How does a bill with no enemies fail to move? That question should trouble anyone who cares about Medicare, about rural health care, and about whether Congress can still do straightforward things.
In plain terms, the CONNECT Act would permanently end the outdated rule that limits Medicare telehealth to patients in rural areas who travel to an approved facility. It would make the patient's home a covered site of care. It would protect audio-only services, critical for seniors without broadband or smartphones, especially for behavioral health. It would ensure that Federally Qualified Health Centers can be reimbursed for telehealth, and it would lock in the pandemic-era flexibilities that Congress has been extending on a temporary basis since 2020. In short, it would turn five years of emergency workarounds into permanent, accountable policy.
The real obstacles have nothing to do with evidence or ideology. The first is cost scoring. The Congressional Budget Office has not yet scored the 2025 version of the bill, but projections typically show increased Medicare spending, perhaps $200 or more per beneficiary per year, because patients who would not have sought in-person care now access services remotely. That projected increase frightens budget hawks in both parties, regardless of whether those members have cosponsored the bill. Until a CBO score exists, no financing solution can be designed, and without one, the Senate Finance Committee has little reason to schedule a markup.
The second obstacle is structural. The CONNECT Act sits in three committees simultaneously: the Senate Finance, House Energy and Commerce, and House Ways and Means. No single committee chair owns it. That fragmentation creates a coordination problem that no amount of lobbying has solved, despite the healthcare sector spending a record $867.5 million on federal lobbying in 2025. On top of that, each short-term extension of telehealth flexibilities reduces the political urgency for permanent reform. The most recent extension, through the Consolidated Appropriations Act of 2026, pushed the deadline to December 31, 2027, giving every member of Congress permission to wait another 21 months. The pattern is familiar: extend, delay, repeat.
Pennsylvania illustrates what is at stake when Congress delays. In 2024, the Commonwealth passed Act 42, a strong telehealth parity law that requires private insurers and Medicaid managed care organizations to cover telehealth at the same standard as in-person care. It passed the state Senate 49 to 1. But Act 42 has a fundamental limitation: it does not — and cannot — cover Medicare. Pennsylvania has roughly 2.8 million Medicare beneficiaries, and not one of them is protected by the state's own telehealth law. Meanwhile, the state faces a projected shortage of more than 6,300 mental health professionals by 2026. For rural seniors in Pennsylvania, telehealth is not a convenience; for many, particularly those relying on audio-only phone calls for behavioral health visits, it is the only realistic way to see a provider. Without permanent
Medicare telehealth coverage, that lifeline, depends on whether Congress remembers to renew it every couple of years.
The stakes go beyond individual patients. In late 2025, Governor Shapiro's administration secured $193 million from CMS as the first tranche of Pennsylvania's Rural Health Transformation Plan, a program designed to build broadband-connected telehealth infrastructure across rural hospitals and clinics, expand remote psychiatric consultations, and create maternal health telehealth hubs. Those investments are built on an assumption: that Medicare will reimburse the telehealth services delivered from those new sites. If Congress does not pass the CONNECT Act, a significant portion of that $193 million will be effectively stranded, and infrastructure built for a reimbursement framework may never be delivered. Pennsylvania is not the only state in this position, but it is a vivid example of how federal inaction can undermine state investment.
The CONNECT Act's problem is not the evidence; rather, the clinical data on telehealth equivalency are mature and broadly accepted. It is not an ideology. The bill has genuine bipartisan support that crosses every conventional political line. The problem is process and path: an unscored bill, fragmented committee jurisdiction, and a Congress that finds it easier to extend than to reform. None of these are reasons to let 2.8 million Pennsylvanians, and tens of millions of Medicare beneficiaries nationally, live with permanent uncertainty about whether their telehealth access will survive the next appropriations cycle. Congress, particularly Pennsylvania's delegation, should push the CONNECT Act to markup and vote well before the December 2027 cliff. The votes are there. The evidence is there. What is missing is the will to use them.
Akshaya Sahasra Ganji is a student at Penn State.
