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Feds Fail to Fund Urban Telehealth Parity (Contributed)

As Congress prepares legislation for new broadband infrastructure projects, it is imperative there be parity between rural and urban programs. Everyone should benefit directly from these investments

Doctor conducts telehealth appointment on a laptop
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Currently there are 14 million people living in urban communities in the U.S. who cannot access telehealth service, yet the Federal Communications Commission and USDA will spend $5 billion this year to get telehealth and broadband to 4 million rural households. At the same time, the FCC’s spending for its $9.25 monthly urban subsidy program, Lifeline, has dropped from $2.2 billion to less than $1 billion. 

In a time when COVID-19 is disproportionally killing Black Americans, urban communities need high-quality affordable broadband services and infrastructure, and not subsidies that go toward poor infrastructure that often is unable to run telehealth apps. For example, USA Today reported that Black people made up 32 percent of Louisiana’s population but 70 percent of COVID-19 deaths. They are 14 percent Michigan’s population but 41 percent of deaths, and in Illinois, 42 percent of COVID-19 deaths are African-American, though they comprise just 15 percent of its population.  

The high percentages of COVID-related deaths are caused by the health issues afflicting this population, afflictions that telehealth can mitigate. But consumers cannot have telehealth without fast, affordable, reliable broadband. Subsequently, federal or state broadband funding that does not target urban communities fails to deliver telehealth or broadband to constituents who need it desperately. 

The FCC plans to finance broadband through the $20 billion Rural Digital Opportunity Fund over the next 10 years. The agency has a Rural Health Care Program (RHCP) that’s being increased to over $1 billion this year, while the Senate wants to add another $2 billion to this fund. Two Senators also want to create a $50 million for fund more telehealth to rural areas, and the USDA has its own cache of broadband cash and loans. 

The FCC’s Lifeline subsidy started as a way to ensure low-income people had basic telephone service come hell or high water. The Obama administration expanded it to give recipients the option to get telephone or broadband. However, there’s no way $9.25 buys poor people anything more than a cheap mobile phone and an inadequate data plan. Furthermore, in an atmosphere one article describes as “proven hostile toward programs aimed at helping poor people get online,” Lifeline is constantly under attack.            

The numbers tell the story

In 2005 I wrote my first book on community broadband that chronicled Philadelphia’s fight for citywide high-speed Internet. I interviewed their steering committee, who explained they often could tell who had home Internet access based on the economic prosperity — or lack thereof — in a neighborhood. Ninety-five percent of the houses in affluent areas had Internet; rates dropped to 45 to 50 percent in low-income neighborhoods.

In the 111 largest U.S. cities, people of color comprise 75 percent of unconnected households, according to the 2018 U.S. Census American Community Survey. These major metropolitan areas need telehealth to level the healthcare playing field. For example, one-third of the U.S. population has high blood pressure, but 43 percent of Black women and a slightly lower percentage of Black men suffer from hypertension. Plus, twice as many Black people die from strokes as all other ethnic groups combined. 

Further, Twenty-eight percent of all men and 17 percent of women in the U.S. don’t have a personal doctor or health-care provider. But an analysis by the Kaiser Family Foundation shows higher rates for minorities, such as 33 percent for Hispanic women and 31 percent for African-American men

It's also notable that many of our essential workers, and low-income workers in general, must work two and three jobs to make ends meet. They typically don’t get paid sick leave to visit doctors, which is particularly bad for workers with chronic illnesses. Redlined public transportation systems are the bane of the working poor, and another reason they don’t see doctor often. 

As Congress prepares legislation for new broadband infrastructure projects, it is imperative there be parity between rural and urban programs. Both rural and urban communities pay federal taxes and are assessed fees on their phone bills to fund these various broadband and telehealth grant programs. Everyone should benefit directly from these investments 

A policy paper from the National Digital Inclusion Alliance (NDIA) addresses in-depth the issue of parity in federal broadband funding, noting that “the federal government’s existing broadband programs target tens of billions of dollars to expand broadband availability for residents of ‘unserved’ and ‘underserved’ rural areas, while studiously ignoring tens of millions of urban Americans who still lack high-speed internet service.”

The end goal

It’s name indicates that the RHCP target only rural hospitals. “Many people don’t realize that hospitals in urban areas can be included in grants that are made to consortia,” says former FCC Commissioner Mignon Clyburn. In a consortium, a urban hospital serves as an “anchor“ for the rural hospitals, providing them with specialists, nurses and telehealth resources.

Besides expanding the RHCP to fully include stand-alone urban hospitals, the FCC still has a big problem. The grants boost healthcare providers’ fiber broadband and provide patients with tablets and other equipment to facilitate telehealth, but they fail to provide broadband to private homes. Giving homes telehealth without reliable, affordable Internet access is like giving people boots and telling them to pull themselves up by their bootstraps, but not giving them straps.                

For example, Neighborhood Family Practice (NFP) is a seven-office practice in Cleveland, Ohio, and one of the first recipients of the FCC's Emergency COVID-19 telehealth grants. Twenty-seven percent of Cleveland households do not have Internet access, and some of them are NFP patients. “If you consider a patient who has achronic illness and is older," said NFP CEO Jean Polster, "they also are less likely to be tech savvy or to have broadband access.” 

The U.S. House of Representatives has a $100 billion broadband infrastructure bill on the table, hopefully with stated urban/rural funding parity goals. What they really need, however, is a companion bill that mandates strict accountability and deep audits that hold grant recipients’ feet to the fire. It doesn’t help to give away billions if there is neither incentive nor punishment to funding recipients for finishing the job correctly.     

Given the inadequacy of a federal $9.25 broadband subsidy in a gigabyte world, the FCC’s Lifeline program also needs a makeover. One option is the the Emergency Broadband Connections Act, introduced by Sen. Ron Wyden, R-Ore., that raises the subsidy to $50 a month ($75 on tribal lands), encourages ISPs to offer free minutes and data, and provides laptops or computers for those who qualify. 

I recommend adding one more element to the makeover: Municipal and community leaders should be encouraged to form urban co-ops and nonprofit organizations to build constituent-owned networks that are managed by people experienced in telecom. It may seem like a radical idea, but this arrangement puts the people who have the boadband pain directly in charge of resolving infrastructure issues. 

Too many poor people have been left with insufficient broadband and healthcare. Isn’t it time for new solutions?

Lauren Harrison is the managing editor for Government Technology magazine. She has a degree in English from the University of California, Berkeley, and more than 10 years’ experience in book and magazine publishing.
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