Rural Health Care

The Federal Communications Commission adopted rules making multiple improvements to the Rural Health Care (RHC) Program, which helps rural health care providers afford the broadband connectivity needed for telehealth and telemedicine services. This action will improve program administration and increase participation by allowing health care providers that expect to become eligible in the near future to request funding sooner, aligning program deadlines, simplifying rules for calculating urban rates, streamlining administrative processes, and freeing up unused funding for other purposes.

Here’s what to expect at the Federal Communications Commission's December open meeting.

• We’re going after junk fees that harm consumers and hamper competition.
• We’re cracking down on illegal robotexts.
• We’re making smartphones more accessible to consumers with hearing loss.
• We’re removing barriers to broadband deployment.
• We’re improving health care in rural communities.
• We’re protecting consumer data.
• We’re protecting local TV programming.
• We will also consider an item from our Enforcement Bureau.

Healthcare providers (HCPs) and patients are increasingly relying on telehealth services (healthcare provision over the internet) to provide and seek care. It turns internet access disparities into a health equity concern, i.e., poor internet access can contribute to poor health. In response, two Federal Communications Commission programs in the United States—Healthcare Connect Fund and the Telecom Program—subsidize internet access for HCPs in rural or remote areas.

There have been several lawsuits over the last few years that challenge the legitimacy of the Federal Communications Commission's Universal Service Fund (USF). A suit from a non-profit group called Consumers’ Research argues that USF fees are taxes and that the original creation of the USF was unconstitutional since the Telecommunications Act of 1996 gave the FCC the power to levy taxes.

According to the Federal Communications Commission (FCC), 8.3 million households lack access to high-speed broadband. Providing universal access to communications service—initially voice service and now broadband—has always been a challenge in the United States. Although connecting urban, populated areas is relatively easy, serving sparsely populated rural areas is difficult due to differences in terrain and population density.

Two broad proposals have been advanced to modernize the Universal Service Fund's contributions system: 1) expanding the contribution base to include revenues from broadband internet access service, and 2) broadening the USF contribution base to include entities including edge providers such as streaming video providers, digital advertising firms, and cloud services companies. The most economically efficient option for reform is to expand the contribution base to include broadband internet access service revenues.

The  Universal Service Administrative Company (USAC) submitted projections of demand and administrative expenses for federal universal service support mechanisms for the fourth quarter of 2023. The Federal Communications Commission's Wireline Competition Bureau, in consultation with the FCC's Office of Managing Director, previously directed USAC to carry forward up to $211.50 million in unused funds from prior funding years to the extent necessary to satisfy funding year 2023 Rural Health Care program demand.

The Congressional directive in the Telecommunications Act of 1996 is for the Federal Communications Commission (FCC) to ensure that there be specific, predictable, and sufficient Federal and State mechanisms to preserve and advance universal service. The dilemma is that the source of Universal Service Fund (USF) programs is end user (i.e. retail) revenues from international and interstate wireline and mobile services, as well as revenue from providers of interconnected Voice over Internet Protocol (VoIP) services.

As what we can do with the internet has expanded, so too has the way we connect, and how we use it—at home and on the go. In the United States today, it has become the norm for a majority of households to have two types of subscriptions to the internet—mobile data for their phone and fixed (and for the most part) wireline service for their residence. Over 75 percent of households whose annual incomes exceed $50,000 have cellular data and wireline broadband subscriptions. For households below that level, 44.7 percent have both types of subscription plans.

The US telecommunications market has significantly evolved since Congress last overhauled the Communications Act more than a quarter century ago. But the Federal Communication Commission’s universal service distribution policies – though periodically tweaked – are still rooted in a framework designed to support incumbent telephone companies. However, the Congress and the FCC now have before them an opportunity to reimagine and reinvent universal service policy for the future.