This past winter, one of us, Alister, was speaking with the daughter of an elderly patient at a community health center in Boston. Her mother had recently been admitted to a local hospital for pneumonia, and doctors believed that she was an ideal candidate for an innovative “home hospital” program, which leverages remote care through the use of internet-enabled devices, video conferencing, and in-person home visits so the patient can receive care in the comfort of her own home.
But the plan fell apart. Though she was medically suitable and had a caring daughter ready to assist her, she lacked something critical: She didn’t have a stable internet connection at home. Rather than returning home, she remained in the hospital.
As this moment illustrates, health care and internet access are now inseparable. Those without reliable access to the internet find themselves facing major barriers to accessing telehealth services, patient portals, videoconferencing, and other health care technologies that have become vital in modern medicine. This digital divide perpetuates health inequalities and reinforces existing inequities.
To address this issue, it is crucial to bridge the gap between internet access haves and have-nots. But a program that is making major headway may run out of funds within the next year.
In the United States, the Bipartisan Infrastructure Law established the Affordable Connectivity Program (ACP) in 2021 to tackle the digital divide, which disproportionately affects older, rural, and ethnic minority communities. With a $14.2 billion allocation, the ACP aims to subsidize high-speed internet access for low-income Americans. Eligible households can receive up to $30 per month (or $75 per month for households on tribal lands) as a subsidy for any internet service plan provided by participating companies. Additionally, certain households qualify for a one-time $100 subsidy for a desktop, laptop, or tablet computer. To be eligible for the ACP, households must have been enrolled in specific programs over the past year, such as Medicaid, the Supplemental Nutrition Assistance Program, or WIC. The ACP has played a crucial role in subsidizing high-speed internet access for lower-income Americans. Organizations like Link Health (where we work), Digital Charlotte, and EducationSuperhighway are actively working to raise awareness about the program and encourage sign-ups. Currently, more than 16 million households have enrolled in the ACP, with many more expected to join in the coming months.
But the program is set to expire once its allocated funds are exhausted, which is expected to happen by mid-2024. If that happens, it could impede progress in closing the digital divide and hinder access to essential services, including health care. Telehealth services hold particular importance for marginalized communities, such as people of color and patients with chronic illnesses. A significant portion of telehealth visits in 2021 — 44% to be precise — were related to chronic conditions, which are more prevalent in lower-income areas. Research has shown that the use of telehealth services can potentially reduce mortality rates and hospital stays among lower-income patients.
It isn’t only patients who face internet hurdles. This lack of access is particularly troubling in “double-burden counties,” where home broadband rates are low, and mortality rates for diseases like cancer are high. The Covid-19 pandemic further accelerated the use of telehealth services, with telehealth visits skyrocketing by 80% in regions heavily impacted by the virus. In 2020, 46% of consumers reported using telehealth services, a significant increase from a mere 11% in 2019.
To ensure marginalized communities have access to telehealth services, extending the ACP beyond its expected end-date of mid-2024 is vital.
Congress must craft and pass legislation that both guarantees funding for the ACP and requires broadband providers to offer affordable and reliable internet access to low-income households. This legislative approach would secure funding for the ACP and establish a long-term legal framework, ensuring the program’s sustainability and effectiveness. By enshrining the ACP’s mission into law, it could become a permanent fixture of the U.S. health care system. Furthermore, this legislative approach could incentivize telecommunications companies to invest in broadband infrastructure in rural and low-income areas, expanding access to reliable and affordable internet for healthcare purposes.
The recent allocation of $42 billion under the Broadband Equity Access and Deployment Program (BEAD) has significant implications for the ACP and its internet investment efforts, as both programs work in conjunction to address the digital divide. While the ACP received $14 billion as a short-term solution to expand internet access in low-income and rural communities, the BEAD program, with its substantial $42 billion investment, focuses on long-term improvement of nationwide internet infrastructure. Overseen by the FCC and NTIA, these sister programs demonstrate a comprehensive approach to bridging the digital divide and ensuring equitable access to internet services for all Americans.
But BEAD on its own is not enough.
Extending the ACP and improving broadband access for all is crucial in achieving equal access to essential health care services — and keeping it that way.
Sammer Marzouk is an M.D. and chemistry Ph.D. student at the Northwestern Feinberg School of Medicine Medical Scientist Training Program. Alister Martin is an ER physician and an assistant professor at Harvard Medical School and a former senior adviser in the Biden administration. Alessandro Hammond is a student at Harvard University and a researcher in oncology and hematology at Boston Children’s Hospital.
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