Telehealth, which is health care (clinical and nonclinical) that is delivered remotely through computers and mobile devices, is helping millions of Americans — especially those who do not have access to medical facilities — stay healthy and receive quality health care during the coronavirus pandemic..
In March, the Centers for Medicare and Medicaid Services (CMS) temporarily expanded Medicare coverage for telehealth visits so that more Americans could access health care from their homes without putting themselves or others at risk of getting COVID-19. Although coinsurance costs and deductibles still applied, many private insurers chose to waive or reduce these fees.
By April of this year, nearly half of all Medicare primary care visits were through telehealth services. In June, a HealthyWomen survey of how women had been affected by the pandemic showed similar results — half of our respondents who could receive health care did so through telehealth.
Despite many millions of people relying on telehealth services, on October 1, many telehealth benefits either expired or were rolled back by private insurers. For example, UnitedHealthcare, Anthem and Aetna chose to either end no-cost coverage or stop waiving the cost of copays and deductibles for non-COVID-19 telehealth visits for privately insured members.
These insurers will continue to waive telehealth costs for Medicaid and Medicare Advantage patients until 2021, but these changes are already impacting health care decisions. Make no mistake: Whether it's now, or months from now, ending no-cost coverage or the ability to use telehealth will prevent many people from receiving the quality health care they need.
From my perspective of over 25 years of federal and state legislative advocacy and policy work from within the insurance industry and trade associations, federal government and several nonprofits, and currently as senior policy advisor at HealthyWomen, heading in this direction doesn't make sense. Instead of rolling back telehealth, the policy discussion we need to have right now is whether the temporary expansion of Medicare coverage for telehealth visits should be made permanent.
Who will suffer the most by ending no-cost telehealth coverage?
Disparities in health care and health care coverage predate the pandemic, especially for women and minorities. For example, the U.S. stands out as one of the only comparable wealthy countries where maternal morbidity and mortality has actually worsened, rather than improved, over the last few decades. This is particularly true for Black women, who suffer such high maternal mortality and morbidity rates that the issue constitutes a public health crisis.
Race isn't the only factor that contributes to disparities — a shortage of maternal fetal medicine (MFM) and uneven provider distribution means rural women lack access to care from maternal-fetal medicine specialists (98% of MFM providers were in urban areas).
And more than 46 million Americans living in rural areas are at greater risk of dying from heart disease, cancer, stroke and chronic lower respiratory disease than people living in cities. Rural communities also have older populations with high rates of preexisting health conditions.
The Affordable Care Act (ACA), which was signed into law in 2010, removed some barriers to care by expanding Medicaid eligibility and forcing insurers to accept most applicants, including people with preexisting conditions. Coverage rates for all racial and ethnic groups increased under the ACA, and the largest coverage gains were for underinsured groups, including Hispanic, Black, Asian, American Indian and Alaska Native people.
Yet, health care disparities still exist across racial, ethnic, geographic and economic lines, particularly for women, and especially for minority women. Telehealth has helped fill some of the gaps by addressing certain disparities.
Lawmakers must make telehealth a central policy issue
More people have died from COVID-19 in the United States than in any other country, making clear that the pandemic in our country is not just a health crisis but also a stress test that has revealed systemic problems in our health care system.
Central to pushing CMS to temporarily increase telehealth access during COVID-19 was the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which Congress passed with strong bipartisan support. The CMS's temporary waiver and insurer decisions to waive or reduce fees was a step in the right direction, as it not only encouraged the public to stay home during a time when social distancing was crucial but also helped increase care to rural and other medically underserved populations.
It's time for Congress to reexamine and revise telehealth rules. This will modernize our health care systems so that, going forward, as many people as possible can continue to receive the health care they need in a safe and effective manner.