Public Health Policy
In March 2020 as part of the public health emergency (PHE) under the Public Health Service Act, the Centers for Medicare & Medicaid Services (CMS) issued waivers that extended telehealth coverage for all Medicare patients during the pandemic. As a result of this policy change, many barriers to telehealth implementation were removed, all providers that charged patients under Medicare could now also charge for telehealth, licensing restrictions were removed, and telehealth now met HIPAA compliance (Lee et al., 2020).
The most pertinent policy is a bipartisan effort introduced by Sens. Scott (R-SC), Schatz (D-HI), and Shaheen (D-NH), along with multiple other members of both parties in both the Senate and the House. The Telehealth Modernization Act (S. 368/H.R. 1332) would extend the telehealth waive provisions permanently, eliminating site restrictions, expanding type of health practitioners eligible to furnish telehealth services, and changing the billing system under Medicare (Felder et al, 2021). The bill has been referred to respective subcommittees in both chambers.
Party Platforms
The Democratic platform on public health follows the strategy of achieving affordable, accessible, and for the most liberal, universal healthcare. They greatly support the Affordable Care Act (2010) which seeks to expand healthcare access as well as Medicare and Medicaid coverage. Democrats seek access and presence of affordable health care, particularly for vulnerable populations, with the popular idea “Medicare-for-all” being prevalent in the party (Democratic National Committee, n.d.). Under it, American residents will be provided free or relatively inexpensive basic health services through a single national insurance system.
The Republican platform on healthcare largely values a hands-off approach. While they recognize that reforms are needed, the Republicans continue to emphasize a competitive market-based model. For example, in Medicare, beneficiaries would be given a choice of private premium plans alongside the traditional program. Republicans vehemently oppose expansion of free services and care in most cases and argue that any suggestion of free care would be economically devastating for the country’s budget (Jindal, 2020).
Democratic (Liberal) Proposal
Telehealth has been an important technological breakthrough in healthcare provision, accelerated significantly by the pandemic. The waivers introduced by CMS to reduce capacities at hospitals and continue provision of healthcare services in the community during a time when contact risk should be minimized have been extremely successful. In supporting the Telehealth Modernization Act (S. 368/H.R. 1332), legislators are helping to improve provision of health services and continuous care in the community, reducing morbidity and mortality from chronic illnesses, and expanding access to healthcare to vulnerable or geographically remote populations. With the aid of modern technology, and presence of smartphones or other devices in practically every household, telehealth is able to mobilize all aspects of the healthcare potential to provide the optimal outcome. It serves to decrease transmission of disease (both within and outside the context of COVID-19), provide adequate safety for online services, direct patients to the correct level or specialty of healthcare, and diminish the burden on providers and the system (Monaghesh & Hajizadeh, 2020). The legislation supporting the expansion of telehealth on a permanent basis will contribute greatly to provide access to healthcare across the US to a wide range of populations and be a step forward in achieving some level of universal coverage.
Nearly 76% of hospitals currently utilize telehealth actively and almost every state Medicaid program has coverage for telehealth services. Telehealth utilization has stabilized at 38% higher than pre-pandemic levels. Out-of-pocket costs per telehealth visit are often much lower ranging $1-30, and insurance or Medicare completely covered such services for 60% of the population (Charleson, 2022). These statistics indicate the widespread usability, satisfaction, and financial accessibility of telehealth services, which emphasizes the need to maintain the current status quo with making the waivers permanent and further expanding this area through policy.
Republican (Conservative) Proposal
In supporting the passage of the Telehealth Modernization Act (S. 368/H.R. 1332), legislators of the Republican party are contributing to the high-tech and rapid development of the healthcare industry to meet the needs of the sector and the population. Adoption of telehealth spiked by nearly 78% in 2020 and has since stabilized at 38% higher than pre-pandemic levels. Uptake has been consistent and positive, with 32% of office outpatient visits occurring remotely, with 13-17% across all specialties (Bestsennyy et al., 2021). Rural Americans which are a considerate portion of the Republican voter base have consistently faced barriers to access of healthcare due to geographic location and provider shortages. Telehealth uptake has created an innovative disruption in rural areas and has seen tremendous growth, benefiting rural health stakeholders who see telehealth as the long-term solution (Mishori & Antono, 2020).
While cost is inevitably a concern, with an expected $250 billion spent on telehealth adoption, there are significant positive signs. First, the service is greatly supported by providers, the investment in virtual care and digital health has rapidly increased with 3x venture capitalist investment in 2020. Both consumer and provider attitudes and perception of telehealth have improved significantly, and while some issues remain such as proper security and mass adoption, these can be addressed with time, investment, and policy. Business models are also evolving to a range of telehealth services to enable longitudinal virtual care. Finally, there are significant cost savings associated with telehealth of approximately 11%, potentially more with greater efficiency, and an estimated return on investment of $3.30 per each $1 spent on the program (Charleson, 2022). Telehealth is an inevitable step forward in the future of health, and with great benefits to stakeholders, patients, and markets, legislation that actively supports the service expansion should be actively supported.
References
Bestsennyy, O., Gilbert, G., Harris, A., & Rost, J. (2021). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? Web.
Charleson, K. (2020). Telehealth statistics and telemedicine trends 2022. Web.
Democratic National Committee. (n.d.). Health care. Web.
Felder, E., Johnson, L., Schaftel, S., & Wadyka, H. (2021). Potential Congressional action on telehealth. Web.
Jindal, B. (2020). What are GOP’s views on health care? WSJ. Web.
Lee, I., Kovarik, C., Tejasvi, T., Pizarro, M., & Lipoff, J. B. (2020). Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation. Journal of the American Academy of Dermatology, 82(5), 1213–1214. Web.
Mishori, R., & Antono, B. (2020). Telehealth, rural America, and the digital divide. Journal of Ambulatory Care Management, 43(4), 319–322. Web.
Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health, 20(1). Web.