Through the surges and lulls of the COVID-19 pandemic, American patients of all ages and backgrounds turned to virtual care to fulfill a wide range of healthcare needs. For seniors, the need for virtual care was especially important, as caregivers sought to keep them home to avoid possible exposure to COVID-19 at the office. Unfortunately, the statute governing Medicare’s coverage of live audio and video visits was enacted at a time when live video calls with a caregiver from anywhere other than another doctor’s office were hard to imagine. At the time, the law expanded coverage in a way that seemed to allow for future developments. But unfortunately, it stood squarely in the way of coverage for live virtual visits, prompting Congress to give the Department of Health and Human Services (HHS) broad authority to waive statutory restrictions like those on telehealth, found at Sec. 1834m(m) of the Social Security Act, but only during the public health emergency (PHE).
Each time the PHE approached its expiration, HHS extended it, and that appears to be the agency’s plan until at least late 2022. On top of the PHE, Congress authorized a continuation of the PHE flexibility for an additional 151 days after its eventual expiration. After that 151-day stretch post-PHE, American patients encounter a big question mark. If Medicare stops covering live audio and video visits, will the rest of the healthcare ecosystem follow suit? Medicare is the largest payer in the United States, at about $1 trillion per year, which means the private market often uses Medicare as a benchmark for what it should cover. Even the vendors’ healthcare providers rely on typically designing their products and services to match Medicare’s Current Procedural Terminology (CPT) coding system, and if Medicare doesn’t pay for a CPT code, that has a tremendous influence on what other insurers and providers do.
This backdrop begs the question of what happens if Congress allows Medicare telehealth coverage flexibility to lapse. If they did, it would instantly turn off coverage for telehealth visits at home for all but an exceptionally tiny subset of beneficiaries. Let’s look at a demographic breakdown from the Centers for Disease Control’s (CDC’s) database, indicating who continues to rely on telehealth, and as a result, which demographics would be most hurt by a lack of telehealth coverage:
This graph doesn’t just show that non-Hispanic Black Americans used telehealth comparatively more than other demographics, like non-Hispanic whites. It also shows that regardless of race, Americans were still using telehealth at a rate of at least 20 to 25 percent of the population. This is a huge increase from where telehealth usage used to be across racial demographics, between 0 and 2 percent. Even so, it is hard to escape the reality that if telehealth coverage suddenly stops, the demographic most impacted by a margin of at least 5 percent are Black Americans.
Telehealth usage across age demographics also tells an interesting story. As the graph above shows, seniors consistently make use of telehealth more than other age groups. Even during the relative lulls in COVID-19 infections over the summer of 2021, when all age groups had relatively fewer telehealth visits, seniors 70 and older consistently used telehealth more than other age groups. Even though seniors are perceived as being less tech savvy than their younger counterparts, their markedly higher usage of it is notable. But perhaps even more surprising is how high a percentage of 18-to-29-year-olds had a telehealth visit in the preceding four months. Even during the lowest period captured above, around September of 2021, more than 15 percent of Americans reported having had a telehealth visit in the prior four months. In many parts of the country, pandemic conditions did not force people to stay home or limit their travel; what you see in that 15 percent is a reliance on telehealth among a demographic that uses the healthcare system the least, during “normal” conditions akin to those we can expect in the future.
Policymakers need to know what happens when the PHE ends. These graphs are a strong indication that a significant percentage of American patients would lose access to healthcare if Medicare no longer covered live audio and video visits. To restate the obvious, taking away telehealth coverage would disproportionately harm Black and older patients because the data shows that those demographics rely on telehealth more than other cohorts. Other datasets help us understand the relative costs of telehealth against in-person visits, or whether telehealth costs are additive or substitutive of in-person care. But these data show who would lose access to care, and the cost of denying healthcare is, in our view, too high a price for us to pay.