One of my earliest trips as a Federal Communications Commission commissioner was to a health care clinic in Fort Yukon, Alaska, population 554. The clinic may not have all the amenities of a big-city hospital, but it does have a broadband connection.
High-speed internet access has made a big difference for this clinic. It’s meant access to doctors far away who can review medical information beamed to them by a local nurse.
Fort Yukon’s story isn’t unique. Today, communications technology has fundamentally transformed the delivery of health care in rural America. Telemedicine can help address the workforce shortages that are too common in rural health facilities.
Rural patients can use interactive videoconferencing to consult with specialists anywhere in the country — expert care that was unavailable and unimaginable not long ago. Chronic disease management has been revolutionized as wearable sensors can detect real-time complications and alert a family member or first responder to intervene.
Digital tools can empower people with diabetes to monitor their blood-glucose levels. Bottom line: digital medicine helps rural communities increase access to health care, reduce costs, and improving patient outcomes.
No state stands to benefit more from telemedicine than Alaska, which is home to many of the most remote communities in America. In a filing with the FCC, the Alaska Native Health Consortium estimated that 20 percent of Alaska Natives rely on telehealth, and that remote consultations within their network save $10 million annually in avoided travel costs. They put it simply: “(W)e cannot provide care in rural Alaska without telecommunications.”
But there’s a fundamental challenge in Alaska, as in many parts of the Lower 48: promoting enough broadband to support digital health services. Nearly one-quarter of Alaskans can’t access fixed broadband service to support high-bandwidth applications like telemedicine. In rural areas, that number is dramatically higher.
Established in 1997, the FCC’s Rural Health Care Program is an essential tool for closing these gaps in internet access. This program helps health care providers afford the connectivity that they need to better serve patients. But it’s facing some real problems.
Most significantly, the program is currently underfunded. Its budget hasn’t increased a dime beyond its initial allocation of $400 million a year in the late 1990s. A second problem is that under today’s rules, if the program is oversubscribed (that is, if more than $400 million in reimbursements is requested from the program), every recipient sees a funding reduction.
In 2016, program recipients saw a 7.5 percent trim in support. For funding year 2017, we’re looking at a chop of up to 26 percent.
We need to update the FCC’s Rural Health Care Program to better reflect the needs of and advances in digital health care. That’s why I recently introduced a plan to increase the program’s annual funding cap from $400 million to $571 million.
This new spending level reflects where the cap would be today if it had been adjusted for inflation all these years. This 43 percent increase would apply to the 2017 funding year in order to give rural health care providers immediate relief.
Going forward, the plan would also give providers more certainty by adjusting the cap annually for inflation and allowing unused funds from prior years to be carried forward to future years.
Notably, support for this approach is bipartisan. This May, Sens. Lisa Murkowski and Dan Sullivan joined a coalition of 30 U.S. Senators from Alaska to Alabama and New Hampshire to New Mexico in calling on the FCC to increase the Rural Health Care Program’s spending cap. And the Trump Administration has broadly recognized the value of telemedicine, especially for veterans.
And this proposal is just a start. We also need to make sure that every dollar spent in the program is spent wisely to benefit health care providers in Alaska and their patients. That’s why the FCC is moving forward on a separate track to make sure that the program functions more efficiently.
This proposal is also personal. I grew up in rural Kansas, the child of rural doctors. I can remember my father waking up early to make long drives to small towns in order to treat patients who otherwise would never see a specialist. For me, this issue isn’t about technology; it’s about people and their ability to access to basic care they need to lead healthy lives.
As long as I am FCC chairman, one of this agency’s top priorities will be harnessing the power of communications technology to improve health care in rural America. Devoting the resources necessary to make the FCC’s Rural Health Care Program a 21st-century tool will go a long way toward achieving this result.
Ajit Pai is the chairman of the Federal Communications Commission.