In today’s digital age, access to healthcare and the internet are often inseparable. Yet the internet isn’t equally accessible to everyone. People who lack digital technology are unable to use telehealth services, such as patient portals and videoconferencing, which have become a crucial part of medicine in many regions. They are also unable to engage with remote patient monitoring and other healthcare technologies that could improve their health. This digital divide can result in considerable health inequalities that entrench existing inequities. Bridging the gap between those who have access to the internet and those who do not is therefore crucial for ensuring equitable healthcare access for all.
In the US, the Affordable Connectivity Program (ACP), established by the Bipartisan Infrastructure Law, aims to close the digital divide, which disproportionately limits access to technology in rural communities, as well as those with a greater number of older people, or those from ethnic minorities.1 The programme allocated $14.2bn to subsidise high speed internet access for Americans with a lower income.2
Qualifying households are eligible to receive a subsidy of up to $30 a month (or $75 a month for households on tribal lands) for any internet service plan offered by a participating provider.3 Additionally, certain households can receive a one-time $100 subsidy for a desktop, laptop, or tablet computer. To qualify for the ACP, households must have been enrolled in one of several programmes over the past year at the time of application, including Medicaid or the Supplemental Nutrition Assistance Program.3
The ACP has had a crucial role in subsidising high speed internet access for Americans with lower incomes. To continue this progress, several organisations, such as Link Health, Digital Charlotte, and EducationSuperhighway, are working to increase awareness of the ACP and encourage signups for the programme. More than 15 million US households have already enrolled in the ACP, but many more are expected to sign up in the coming months.4 Yet the programme is set to expire once its allocated funds are exhausted, which is expected to be in mid 2024.5 If the ACP were to expire prematurely, it could hinder progress in closing the digital divide and impede access to essential services, including healthcare.
A vital component of healthcare delivery
Improving Americans’ access to the internet is becoming even more important as the use of virtual care grows. Around 76% of US hospitals reported using video technology to connect with patients in 2017,6 and the covid-19 pandemic accelerated this trend.7 Telehealth visits skyrocketed in 2020, representing 80% of visits in regions with high rates of covid-19 infection.8 Additionally, 46% of consumers reported using telehealth services in 2020 compared with 11% in 2019.7 Research suggests telehealth usage is not as high as it was during the height of the pandemic, but that it remains above pre-pandemic levels.9
Telehealth services are increasingly being used by patients for all kinds of reasons, including management of chronic illnesses. In 2020, 32% of patients in the US with a chronic condition had used telehealth recently, including almost 44% of patients with diabetes and 37% of patients with asthma.10 Yet the communities most in need of these services may be least able to access them. Many chronic conditions are more prevalent in patients with lower incomes and in black and Hispanic people11—precisely the communities that are most disadvantaged by the digital divide. At the same time, some research has shown that use of telehealth services can potentially decrease mortality and length of hospital stays.1213
Evidently, internet access is an essential component of healthcare delivery in the US, yet around a quarter of American adults don’t have broadband internet at home and more than 60% of healthcare facilities outside of metropolitan areas lack access to reliable broadband.1415 This lack of access is particularly worrying for “double burden counties,”16 areas with low rates of home broadband and high mortality rates for diseases such as opioid addiction.
As essential health services increasingly move online, the landscape of internet provision must change to ensure marginalised communities can access healthcare. If we want to provide everyone with access to telehealth services, it’s vital that the ACP is extended beyond its expected end date. On 16 June 2023, Link Health helped mobilise the healthcare sector by serving as the national coordinating organisation for the White House’s ACP Healthcare Day of Action, which rallied dozens of healthcare organisations around the importance of the ACP and its extension. To accomplish this extension, Congress can craft and pass legislation that guarantees funding for the ACP and which requires broadband providers to offer affordable and reliable internet access to low income households. By enshrining the ACP’s mission into law, it could become a permanent fixture of the US healthcare system, helping to bridge the digital divide, and providing essential healthcare services to all individuals.
Moreover, this legislative approach should incentivise telecommunications companies, through tax reductions and federal grants, to invest in improving broadband infrastructure in rural areas and those with communities on low incomes, thus expanding access to reliable and affordable internet for healthcare purposes. The government should provide tax credits or other incentives to broadband companies that invest in these areas to help improve healthcare outcomes for underserved communities.
The expansion of telehealth should be an opportunity to reduce healthcare inequalities, not deepen them. Extending the ACP and improving broadband access is the best way to ensure equal access to telehealth across the US and to work towards an equitable healthcare system.
Footnotes
Competing interests: None declared. SM, DV, and NJ are volunteers at Link Health, a non-profit focused on increasing internet access through the Affordable Connectivity Program (ACP). AM is the founder and director of Link Health.
