Telehealth bill enjoys wide support, but Senate passage isn’t guaranteed

Health advocates have secured overwhelming support for legislation to expand telehealth flexibilities, but the fight isn’t over yet.

The House of Representatives overwhelmingly passed a bill in July that would extend telehealth benefits and reimbursements from Medicare through 2024. The House approved the bill with a 416-12 vote, a remarkable show of support given the bitter partisanship in Washington.

However, the Senate must still approve the legislation. While supporters are confident the Senate will pass the bill, it’s not a sure thing, said Kyle Zebley, vice president of public policy for the American Telemedicine Association.

“There are obstacles in the Senate,” he said.

“Despite having every reason to be optimistic, despite where we stand …. It’s not a given,” Zebley told Chief Healthcare Executive. “There’s a reason why our members make sure they have a voice in the halls of Congress.”

The House passed the bill overwhelmingly and unusually swiftly, which could prompt the Senate to take a more deliberative approach, Zebley said.

“The bill passed with the speed that it did through the House in a way that could lead some to think for procedural purposes or political purposes …. The Senate might not be so inclined to pick it up,” he said. (Check out excerpts of our conversation with Kyle Zebley. The story continues below the video.)

• Read more: Patients in most disadvantaged areas used telehealth, study shows

‘A uniquely popular issue’

To be clear, Zebley remains optimistic that the Senate will pass the bill, especially since it has demonstrated such broad bipartisan support. He said Democratic and Republican senators are backing the legislation.

“We’d be hopeful to maximize the positive momentum,” Zebley said.

Biden has indicated he would sign the measure. The White House issued a statement of support for the bill last month.

Telehealth is being used in rural, suburban and urban areas, so it’s hard to imagine a region or congressional district that isn’t seeing the benefits of virtual care, Zebley said.

“Telehealth is just a uniquely popular issue,” he said. “We see that in poll after poll."

Still, the clock is ticking.

The Senate doesn’t have much time left in the current legislative session. Senators will return in September after an August break, but many will be consumed with the mid-term elections in November. If senators don’t move fairly quickly on the bill, the Senate could simply run out of time.

“That’s always a challenge in an even-numbered year,” Zebley said, adding, “I think calendar time is certainly an obstacle.”

• Read more: Using telehealth to improve equity and access

Zebley said it could be taken up in the “lame duck” period between the November elections and the entrance of the new Congress. Some popular legislation can get done in the lame duck period, he said.

Even with bipartisan support in Congress, U.S. Rep. Lloyd Doggett, a Texas Democrat, has voiced concerns over the potential of fraud in telehealth. He was the lone Democrat to oppose the House bill, and while he said he supports the expansion of telehealth, he said there need to be more safeguards to prevent abuse, which he said the legislation lacked.

“Whenever billions of federal dollars are available anywhere, some will try to steal it and that’s what’s happening with telehealth,” Doggett told Politico.

Zebley said those concerns shouldn’t derail the legislation.

“We think there are layers of accountability in place to make sure that fraud is rooted out,” he said. “The Medicare program and the Department of Justice, the Department of Health and Human Services, and their office of Inspector General, we know they have the resources to root out any examples of fraud. And any fraud is too much fraud.

“But one thing that should be made clear is telehealth is no more prone to fraud, waste or abuse as opposed to in-person care,” Zebley said.

• Read more: Doctors welcome telehealth, but some worry about access

‘Act sooner than later’

The government’s waivers for providers offering telehealth are largely tied to the federal COVID-19 Public Health Emergency. President Biden and Congress approved a provision in the spring to extend telehealth flexibilities for five months beyond the end of the public health emergency.

With Congress already approving a five-month extension beyond the public health emergency, Zebley said it’s possible some in the Senate may see less urgency for an extension through the end of 2024.

The Biden administration has typically been renewing the public health emergency every 90 days, and the latest extension runs into mid-October. Since federal officials have repeatedly said they would provide 60 days notices before ending the public health emergency, health advocates expect the Biden administration to once again extend it, which would take the public health emergency into January 2023.

But as Zebley said, it’s possible that could be the last extension of the public health emergency. “That means Congress should act sooner than later,” Zebley said.

The provision allowing telehealth flexibilities to continue for five months beyond the public health emergency “was a huge show of support,” Zebley said. “It’s not nothing. It’s not two years, either.”

Telehealth usage has soared during the COVID-19 pandemic. The federal government relaxed restrictions on telehealth in the early days of the pandemic, and in the early months, millions began virtual visits to providers. The use of telehealth has dipped since the first several months of the pandemic, but it is still far higher than before the arrival of COVID-19.

Health advocates would like to see permanent telehealth reforms, but for now are hoping the Senate will approve the telehealth bill extending reimbursements for two more years.

Biden has voiced strong support for telemedicine, Zebley said. He also credited former President Donald Trump’s administration for quickly implementing waivers to allow providers to offer telehealth services early in the pandemic.

Biden has continued that strong support and Zebley called the president an “enormous ally.”

“We really couldn't have asked President Biden and his team of appointees and other government officials …  for more in terms of their public comments,” Zebley said.

While the main concern is focused on getting a two-year extension for telehealth, Zebley said telemedicine advocates are hoping to see permanent reforms. They also hope the Senate will include some elements that didn’t make it in the House telehealth bill.

Ideally, advocates would like to see the Senate bill include a provision that would offer telemedicine coverage for 35 million Americans in high deductible health plans, as well as a waiver for remote prescriptions of medications.

“However we can get good telehealth policy, as long as we can get it to the president’s desk as quickly as possible, that’s obviously our preference,” Zebley said.

But he added, “We feel that a good bill can be made better.”

Health providers are counting on the continuation of telehealth services. Anthony Sossong, chief medical director in behavioral health for Amwell, the telehealth company based in Boston, told Chief Healthcare Executive in a July interview that he is hoping to see meaningful telehealth reform in Washington.

“What happens in the next 12 months is going to set the stage for the next 10 years of treatment,” Sossong said.