Expanding telehealth is vital to the trans community

COVID-19 has been hard on Americans across the country, but there may be one silver lining: the breakdown of red tape that has allowed people to see providers of their choosing and get the care they need. The urgent need for remote health care removed needless regulation in health care settings with a pen stroke. As COVID-19 cases decline, this openness and flexibility is something we must preserve in order to come out of the pandemic stronger, especially for underserved populations like the transgender community in rural areas.  

Over the last year, we have seen unprecedented attempts by politicians getting between patients, families and providers, criminalizing transgender children’s identities and reducing their access to health care. It is time to stop letting politicians boss around the doctors.   

Fortunately, there are positive steps being taken. During the start of the pandemic, we saw more than a 20-fold increase in telehealth visits. Many states responded to increased demand by granting waivers to permit providers to practice amidst rapidly increasing telehealth needs, benefiting diverse patient populations    

This defied the tangled web we call the American health care system.   

Health care in the U.S. is a patchwork of federal and state regulations that control licensing and, as a result, decide who is allowed to practice in which state. In many parts of the country, such as New England, multiple states are clustered together and yet patients living 10 miles from a provider cannot access care unless they are physically located across state lines.    

Believe it or not, these state licensure laws are an antiquated remnant from the time of the Civil War meant to control unrestricted entry into medicine. Nursing and other clinical professions followed these laws even though health care, rooted in science, does not differ from state to state. Today, this bifurcated system prevents a more perfect health care union from forming. The red tape directly impairs the ability of providers to care for those in rural settings, less-resourced states and communities on the margins.   

This lack of unified licensing, or mutual recognition, leaves Americans vulnerable to another national health crisis. Less unification means a system less poised to respond across state lines and as we’ve learned over the last year, COVID-19 knows no bounds.   

Health care standards have no business being controlled by politicians. In reality, it’s politicians who should be listening to clinicians. There is a path forward to unify our broken system. We should use this moment to invest in pathways that have already been accepted by Australia, Europe and the U.S. Veteran’s Administration.    

The most comprehensive one-stop approach would be an appeal to the federal government. A national licensing standard would solve this — the creation of one unified agency, similar to the apolitical Centers for Disease Control and Prevention (CDC), which would follow standards and allow for one licensing pathway. This would prevent politicization from state governments.    

Short of implementing a national licensing process, providers could follow nursing’s lead and sign on to licensure compacts. Compacts would allow for less federal bureaucratic red tape and enable utilization of current state resources. This process of mutual recognition would increase health care access and not require additional bureaucratic burden.  

Even if states do not follow the lead, Health and Human Services (HHS) can act. The secretary of HHS used Section 1135, an existing public health waiver authority, to preempt state statutes. This provided temporary, limited protection for telehealth services. Currently, HHS could begin to investigate ways to continue to facilitate cross-state vital telehealth services and to work with Congress on longer-term solutions.  

In the end, these interstate licensure issues create a barrier for patients. Revoking access will make it more difficult for clinicians treating patients. Moreover, the option of increased access that was provided during the height of the pandemic would also be less available. This will drastically reduce the availability of care for our most marginalized, such as transgender patients of color in rural settings.    

Aligning health care access with the needs of our country, including the most marginalized, is crucial.    

COVID-19 made rapid changes in technology and health care possible. It is time that policymakers either adapt accordingly or get out of the way.   

Dallas Ducar is the founding CEO of Transhealth Northampton.