POLITICO spoke with nine consultants and lobbyists who advocate on behalf of clients or businesses that care about telehealth policy — such as employers, insurers, providers, health systems and the telehealth companies — who said that abortion issues could threaten policy wins. Most would speak only if granted anonymity because of the divisive nature of the issue.
Although abortion services represent a small percentage of overall telehealth services, consultants and lobbyists are also concerned that digital providers could become the next frontier in legal battles, as patients in states where the procedure is illegal seek other ways to access it.
“There’s a long history of abortion being a contentious element of debates over health care coverage and financing, and that’s likely to be even more true going forward. It’s going to be very hard to have a debate about any health care issue without abortion rights being a part of it,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation.
Easing of rules
The federal government waived dozens of care restrictions for virtual visits as the country locked down with a particular focus on the Medicare program, such as allowing providers to be reimbursed for telehealth care versus in-person visits. Congress has extended these flexibilities for 151 days after the public health emergency ends — which lobbyists think will be early next year.
Lawmakers also suspended a law that prohibits controlled substances from being prescribed remotely, and gave employers the option of offering pre-deductible coverage of telehealth services for people with high-deductible health plans — these expire at the end of the public health emergency and on Dec. 31, respectively.
The race is on to keep pressure on Congress to extend these policies, which have been beneficial for providers and telehealth companies — making it even more important to avoid thorny questions about reproductive rights.
“We are not letting our foot off the gas,” said Ilyse Schuman, the senior vice president of health policy at the American Benefits Council, of the group’s intense lobbying efforts to extend the provisions related to telehealth coverage for those in high-deductible health plans. But its members haven’t been talking about abortion.
“Employers are just trying to … grapple and understand the implications of Dobbs,” she said, referring to Dobbs v. Jackson Women’s Health Organization, the recent decision that overturned Roe. “A lot of folks are just trying to figure out what this really means for their policies and for their benefit plans. There might be a lot more questions and answers that emerge from that in the weeks or months to come.”
The pandemic has been a boon for those offering telehealth services, including the emergence of new telehealth companies and a broad expansion of offerings from providers due to swelling patient demand. Although studies have shown that telehealth usage has plateaued, it’s still many times higher than pre-pandemic levels.
A Republican health care lobbyist said that key lawmakers from both parties leading the effort to extend telehealth flexibilities don’t want to get pulled into the abortion debate, either, because they’re also focused on the benefits of the larger goals of telehealth policy. Since there is already legislative framework — and momentum — to extend the existing flexibilities, bringing abortion into the mix could threaten those bipartisan negotiations.
While there may be policymakers, both progressive and conservative, who want to use telehealth provisions to address abortion federally, “the folks that are in the room negotiating the telehealth compromise are not going to be interested in introducing this issue into the conversation,” she said.
‘Not a debate about the merits’
Companies or providers involved in telehealth may not be able to avoid the question of abortion for long, though, as states move to protect or ban the procedure — while simultaneously updating their telehealth laws.
“If you’re helping a client, you tell them, ‘First of all, it is unclear whether you’ll be able to avoid this. Absolutely unclear. Because the minute it gets raised as part of the debate — that’s it, it’s over.’ So not talking about something in the course of negotiation is not necessarily going to work,” said a 20-year veteran of the health consulting industry who was granted anonymity to speak about client matters.
States that prohibit abortion do not make exceptions if a provider is in a different state, so some people may find it easier to take a telehealth appointment in an abortion-friendly state than finding a physical clinic. There’s already been a surge in demand for getting abortion medication online.
“This is not a debate about the merits of telehealth. Everyone recognizes that telehealth increases access to health care services, whether it’s chronic disease management, mental health, post-acute care, primary care, specialty consultations or other services,” said Krista Drobac, the executive director of the Alliance for Connected Care, a coalition of companies and providers working to extend the telehealth flexibilities. “This is a debate about the enforcement of the standards of care set by the state. Medical providers have always, and will continue to be, required to abide by the laws and standards of care set by the state where the patient is located, regardless of where the provider is located.”
Telehealth advocates have long had to balance reproductive rights with telehealth access.
One policy consultant who works with telehealth companies noted states such as Arizona and Florida, which she said have “really great” telehealth policies — including licensure waivers and favorable coverage provisions — have also moved to ban abortion. It’s an example of the tensions that exist for those working in telehealth in balancing their views on abortion with wanting to advance policies that expand telehealth.
“The struggle for people that advise on this space is, it’s a hard needle to thread because there’s other critical health services — [medication-assisted treatment], contraceptive services. There’s so many contraceptive deserts in Texas, where telehealth has been a game-changer,” she added. “That is a balance, that is a tension that a lot of us have had before this decision. And the question is, what now, right?”