FCC vote on low-income Internet access could affect health disparities

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

Photo: Appleando via Flickr

The Federal Communications Commission (FCC) last week voted 3-2 along party lines to scale back Lifeline, a program that helps about 12.5 million low-income people pay for Internet or phone access.

Lifeline was created in 1985 to help low-income and many rural households to access communication services such as telephone and eventually mobile service. Under the Obama Administration, the FCC in 2016 expanded Lifeline to include broadband access. Eligible households receive a $9.25 monthly subsidy to defray the cost of phone or Internet service.

A single person making $16,000 per year or less, or a family of four making $33,000 or less, can qualify for Lifeline assistance.

As Steve Dent explained in a detailed story for Engadget, some of the just-approved changes could force 70 percent of Lifeline enrollees to seek a new provider, which might not be available in some communities.

Some of the FCC changes will take effect soon and others are still out for public comment. Residents of Native American tribal lands will be affected almost immediately. Starting 90 days after the Nov. 16 vote, people on tribal lands can no longer receive an additional $25 per month subsidy (on top of the $9.25 subsidy) if they receive their service from so-called “resellers” (providers that don’t maintain their own network) rather than from a regular carrier such as Verizon or AT&T.

Felicia Fonseca at the Associated Press explained that about half a million people on tribal lands now receive the $25 subsidy. Joe Redcloud of the Oglala Sioux Tribe in South Dakota told Fonseca that eliminating resellers would give Native Americans fewer or no options for mobile service.

“This will be a travesty to Indian Country because it will turn back the clock to times when consumers had but one choice,” Redcloud said.

Lifeline provided subsidies of about $1.5 billion in 2016, according to the AP. The three FCC commissioners who voted for the changes said Lifeline is in need of reform to cut down on waste, fraud and abuse, some of which they blamed on the use of resellers.

As I wrote earlier this year, advocates for equal Internet access fear that cuts to the Lifeline program could exacerbate disparities in health care and education.

Many hospitals and health plans (including those serving Medicaid patients) are expanding use of Internet-based communications tools to improve their members’ health. These tools include patient portals where people can email their doctors, make appointments and receive test results. Home monitoring increasingly requires a broadband component to relay data back and forth. Something as simple as text messages to remind a patient of a prenatal appointment or alert them to a flu shot clinic could be problematic if the patient can’t afford mobile service. These are just a few examples in which patients could get left behind in quality of care if they lack reliable Internet access.

As of November 2016, 73 percent of U.S. adults had broadband access at home, according to the Pew Research Center. Racial disparities in that access figure exist. While 78 percent of white adults have home broadband, just 65 percent of African American and 58 percent of Hispanic adults do, according to Pew.

President Trump in his 2018 budget plan proposed to cut the budget of the Institute of Museum and Library Services by 90 percent. IMLS provides grants to museums and libraries, much of which is used to provide free Internet access and other digital resources. However, in September the House did approve full federal funding for library programs in its spending package. You can learn more about the #saveIMLS movement at American Libraries magazine.

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