FCC reversal on broadband subsidies dampens telehealth's potential

Clarification: This post originally stated that an FCC order barred nine companies from offering broadband internet through the Lifeline program. The ban is temporary as their role is being reconsidered.

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It should come as no surprise that a hold has been put on Lifeline subsidies for broadband internet. FCC Chairman Ajit Pai, recently appointed by President Donald Trump, voted against the proposal last year when he served as a Republican Commissioner.

There are currently 23 million Americans without high-speed internet, according to the FCC. More than 12 million households without access to internet would qualify for subsidies under the proposal, according to data collected by the Universal Service Administrative Company, which administers the Lifeline program.

As Pai said in a post on Medium, the nine companies are only 1% of those participating in the Lifeline program and all but one do not have any customers. He also said there "is a serious question to whether the FCC has the legal authority to designate Lifeline providers or whether such designations must be made by state governments." 

The potential for telemedicine to improve access to health is limited if people do not have the internet. Last month, Pew Research reported 77% of Americans own a smartphone today. In April 2015, they stated lower income and "smartphone-dependent" users are likely to use their phone for job and employment activities. In addition to employment activities, smartphones have the potential to gain healthcare services access to lower-income individuals. A study led by Dr. Kenneth M. McConnochie from the University of Rochester posits telehealth could benefit lower-income families who may forgo healthcare services otherwise. 

But those families would likely need reliable internet to easily use such services. A significant portion of the 12 million that could gain high-speed internet access is also likely eligible for or covered by Medicaid. CMS issued a final rule last year prompting states to explore opportunities for telehealth in Medicaid programs.   

The FCC has an important role in improving telehealth services. Through the Rural Health Care Program, for instance, the FCC can deliver up to $400 million annually to rural healthcare organizations to build out high-speed internet capabilities. More than a third of Americans living in rural areas lack access to high-speed internet. With access limited due to physical distance, this population stands to benefit immensely from high-speed internet and telehealth coverage.

Despite these federal efforts, barriers remain and some initiatives show signs of inconsistency. The FCC just nixed a plan that could improve access to high-speed internet and the Rural Health Care Program has never doled out the full $400 million, Wired reported. While the federal government encourages telehealth coverage, a wide web of state laws could damper adoption and discourage companies from expanding telehealth services.

Lifeline subsidies are not necessarily done for. For now, the FCC is reconsidering the role of the nine companies that would have delivered broadband internet through the Lifeline program. Chairman Pai told Ars Technica last year that he would have voted for broadband subsides if the annual budget had been set at $1.75 billion rather than $2.25 billion.

Further action might reveal how the FCC under the Trump administration will take on the responsibility of making services available to low-income people. When it comes to healthcare, the Lifeline decision illustrates how competing priorities and degree of coordination at federal agencies affect certain initiatives, whether to help or hinder.  

Filed Under: Health IT Policy & Regulation
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