Post-pandemic telehealth should leave no beneficiary behind

The impending loss of access to telehealth benefits for many patients enrolled in employer-sponsored health plans could be a significant loss for millions of workers and their families. 

Widely permitted during the COVID-19-driven public health emergency (PHE) that's set to end on May 11, telehealth became the default option for most medical visits and significantly raised the public's comfort level with virtual care. It is an affordable, convenient and efficient option for all key stakeholders. This is why enactment of the Telehealth Benefit Expansion for Workers Act of 2023 (H.R. 824) and adoption of common sense, national telehealth policies is essential – and urgent.

At the height of the pandemic, seeing a doctor about a medical condition or issue that was not suspected COVID-19 was a nerve-wracking, fear-inducing prospect — if one could even secure an appointment. Masking requirements, vaccine mandates, overcrowded emergency rooms and clinics, and medical worker shortages kept many away from their primary care physician, urgent care centers and other medical facilities. This all led patients to delay medical care, potentially worsening their health conditions. 

Amidst these healthcare access concerns, however, was a silver lining: an explosion in the availability and use of telehealth services. According to a Kaiser Family Foundation (KFF) report, the share of outpatient medical visits delivered by telehealth rose from virtually none prior to March 2020 to 11% during the first six months of the pandemic. For the three in 10 Americans who reported depression or anxiety symptoms during the same period, the share of mental health counseling sessions delivered by telehealth was even greater: 40%, according to KFF. Separately, a Rand Corporation study found that in March 2021, 62% of Americans expressed a willingness to use video telehealth services.

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At least some of the rise in the use of telehealth services emanated from the actions of the Trump Administration and Congress in 2020 to eliminate telehealth access barriers to Medicare beneficiaries. Medicare eliminated state licensure barriers, allowing a willing and qualified telehealth provider to see a willing Medicare patient via telehealth without regard to their location. Medicare also dropped other requirements that patients travel to specific originating sites, or that a provider and patient have a pre-existing relationship. Lawmakers on Capitol Hill are looking to make these Medicare telehealth waivers permanent in the 118th Congress, but it is critical that private sector patients are not left behind. 

Congress passed legislation that temporarily allowed employers to offer free or low-cost telehealth visits to their employees and beneficiaries during the pandemic, even before patients paid their deductibles, so they could get medical care when and where they needed it. Congress later extended the policy until 2025 so patients can continue to utilize the benefit.

Likewise, the U.S. Department of Labor temporarily allowed employers to expand standalone telehealth offerings to employees ineligible for an employer's health plan. This is especially beneficial to part-time workers, seasonal workers, interns and other groups of employees who tend to make less money, and get more value out of a standalone telehealth benefit. But the relief lasts only until the end of the PHE as announced recently by the Biden Administration.

Because of the imminent loss of the standalone benefit, the ERISA Industry Committee (ERIC) and employer community urge Congress to support H.R. 824 and adopt additional policies that will secure permanent access to telehealth services for millions of employees, retirees and their families.

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The legislation, introduced with bipartisan support, would allow employers to treat benefits for telehealth services like excepted benefits, allowing them to be offered like dental and vision coverage.

ERIC also has urged Congress to adopt policies to eliminate state barriers to telehealth access so there is national uniformity, including: 

• Implement a permanent solution to interstate licensure for telehealth providers. There are different paths forward on this, including national reciprocity, a national license and comprehensive interstate compact with financial incentives for states.

• Specify a simple set of federal standards for telehealth. It is appropriate for a state to regulate the practice of medicine at brick-and-mortar medical facilities within the state's geographic boundaries. However, it makes little sense to have 50 different rules for telehealth depending on where a provider or patient may be located at any given moment.  

Telehealth not only served as an essential lifeline to care for tens of millions of Americans during COVID-19, it has forever changed the way Americans access medical care and especially mental health care. It is convenient and affordable, and is particularly helpful for patients in rural areas or states experiencing a shortage of medical or mental health providers.  
ERIC urges Congress to pass the Telehealth Benefit Expansion for Workers Act of 2023 (H.R. 824) and enact commonsense policies to ensure permanent access to life-improving – and, no doubt, life-saving – telehealth benefits and services for all.