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This may not sound surprising, but our most meaningful finding was not in the overall numbers, but the characteristics of the populations assessed.

We found telemedicine reached patients in even the most disadvantaged neighborhoods in the country. We hope this comes as a relief to readers.

In March 2020, Congress waived barriers to expand the scope of telemedicine coverage in response to the COVID-19 pandemic. The intention of the waiver was to improve access to the health care system for all Medicare beneficiaries when in-person visits were being limited.

There were concerns about this expansion amid national discussions that the pandemic was exacerbating preexisting health disparities.

With morbidity and mortality in marginalized populations being reported in disproportionate numbers, this fueled a fear that increasing telemedicine coverage would further worsen these disparities.

Critics of the waiver suggested that expanding the scope of telemedicine would only improve health care access for the most fortunate—those with the best Internet and up-to-date smart phones—while others were left behind.

With our unique access to 100 percent of Medicare fee-for-service claims, we had the opportunity to investigate this fear on a national scale.

We were relieved to find that the rapid increase in telemedicine use after the wavier was not associated with worsening disparities.

In fact, patients living in the most disadvantaged neighborhoods experienced the greatest net increase in telemedicine use relative to their counterparts living in the least disadvantaged neighborhoods.

The only population that did not experience a dramatic increase in telemedicine use were elderly patients—revealing a population that could benefit from targeted interventions to improve their access.

On a more personal scale, we work predominantly with patients with vascular disease, the majority of whom are covered by Medicare.

Many of our patients live in deprived neighborhoods in inner city Baltimore. When the telemedicine waiver first took effect, our anecdotal impression was that telemedicine was not a helpful resource for our patients.

Time, experience, and the results of this investigation proved us wrong.

Our findings give us incentive to strengthen this resource in vascular surgery clinics. Telemedicine gives us the means to review imaging or test results, check in on patients, and provide an overview of upcoming surgeries without interrupting the day-to-day lives of our patients.

This is not to say that we prefer seeing our patients virtually, or that this is equivalent to personally conducting wound checks, dressing changes, and in-person physical exams, but there are barriers to care that predated the pandemic that will continue to exist long after, and telemedicine may help to bridge this gap.

Now, more than two years after the start of the pandemic and the initial surge in telemedicine use, how much does this continue to matter?

The declaration of the nationwide public health emergency was last renewed on April 12, 2022, continuing the waiver that allows telemedicine coverage to persist at least through July 15, 2022.

However, when this declaration officially ends in the future, broad telemedicine coverage will be lost unless regulations permanently change.

While we miss the normalcy of regular in-person health care visits, our analysis revealed the potential telemedicine has to reach different populations, supporting it becoming part of our new normal.

Even when in-person appointments are considered safe, safe does not necessarily mean accessible.

In an ideal world, there would be no barriers to health care access for anyone, but reality is far less than ideal.

By reducing fears that the waiver has worsened disparities in health care access, we hope our study provides motivation to advocate for continued telemedicine coverage beyond the nationwide public health emergency.

As long as the Centers for Medicare and Medicaid Services cover telemedicine for all its patients, we have the opportunity to strengthen the health care system to make it as accessible as possible for patients of all backgrounds.

Blake Shultz and coauthors discuss how millions of Americans carrying medical debt are often subjected to a downward financial spiral including lawsuits, wage garnishment, home liens, and other aggressive debt collection practices.

In part two of her Forefront series on the final 2023 Notice of Benefit and Payment Parameters from HHS, Katie Keith summarizes the changes that are specific to the exchanges.

Robert Field posits that while prospects for a federally run public option are slim in a closely divided Congress, they are considerably greater at the state level.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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