WASHINGTON–In March 2020, Stephanie Hendrick, a retired teacher in Roanoke, Virginia, contracted COVID-19, a virus that over 110 million people in the U.S. would contract over the next couple of years.
She recovered from the initial illness, but like many, she soon began experiencing long COVID symptoms. In the early months of the pandemic, hospitals and medical centers prioritized care for individuals with active COVID-19 infections, and pandemic restrictions limited travel and in-person treatment for other medical conditions. Hendrick’s options for care for long COVID were limited.
“No one knew what was going on,” Hendrick said. “No one knew what to do.”
But then, she found a north star: telehealth services. Hendrick contacted MedStar Health, a nearby healthcare provider, and she began meeting online with a physician. Through the computer screen, Hendrick was able to get a prescription for pulmonary cardiac rehab treatment and saw a speech pathologist to help deal with her symptoms.
“For me, if it hadn't been for that, I wouldn't have gotten care. I would have just floundered,” she said.
Hendrick’s experience with medical care since the start of the pandemic mimics the experiences of millions of other Americans. Due to the pandemic, many more medical professionals began to see patients online. According to the Centers for Disease Control and Prevention, over 85% of physicians used telehealth services to treat patients in 2021, compared to 15% two years prior.
In August 2020, amid the pandemic, President Donald Trump signed an executive order expanding telehealth accessibility, including loosening restrictions for the 68 million Americans on Medicare. In 2022, President Joe Biden extended those provisions, and Congress has funded them in yearly budgets.
But, many of the expansions of telehealth access expire in less than four months. Without permanent legislation authorizing telehealth, the medical community has been unable to make the necessary investments in IT and other infrastructure to serve patients at or near their homes. In March, Trump and Congress extended telehealth access rules and funding until Sept. 30, but advocates and medical professionals continue to push for permanently enshrining the provisions into federal law.
“This should be a no-brainer for them,” Hendrick said. “There shouldn't be any questions about it.”
Telehealth usage by Medicare recipients has decreased since 2020, but remained about double what it was before the pandemic, according to data from the Kaiser Family Foundation.
Members of Congress have introduced more than a dozen bills to expand telehealth services. Some have passed, such as the expansion of telemental health coverage, which was made permanent in 2021. But most have not progressed through Congress.
In March, Senator Brian Schatz, D-Hawaii, introduced the sweeping bipartisan CONNECT for Health Act, which would make many of the temporary provisions permanent. The bill would remove geographic requirements for telehealth services provided under Medicare and broaden the scope of medical professionals who may provide services.
However, the same bill was previously filed in 2019, 2021, and 2023, and Congress failed to act.
Experts said that by relying on one temporary provision or extension after another, Congress has hurt the medical industry and patients.
“In so many ways, this is an example of the muscle memory Congress has, of how it operates. It's a clear juxtaposition to state policy,” said Kyle Zebley, senior vice president of public policy at the American Telehealth Association.
Many state governments have implemented new telehealth rules to increase options for customers over the last five years. States like Florida and Oregon allow out-of-state telehealth providers to deliver services. As of last year, every state, Washington, D.C., and Puerto Rico offer telehealth services for those covered by Medicaid.
The Trump administration has been a vocal supporter of telehealth. Health and Human Services Secretary Robert Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz both support expanding quality healthcare access, a Health and Human Services spokesperson said to the Medill News Service.
“They believe that leveraging technology is essential to modernizing our healthcare system and ensuring that all Americans, especially those in rural areas, receive the care they need,” the spokesperson said.
Lawmakers from both parties have also backed legislative changes to enshrine the telehealth provisions. Republican lawmakers, who disproportionately represent rural areas, support telehealth. Rural regions support telehealth investments due to a lack of medical specialists and important medical equipment. Democrats support telehealth services because they offer convenience for people who may not be able to leave work or family for a regular doctor's checkup.
Dr. Ethan Booker, MedStar Health’s chief medical officer for telehealth, said the medical community cannot make the needed investments in telehealth until Congress passes a law to support telehealth. MedStar was an early adopter of a telehealth model in 2016. Booker noted that the massive growth of telehealth demand during the pandemic sparked public and private investment.
“There was a lot of excitement around a sort of continued ramp (up) in volume of telehealth, and I think there was a fair amount of speculative investment,” Booker said.
As the pandemic died down, so did the exponential investment in the industry. Congress’s failure to make increased telehealth permanent created “a challenge for the health system.”
“I know we can deliver outstanding care,” Booker said. “I think permanence and more certainty around the regulatory environment will allow us to do much more effective cost-effectiveness research.”
Neither Zebley nor Booker anticipated that the telehealth provisions would disappear on Sept. 30. They expected the law to pass or for Congress to approve further extensions.
Senator Mark Warner, D-Va., one of the five senators who sponsored the CONNECT for Health Act, said the bill should pass “without delay and make affordable, high-quality care more accessible, no matter where they live.”
However, despite the September deadline for the provisions, the bill has seen no movement after being referred to the Senate Finance Committee in April.
Booker said that passing laws to support telehealth will help towards the goal of integrating telehealth services with standard medical care for patients across the country.
“People often ask what will success look like in telehealth, in digital health, in these new care models. And my answer usually is when we stop talking about it that way and we're just talking about healthcare,” Booker said.
This reality is also reflected in the lives of patients. Hendrick has friends and family in Roanoke who live in both suburban and rural regions. Hendrick's family is deeply connected to the medical community. Her father was a doctor, her mother and sister nurses, her brother is a medic, and her daughter is a physician assistant. She says telehealth is part of all of their careers.
For Hendrick’s circle, filled with medical personnel, telehealth is the norm.
“It shouldn't be that if you can't get to a doctor's office for whatever reason, you don't get medical care,” Hendrick said. “There should be a way for all of us to be able to look at a physician or a nurse face-to-face [on a screen] and be able to say, ‘Here's what's going on,’ and them to be able to say, ‘I can help you.’”
Ismael M. Belkoura is a graduate journalism student with the Medill News Service at Northwestern University. He specializes in health, business, and legal reporting.
To read more of Ismael's work, click HERE.
The Fulcrum is committed to nurturing the next generation of journalists. To learn about the many NextGen initiatives we are leading, click HERE.
