, he needs the assistance of a caregiver and at least one family member in order to pack up and drive his custom-designed wheelchair van and to make sure he’s traveling with everything he needs: backup equipment, supplies, batteries, and medication. If his ventilator or other breathing machines fail, he will die, so this gear is critical. It is in every definition an ordeal.
By contrast, it takes him approximately five minutes to sign onto a telehealth visit on his computer, which he can do from his bed.
The ability to see doctors virtually has been a silver lining of the pandemic. It’s gone a long way to making health care more accessible to those who are too disabled or too vulnerable to go to the doctor, as well as making things much more convenient for everyone else—especially those living in underserved rural areas. It is perhaps the only improvement to the health care industry in recent years.
Telehealth funding for Medicare patients—some 66 million Americans, which includes seniors as well as many with long-term disabilities—was enacted in March 2020 but was set to expire at the end of December 2024 if Congress did not act. In its current state of dysfunction, multiple bipartisan bills oriented at extending telemedicine floundered in committee all year, only for parts to end up hastily shoved into a continuing resolution that lawmakers had actually, somehow, agreed upon—just days before the government was set to run out of funding. That initial deal was better than expected for health care; it included an extension for telehealth, continued community health care center funding, and measures to both lower prescription drug prices, as well as (mostly) reverse a pay cut to Medicare providers.
But that plan fell apart for a familiar reason: Republican Party nonsense, with a new disturbing twist. On Wednesday, Elon Musk and Donald Trump trashed the continuing resolution, causing “an epic meltdown” as House Speaker Mike Johnson attempted to come up with a new bill that could be passed in two days, under threat of government shutdown. The bill that ultimately passed is a stopgap measure, extending telehealth for Medicare for three months but leaving out pharmacy benefit manager reforms and maintaining the Medicare provider pay cut.
If extending telehealth was the low bar to clear, Congress managed to do even less. Though the measure, in theory, has bipartisan support and may be extended further in the next congressional session, we can be pretty certain that the next bill won’t be increasing pay for Medicare doctors.
While most of the expanded social safety net measures granted in the early days of Covid have become vestiges of the past, in this case lawmakers did choose to continue it, but its long-term future remains uncertain. Ahead of Trump’s daunting threats to cut Medicaid, continuing telehealth services remains an urgent necessity for health care access, especially for disabled people, seniors, and rural populations.
“Telehealth access changed healthcare for the better, narrowing the gaps in health disparities between different populations,” stated a recent press release from People’s CDC, a public health advocacy organization. Ending telehealth would “force disabled, terminally-ill, high risk, immunocompromised people into in-person visits for services that absolutely don’t require in-person exams.”
People with chronic health issues, who have more appointments generally, face challenges in accessing in-person care. Plus, avoiding going to the doctor while actively ill helps protect other patients and staff at health care facilities and avoid forcing themselves out of the house when they feel unwell. Among older Medicare beneficiaries, nearly 20 percent reported difficulty getting to appointments, which for people over 65 averaged about 17 visits per year, as Judy Stone reported in Forbes.
People eligible for Medicare due to long-term disabilities report higher use of telemedicine—37 percent versus 23 percent of those who qualify due to age, according to KFF. But telemedicine is popular overall. In the early pandemic, nearly half of Medicare patients used telehealth. While this number dropped to around 13 percent by the end of 2023, that is still a significant chunk.
Telehealth can also help bridge disparities in access among people of color, who disproportionately report difficulty accessing necessary health services, as Dr. Tem Woldeyesus, a clinical assistant professor at Stanford Medicine who works as a primary care provider at Roots Community Health in Oakland, California, noted. He told The New Republic that telehealth, and especially phone-based telehealth, has significantly helped his patient population, who are primarily Black and on Medicare or MediCal (California’s version of Medicaid).
“A lot of our patients have difficulty with taking time off from work, traveling to our clinic. That’s all costs that they incur, whether it’s from time paid off at work versus the Uber costs or childcare costs they would have to pay for,” he said. Not only does telehealth increase the clinic’s capacity, it “also helps us advance their care along and save lives down the road.”
Research suggests that this increased access to preventative care also helps improve patients’ ability to adhere to patient plans and reduces emergency department visits.
Dr. Woldeyesus has found that phone appointments are especially beneficial in tackling access gaps for patients. “Oftentimes the folks that are the sickest and have the highest needs may be the ones that have the most limited digital literacy and ability to connect over video,” he said. “So, phone appointments actually become the lowest-tech but highest-impact mode of communication.”
