Gas Prices Hurt People Going To The Doctor, But Interstate Telehealth Can Help

Everyone can’t help but notice that since the end of 2020, prices at the pump have nearly doubled across America. Gas costs $4.50 a gallon in Texas, $4.40 in Missouri, and over $6.00 in California. This means double the cost for road trips, commuting to work, and getting groceries. Yet even more tragically, the cost of getting to the doctor’s office has also doubled.

Before the pandemic, some Americans were coughing up the funds to cover 100 mile car rides just to see their doctors—with today’s fuel inflation, some people are now burning an additional $60 in gas on top of the out-of-pocket amount they pay for their medical bills. The solution to saving people from costly medical commutes lies in expired pandemic telehealth rules. In order to help patients avoid electronic wait lists and costly drives, states need to reinstate pandemic era rules that allow doctors to freely offer interstate telehealth.

Rising gas prices hit those who drive the most the hardest. Unfortunately, when it comes to healthcare, patients driving the farthest tend to be people with the lowest incomes living in the most rural places. Nearly 30 million Americans do not live within an hour of a major healthcare center. Look at Texas: Out of its 254 counties, 64 do not have a hospital in their jurisdiction and 35 lack a single physician.

Even before fuel prices soared to record levels, 52 percent of Texans said they avoided getting basic medical appointments last year due to the cost of health care. The sad reality is that most Americans barely have savings to pay for unexpected medical bills, which makes the additional five dollar per gallon burden all the more damaging. For rural patients, a few extra dollars in commuting costs can be the difference between getting care or not.

Governors with large rural jurisdictions tried expanding access to telehealth to address COVID concerns and reduce the cost of care. In the beginning of the pandemic, many states encouraged telehealth by reducing the out-of-pocket amount patients pay and by temporarily suspending licensing requirements to let providers offer care across state lines. Initial results showed major promise in improving access. One HHS study showed that Medicare saw a 63-fold increase in telehealth utilization during the pandemic.

Telehealth saved many from making a 100 mile drive and gave them access to much needed care, but this success was not without shortcomings. Despite telehealth’s initial progress, it still didn’t resolve the emerging consequences of health professional shortages, nor did it prevent the return of licensing barriers for out-of-state providers trying to directly help underserved populations.

During the pandemic, health professional shortages were not as detrimental because all 50 states used their emergency powers to give patients unprecedented access to states with a surplus of providers. However, with the pandemic tapering, 35 states have now seen these emergency declarations expire, allowing the interstate telehealth walls to be rebuilt.

This is problematic because the national supply of doctors is not equitably dispersed across the United States. For instance, Massachusetts has about 446 active doctors per 100,000 patients, while some larger states like Texas have only 232 active doctors per 100,000 patients. As a result, Texas providers face a higher demand than they are able to meet, even with telehealth. All the while there is an abundance of high quality providers in other states who could offer assistance, but they are no longer allowed to help because of resurrected pre-pandemic licensing barriers.

With state borders restricting telehealth, states with the most need are watching telehealth wait lists pile up. When the American Psychological Association surveyed its members last fall, it found a surge in demand and new referrals, particularly for anxiety, depressive, and trauma-related disorders. Yet more than 600 psychologists said they had no capacity for new patients and 68 percent said their wait lists were longer than they were in 2020.

And it’s not just patients needing mental health services that are placed on wait lists. Patients seeking neurology to dermatologist specialists have to wait 3 months before they can get their first consultation appointment. Despite telehealth’s promise as a method to cut back on wait times, the reality is that if a state physically has fewer doctors available, it will take longer to see patients in-person or on the computer.

One study from Michigan found that nearly 1 in 5 rural patients received care from out-of-state doctors during the pandemic. Patients have already witnessed the boon of interstate telehealth, but yet many states are now reverting back to a time when Michigan doctors couldn’t see patients living just across the border in Ohio.

Technically, there are some avenues for out-of-state providers with more capacity to see underserved patients through licensing compacts. However, these compacts only apply to a few kinds of providers in the states that have adopted them, the approval process can be grueling, and the agreements often don’t cover the full scope of care all patients need.

Telehealth is the least costly and most direct way for doctors to reach rural patients struggling to stay afloat in the midst of rising inflation. In order to meet demand, states need to acknowledge the unequal medical professional supply across states and allow providers residing in states with a greater patient-to-provider ratio to offer their services through interstate telehealth.

Americans deserve to get care from whomever they want from wherever they are residing. With gas prices continuing to soar and the supply of telehealth providers reaching capacity, state policy makers need to knock down the nonsensical hurdles that hurt patients’ access to care whether it’s just down the street, or over an arbitrary state line.

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Josh Archambault (@josharchambault) is the Founder of President’s Lane Consulting, and a Senior Fellow at Cicero Institute (@InstituteCicero) and Pioneer Institute (@PioneerBoston).

Tanner Aliff (@taliff5) is a Healthcare Policy Manager at the Cicero Institute.