By Surabhi Dangi-Garimella, PhD

The 21st Century Cures Act is being rekindled: introduced in Congress in November 2021, CURES 2.0 proposes to upgrade several areas of the U.S. healthcare system, one of which is telehealth. The Telehealth Modernization Act includes changes that will do away with Medicare’s restrictions on patient and provider location at the time of care delivery, among other things. However, the struggle for digital literacy among a significant number of users and lack of access to broadband/high-speed internet restricts the reach of this potentially far-reaching healthcare delivery option.

The COVID-19 Exposé

The stress imposed on our healthcare system during the peak of the COVID-19 pandemic in 2020 laid bare all the cracks that exist within the system, including disparities in access for our most vulnerable populations: the elderly, those living in rural communities, and low-income populations. While telemedicine ensured some level of care continuum for a vast majority of people despite the shutdowns and restrictions that were imposed, inequity was evident.

Limited digital literacy and access pose barriers for diverse pockets of the population:

  • Only 55-60% of older adults (65+) have a smartphone or broadband access
    • 73% use the internet, but only 60% can fill a form online, look up websites, and send an email
  • Those who are low-income (one out of every eight Americans) struggle with digital access:
    • Low smart phone ownership (71%)
    • Broadband at home (59%)
    • Basic digital literacy (53%)
  • Geographic location restricts broadband access for those living in rural neighborhoods: this includes 25% of rural Americans 

Video-based telehealth visits are out-of-reach for vulnerable patients who constitute the above statistics. A report by the Office of Health Policy that evaluated telehealth use by Medicare enrollees in 2020 compared to 2019, found:

  • Lower telehealth use by rural beneficiaries
    • Highest usage was in urban states in the Northeast and the West Coast
  • Lower telehealth use (slightly) by black enrollees compared to white enrollees—highest usage was by Hispanic and Asians

Using Data to Inform Policy Solutions 

The solution to this digital disconnect lies in a multi-pronged approach to address some of the underlying issues:

  • Screening: Screen patients for barriers to telemedicine access, especially if they fall among the known vulnerable groups (older adults, low-income, minorities, rural location)
    • Figure out ways to provide a smart device (phone/tablet) for populations that cannot afford one
  • Education: Develop educational modules to teach patients how to do a tele visit with their doctor
  • Broadband internet access: 
    • Expand low-cost or free broadband, especially in low-income neighborhoods and in rural areas
    • Make patients aware of low-cost or free broadband internet in their area
    • Offer telephone visits for those patients who cannot—or prefer not to—do a video visit
  • Pay parity: Modify state/federal laws that will ensure telephone and video visits are reimbursed at the same rate, especially within Medicaid, which serves some of our most vulnerable citizens.

Work Being Done at the State Level

Nine states have seen some success with their broadband expansion efforts: California, Colorado, Maine, Minnesota, North Carolina, Tennessee, Virginia, West Virginia, and Wisconsin. They have engaged in the following methods:

  • Outreach efforts at the state and local levels to engage and educate stakeholders and develop partnerships
  • Developing clear policy frameworks with defined goals, tasking an agency or creating an office to lead statewide programs for broadband expansion, including identifying and addressing barriers faced by underserved regions
  • Building capacity for local broadband infrastructure projects
  • Ensure funding to support these expansion programs
  • States that are supporting infrastructure projects for expansion are using the lessons learned to improve on these programs 

Other states and regions can use these programs as a template to further their own expansion efforts to improve telehealth access for their most vulnerable populations.  


Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.