Unfortunately, he noted, the expiration of the Affordable Connectivity Program in June, which discounted broadband internet access for eligible households, will make it more difficult for some low-income patients to conduct video appointments. “Seeing some of the support that made [health care] accessible now start to diminish, whether it’s funding or reimbursement or affordability of broadband,” is “kind of an unfortunate story that’s unfolding,” he said.
These concerns speak to the importance of pay parity—that doctors get paid the same amount from insurance for in-person and telehealth visits, including audio-only. The telehealth policy changes introduced at the beginning of the pandemic guaranteed this, and must continue for safety net clinics like Dr. Woldeyesus’s to continue providing this service. Though the stopgap bill does include a measure to bill audio services at the same rate as video or in-person, it also upholds a pay cut for Medicare providers, and left out $4.6 billion towards community health center funding, which was included in the original version.
Telemedicine coverage is also crucial for increasing health care access for people who live in rural communities. Leigh Boyd, a Medicare patient who lives in the 300-person town of Irwin, Idaho, said that taking away telemedicine coverage would be “a disaster.” Where she lives, there is no mass transit or Uber, so transportation can be an issue, especially in inclement weather. The closest medical hub is an hour away in Idaho Falls, she said, but for more complex care people might have to travel over four hours to Salt Lake City.
“It’s not like a post-Covid leftover,” she said. “It’s become a real thing for people to be able to do to continue to get good medical care.” Taking away telehealth access, she continued, would feel like “discrimination” against people living in rural communities.
Since the end of the state of emergency in May 2023, several bills have circulated in the House and Senate to extend the coverage, which advocate either for a permanent extension or a two-year extension to the benefit.
One that has gained traction is the Telehealth Modernization Act of 2024, introduced in the House by Representative Earl “Buddy” Carter, a Republican from Georgia, and in the Senate by Florida Senator Rick Scott in March. The bill proposes a permanent expansion of telehealth benefits for Medicare patients.
“In every congressional district in America, there are patients who rely on telehealth for quality medical care,” said Representative Carter to The New Republic. “We must ensure that this critical access point remains available to seniors, especially those who may live hours away from the nearest health care provider.”
Though the bill counted with dozens of sponsors from across the political spectrum, it was not brought to a vote, nor have the other similar bills introduced in Congress. Perhaps it will gain more traction under the next congressional session, and pass on its own, outside of an omnibus legislation bill.
But there’s always the possibility that a critical window has now closed. Momentum had been building in the lead-up to the end of the year. In early December, dozens of industry leaders sent a letter to Congress imploring them to extend the telehealth benefits folded into last year’s appropriations. A letter from 100 legislators advocating for an extension, led by Senators Brian Schatz and Roger Wicker, followed.
In addition, an online petition garnered nearly 18,000 signatures, while leading industry associations such as the American Medical Association also voiced their support. Insurance companies like Cigna and Blue Cross Blue Shield have also lobbied for the bills, indicating a financial benefit to all stakeholders involved.
The initial bill included substantial reforms and guardrails on Pharmacy Benefits Managers, or PBMs, middlemen who notoriously jack up drug costs. PBM reforms are a part of the Preserving Telehealth, Hospital, and Ambulance Access Act, Rep. David Schweikert’s bill.
Rep. Carter also supported PBM reform as a way to “offset telehealth expenses,” he told The New Republic. But because PBM reform was slashed from the final bill, it is unclear how telehealth benefits will continue to be funded in the long term.
As the end of the year drew closer (and closer), extending telehealth for Medicare patients seemed like a no-brainer. But the intervention by Elon Musk disrupted that plan, which was already beset by the now familiar sight of lawmakers making last-minute scrambles through their incompetence. After the administration and government ignored health care issues all year, things like disaster relief, telemedicine benefits, and pediatric cancer research were at stake in the omnibus bill, not to mention funding the government period. But Musk and Trump decided to go scorched earth, consequences be damned.
Ahead of the specter of the next Trump presidency, with cuts to Medicare and Medicaid hanging in the balance as well as the omnipresent threat to repeal the Affordable Care Act, all we can hope for is that the next administration realizes just how unpopular that would be, and shifts course. Not to mention whatever RFK, Jr., plans to do to health care policy, if confirmed. While patients don’t have to worry about losing telemedicine benefits in a week, their respite may prove to be terribly temporary.
The post How Telemedicine Benefits Became a Casualty of Congress’s Chaos appeared first on New Republic.
