In 2016, the United Nations declared that the ability to access the internet was an essential human right. More specifically, it was added to the , which promoted the "." However, despite the clear importance of internet access around the world, the U.S. is falling behind in ensuring its communities of color and other marginalized groups have access to this valuable human right.
We're here to tell you that health systems and centers can play a major role in changing that.
Disparities in Internet Access
Having the right to access the internet gives an individual access to a nearly limitless source of information. In terms of healthcare, the internet has become an essential part of delivering care to rural communities or places hit by disasters. Moreover, the COVID-19 pandemic triggered a dramatic increase in the use of telehealth as one concrete way to increase healthcare access. Despite its promise, telehealth has the potential to widen the healthcare access gap and leave vulnerable patients further behind. This is because even though internet usage is common in the U.S., of low-income Americans do not have access to broadband internet. Additionally, even though smartphones may be an alternative to having a home internet connection, of adults ages 65 and older do not have access to a smartphone. These digital equity disparities reverberate across racial lines as well. A found that only 69% of Black and 67% of Hispanic Americans own a computer, compared to 82% of white Americans.
The Biden-Harris administration understands the critical role telehealth has played concerning mental and behavioral health, in particular during the COVID-19 pandemic, and moved swiftly to bridge the gap in internet access. The Bipartisan Infrastructure Law committed a historic $65 billion in funding to help ensure every American has access to high-speed, affordable, and reliable internet. The (ACP), a provision of the Bipartisan Infrastructure Law, improves access to broadband nationwide and helps address disparities in access to care by helping patients directly cover the cost of internet service plans. Specifically, the ACP provides a subsidy of up to $30/month for lower-income households (or $75/month for households on tribal lands) on any internet service plan offered by a participating provider. It also provides a one-time $100 subsidy for a desktop, laptop, or tablet computer.
At last count, the Federal Communications Commission (FCC) reported that American households have signed up for the program. This leaves out approximately 38 million more eligible American households who are missing out on support to pay their internet bill before the program . The FCC has released enrollment data by state, zip code, and county, which can help identify target areas where uptake of the program is low. The nonprofit sector has mobilized to fill the gap. Programs like , , and have helped to enroll patients in the ACP in public school classrooms as well within the private sector.
Health Systems Can Help Increase Access
While these mobilizations have resulted in considerable early impact, the healthcare sector remains an untapped venue to connect patients to the ACP with the aim of promoting access to telehealth. This is particularly true given Medicaid patients for the ACP. Importantly, only 13% of Medicaid patients are currently enrolled.
Health systems or facilities can engage patients with the ACP through a variety of approaches, ranging from passive awareness building to active enrollment. On the passive end, Massachusetts General Hospital Emergency Department has already partnered with a nonprofit organization, , to leverage ready-made materials like posters, handouts, and discharge paperwork that invite patients to enroll themselves in the ACP while they wait in the waiting room. Health settings can also use more active sign up methods to help close the digital divide. Community health centers have a critical opportunity to leverage in-person ACP sign up events as has been piloted at the in Boston, leveraging staff or volunteers to manage the sign up process.
Lastly, facilities could consider institutionalizing active ACP enrollment into the hospital check-in process itself. Registration staff could (with patient consent) input the patient check-in data (name, address, date of birth etc.) they are already collecting into in order to automatically enroll the patient in the ACP. Handling of patient applications and subsequent steps coordinating installation and set-up could be handled by third-party organizations contracted by hospitals, clinics, and community health centers. It would also be important for waiting room receptionists and hospital administration to be able to answer questions about the form.
Models like these -- which are sensitive to local contexts and target low-income patients across our nation's hospitals, federally qualified health clinics, and community health centers -- could provide valuable access points to an otherwise hard to reach population of ACP eligible communities.
It's clear that the ACP is another landmark intervention in the effort to close the digital divide. It's also clear that interventions like it will mean little if they do not reach the populations they were designed to help. With less than 25% of all eligible households signed up for the ACP, it is evident that we have work to do to connect the dots. Healthcare may be the missing piece that can help link vulnerable communities to the ACP, one patient at a time.
is the CEO of and an emergency physician in Boston who writes about the intersection of medicine, community organizing, and behavioral economics. is an undergraduate student at Harvard University and a research assistant at A Healthier Democracy where he explores the intersection of community organizing and how technology can be used to alleviate healthcare inequities.