Rural Health Care

In November 2021, President Joe Biden signed into law the largest U.S. investment ever in broadband access, affordability, and adoption. With $65 billion flowing to broadband, Congress also asked the Federal Communications Commission to determine what impact the Infrastructure Investment and Jobs Act will have in achieving universal service goals for broadband. This week, the FCC launched a proceeding seeking public comment on how to best make sure everyone in the U.S. can use broadband.

Telehealth can't succeed without expanding access to affordable broadband internet, witnesses told the Senate Commerce Committee on Oct 7. But extending the regulatory flexibilities around this access granted under the public health emergency, which are slated to expire when the COVID-19 pandemic subsides, is also critical, they said, stressing that the benefits of telemedicine can't be understated.

Reps Jahana Hayes (D-CT), and Marc Veasey (D-TX) introduced the Preventing Disruptions to Universal Services Funds Act (H.R.5400) to extend access to federal funds for telecommunications programs for three years, eliminating the need for a yearly fund recertification. The bill was created to ensure internet access for millions across the country is not disrupted by federal funding costs allowing for continuous access to available resources.

There is currently a policy debate circulating asking who should pay to fund the Federal Communications Commission’s Universal Service Fund. For decades the USF has collected fees from telephone carriers providing landline and cellular phones – and these fees have been passed on to consumers. As landline telephone usage has continued to fall, the fees charged to customers have increased. To fix this, there have been calls to spread fees more widely.

As the Infrastructure Investment and Jobs Act awaits a vote in the House of Representatives later this month, a debate over the future of the Federal Communications Commission's Universal Service Fund (USF) is already starting. Provisions in the infrastructure bill call for the FCC to quickly complete an evaluation of how the legislation will impact how the FCC's achieves the goal of deploying broadband to all Americans. Congress wants to know how the FCC can be more effective in achieving this goal. One brewing USF issue is how we pay for it.

The Federal Communications Commission’s (FCC) Universal Service Fund (USF or Fund) has been one of the nation’s most important tools for connecting our nation, including rural communities, low-income families, schools, libraries, and rural health care facilities. However, the funding mechanism that supports the Fund is under significant duress. The “contribution base” – the revenues used to calculate USF contributions – has declined 63% in the last two decades, from $79.9 billion in 2001 to $29.6 billion in 2021.

The Biden-Harris Administration announced key investments that will strengthen telehealth services in rural and underserved communities and expand telehealth innovation and quality nationwide. These investments—totaling over $19 million—are being distributed to 36 award recipients through the Health Resources and Services Administration (HRSA) at the US Department of Health and Human Services (HHS). HRSA is making these key investments through the following telehealth programs:

Mayo Clinic Health System unveiled its new mobile health clinic on June 28th as a way to improve health care access for those in rural communities. The mobile clinic includes two exam rooms and an onsite laboratory bringing health care directly to patients, for in-person care or virtual care via the onsite telehealth equipment.

The Universal Service Administrative Company (USAC) projects that, $379.97 million in unused funds is available for use in future Rural Health Care (RHC) Program funding years beginning in 2021. The Federal Communications Commission directs USAC to carry these unused funds over to satisfy funding year 2021 RHC Program demand. The overall RHC Program funding cap for 2021 is $612,016,418.

On March 2, 2021, Senate Commerce Committee Ranking Member Roger Wicker (R-MS) asked Federal Communications Commission Acting Chairwoman Jessica Rosenworcel for a detailed status of funds report for all Universal Service Fund (USF) accounts, including but not limited to the Connect America Fund (CAF), Lifeline Program for Low-Income Consumers, E-Rate - Schools & Libraries Program, and the Rural Health Care Program.