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When Gwen Williams’ mother was dying, taking her to an in-person appointment to get more medicine seemed impossible. So Williams made a telehealth appointment with the doctor—a video call. It was that easy.
“Her comfort was paramount,” Williams, who lives in Minnesota, recounts. “My mother wasn’t conscious during the visit, but [the doctor] was able to see her and was able to get the hospice medications and everything refilled.”
Williams’ mother was on Medicare, as is she. Since 2020, Medicare has covered a wide range of remote medical services, some in critical situations like theirs, and others for routine care. Around one in four telehealth appointments are made by people on Medicare.
Around one in four Medicare patients takes advantage of telehealth.
The fact that Medicare will abruptly cut off that coverage for most specialties on January 1—barely a month away—Williams said, “just blows my mind.”
What we now call telehealth, an umbrella term for remote and digitally assisted medical care, was first developed by NASA in 1960 as a suite of tools to monitor astronauts’ health in space. While it has been gaining traction as a widespread, normalized aspect of care since the beginning of this century, telehealth really exploded in 2020 with the onset of the Covid-19 pandemic.
Until then, for Medicare patients—which includes most Americans over 65, and some younger disabled people—remote care coverage had been limited. In rural areas, for instance, people on Medicare could speak to a non-local specialist via telehealth, but not from home; they still had to go to a local hospital to place the call.
But on March 6, 2020, the Centers for Medicare and Medicaid Services temporarily expanded Medicare’s telehealth coverage to all specialties. That expansion, renewed in 2022, is set to expire at the end of the year, impacting more than 65 million Americans.
Multiple bills have been introduced in the 118th Congress to preserve Medicare telehealth provisions and continue allowing people on Medicare to use telehealth flexibly, but all still await votes in both the House and Senate. Perhaps the likeliest to pass, the Telehealth Modernization Act of 2024, introduced by Rep. Buddy Carter (R-Ga.), received widespread, bipartisan support from members of the House Committee on Energy and Commerce and its subcommittee on health.
“Seniors, individuals with mobility issues, and those living in rural areas rely on telehealth,” Rep. Carter said in a statement to Mother Jones, calling the act “critical legislation that will extend telehealth flexibilities to get Medicare beneficiaries the life-saving health care they need.”
Where so many other health issues can be partisan or controversial, says Telehealth Access for America executive director Alye Mlinar, telehealth manages to be bipartisan. Mlinar hopes the bipartisan support “critical for really any issue” that telehealth has garnered will help lead to another congressional extension.
Epilepsy Foundation chief medical officer Dr. Jacqueline French’s organization has supported telehealth access for people with epilepsy even before the start of the Covid pandemic.
“There’s nothing that we learn from a physical exam that we could not learn from just talking to a person,” said French, who is also a professor of neurology at New York University Langone Health’s Comprehensive Epilepsy Center. The Epilepsy Foundation is one member of Telehealth Access for America, a consortium that includes, among other groups, the American Medical Association, Johns Hopkins Medicine and the National Down Syndrome Society.
There are plenty of patients who can’t make long journeys at all—but for many others, telehealth is still a way to avoid travel risks. Traveling with uncontrolled seizures, for instance, can be dangerous, French notes.
Even if Congress does not extend its current, wide coverage of telehealth for Medicare recipients, a handful of protections—mainly around dialysis, strokes, and mental health—would remain.
Williams, whose mother also relied on telehealth, also praised the separate ways it benefits her: When the doctor who prescribed their mental health medication moved away, telehealth prevented a disruption in her care. She likens the often needless in-person visits to “a meeting that could have just been an email.”
“Just have to have a conversation with your doctor,” Williams said, “paying for transportation, paying for parking if you drive—it’s a real barrier when all you need is to have a conversation, to continue care, or ask a question.”
But there are limitations to a blanket extension of the program, argues Medicare Rights Center senior counsel Casey Schwarz.
“We had really hoped Congress would take the opportunity to look carefully at what a telehealth benefit could and should look like, because while the pre-pandemic status quo is inadequate,” Schwarz told Mother Jones, “A complete lack of restriction or breaks on telehealth services is also inappropriate, and we think has some risk for beneficiaries.”
Schwarz said that she had heard from Medicare recipients “who have received what they believe to be substandard care through telehealth because something that they think would have been noticed or caught in an in-person visit was missed.”
An investigation by Mayo Clinic researchers found that diagnostic accuracy for people on telehealth ranged from 77 percent for ear, nose, and throat doctors to 96 percent for psychiatrists across a 90-day period in 2020. However, specialists, such as rheumatologists, were more likely to request an in-person appointment to continue care, in comparison to primary care doctors.
Schwarz also says that telehealth cannot replace other forms of compliance with civil rights laws around accessibility, like the Americans with Disabilities Act.
“We don’t want to see telehealth fill in a way for providers to indicate that they do not need to meet physical access requirements because they provide telehealth services,” she said.
In-person services, especially from specialists, can’t always be replaced—and people like Schwarz raise the risk of telehealth, often cheaper for providers, being used to justify cuts to in-person services. Williams, for instance, does see their neurologists in-person, so they are able to assess her reflexes and the progression of their neuropathy.
With just weeks until the end of the year and Medicare’s telehealth termination, there is not much time for individual bills to pass through Congress and be signed into law by President Biden.
Mlinar, however, is optimistic that an extension for Medicare telehealth recipients will be part of an annual end-of-year package negotiated by Congress “given the overwhelming support.”
“The biggest question at this point,” Mlinar said, “is [for] how long.”