POLITICO spoke to nine consultants and lobbyists advocating for clients or companies who care about telehealth policies — such as employers, insurers, providers, health systems and the telehealth companies — who said abortion issues could jeopardize policy gains. Most would speak only if given anonymity due to the divisiveness of the case.
While abortion services represent a small percentage of total telehealth services, counselors and lobbyists are also concerned that digital providers could become the next frontier in legal battles as patients in states where the procedure is illegal seek other ways to access it.
“There is a long history of abortion being a controversial element in debates about health coverage and financing, and likely to be even more so in the future. It’s going to be very difficult to debate a health issue without abortion rights being a part of it,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
Relaxation of rules
The federal government waived dozens of healthcare restrictions on virtual visits as the country went into lockdown with a particular focus on the Medicare program, such as allowing providers to get reimbursements for telehealth versus in-person visits. Congress extended this flexibility for 151 days after the public health emergency ends — which lobbyists say will be early next year.
Lawmakers also suspended a law banning controlled substances from being prescribed remotely, and gave employers the option to offer pre-deductible coverage of telehealth services for those on high-deductible health plans — these expire at the end of the emergency in the area. of public health and on December 31, respectively.
The race is on to pressure Congress to expand these policies, which has benefited providers and telehealth companies — making it even more important to avoid thorny questions about reproductive rights.
“We’re not taking our foot off the gas,” said Ilyse Schuman, the senior vice president of health policy at the American Benefits Council, of the group’s intense lobbying efforts to expand provisions related to telehealth coverage for people. plans with a high deductible. But the members have not talked about abortion.
“Employers are just trying… the implications of dobbs‘ she said, referring to Dobbs v. Jackson Women’s Health Organizationthe recent decision that was quashed roe† “A lot of people are just trying to figure out what this really means for their policies and benefit plans. Many more questions and answers may emerge in the coming weeks or months.”
The pandemic has been a boon to those providing telehealth services, including the emergence of new telehealth companies and a wide expansion of provider offerings due to swelling patient question† While studies have shown that telehealth use has declined, it is still: many times higher than pre-pandemic levels.
A Republican health care lobbyist said key lawmakers from both parties Those leading efforts to expand the flexibility of telecare also do not want to be involved in the abortion debate, as they also focus on the benefits of the larger goals of telecare policy. Since there is already a legislative framework — and momentum — to extend existing flexibility, adding abortion to these two-pronged negotiations could pose a threat.
While there are policymakers, both progressive and conservative, who want to use telehealth services to address abortion federally, “the people in the room negotiating the telehealth compromise won’t be interested in bringing this issue into the conversation,” she said. . said.
‘No discussion about the merits’
Companies or providers involved in telehealth may not be able to avoid the issue of abortion for long as states want to protect or ban the procedure, while updating their telehealth laws at the same time.
“When you help a customer, you say, ‘First of all, it’s unclear whether you can avoid this. Absolutely unclear. Because once it comes up as part of the debate – that’s it, it’s over.” So not talking about anything in the course of negotiations isn’t necessarily going to work,” said a 20-year veteran of the health consulting industry who was given anonymity to talk about client issues.
States that prohibit abortion make no exceptions if a health care provider is in another state, so some people may find it easier to get a telehealth appointment in an abortion-friendly state than finding a physical clinic. There is already a huge demand for online abortion medication.
“This is not a debate about the benefits of telehealth. Everyone recognizes that telehealth improves access to health services, be it chronic disease management, mental health, post-acute care, primary care, specialist consultations or other services,” said Krista Drobac, the executive director of the Alliance for Connected. Care, a coalition of companies and providers working to expand telehealth flexibility. “This is a debate about enforcing state-set standards of care. Healthcare providers are always and will be required to abide by the laws and standards of care established by the state where the patient is located, regardless of where the healthcare provider is located.
Telehealth advocates have long had to strike a balance between reproductive rights and access to telehealth.
A policy advisor who works with telehealth companies noted that states like Arizona and Florida, which she says have “really great” telehealth policies — including license waivers and favorable coverage provisions — have also moved to ban abortions. It exemplifies the tensions that exist for those working in telehealth to balance their views on abortion with the desire to promote policies that expand telecare.
“The struggle for people advising on this space is, it’s a hard needle to thread because there are other critical health services — [medication-assisted treatment], contraceptive services. There are so many birth control deserts in Texas where telehealth has been a game-changer,” she added. “That’s a balance, that’s a tension that many of us had before this decision. And the question is, what next? , However?”