Telehealth bill is a step backwards by making audio-only visits more difficult

On June 14, the State Advisory Board on Mental Health voted unanimously to ask Governor David Ige to veto House Bill 1980citing the likelihood of successful suicides if this bill is enacted.

Beyond questions of life and death, two of the most troubling questions raised by HB 1980 are: 1) Should our federal taxpayer-funded health insurance plans provide better access to health care than the Hawaii private insurance? And 2) Should the Hawaiian telehealth law allow audio only pet veterinary carebut prohibit it to people?

During the Covid-19 lockdown, the tried and tested landline was the only lifeline available to so many, especially patients in rural and isolated communities lacking broadband coverage, the poor who lacked access to smartphones and many kupuna intimidated by new technologies.

The federal government got it, and Congress and President Biden ensured that public health insurance reimbursed audio-only telehealth services under Medicare (age 65+) and Medicaid (low income) . Governor Ige agreed and issued an emergency proclamation to compel private insurers to do the same.

Hawaii’s emergency proclamation expired in August 2021.

Despite multiple legislative proposals to make these recent advances in telehealth policy permanent, ensuring that audio-only telehealth services would continue to be available through private insurance, HB 1980 actually takes us back – restricting access to care in a worse way than before the pandemic.

While claiming to adopt audio-only healthcare as the wave of the future, some health insurers testified in favor of HB 1980, but also claimed that audio-only “telehealth” treatment is inferior. They worry that mental health care providers are exploiting audio only as a modality, committing fraud and neglecting their care.

The wording of HB 1980 favored by insurers (unlike the other nine bills which authorized audio-only “telehealth”) imposes unreasonable and burdensome conditions on vulnerable patients before their mental health care can be reimbursed:

  • telehealth technology must be unavailable;
  • the patient must first see the provider in person within the past year; and
  • telephone treatment must be a “covered health care service”.

HB 1980 also adds a new definition of “telephone service” making it ineligible for coverage until new insurance codes are issued (which may take six months or more).

Talk therapy works

All of this is especially harmful to patients on nearby islands who rely on telephone treatment with Oahu providers.

Explain this to the isolated and overwhelmed mother of Laupahoehoe, Kaunakakai or Hana; or the depressed father struggling to stretch his salary all week; or the confused grandfather who uses his cell phone as a paperweight because he gets nervous when it rings.

What happens if they get sick? Or are we entering another Covid lockdown?

Will patients have to wait until they need to go to the emergency room or call an ambulance? Won’t it cost more? What if, by then, it was too late?

Talk therapy via a landline literally saves lives. Otherwise, what’s the point of launching the new 988 suicide prevention hotline in a few weeks?

Additionally, mental health professionals are ethically bound to provide care over the phone, whether or not that therapy is covered by insurance. Unlike insurance executives, mental health providers did not get into this work for the money, but to treat people. We need support, especially when the demand for mental health care is so high.

Talk therapy via a landline literally saves lives.

Legislators have been led to believe by the insurance industry that HB 1980 creates legal authority for reimbursement that did not previously exist. But Kaiser clarified during a hearing they provided reimbursement for telephone care long before the pandemic – and rightly asked for flexibility that did not end up in the bill.

What some health insurers and hospitals really want is the wording of HB 1980 emphasizing that “telephone service” does not constitute telehealth.

Why? Because the law currently requires “telehealth” is reimbursed on an equal basis with in-person visits.

HB 1980 protects the profits of health insurers, but again leaves us with these questions:

Why should hard-working families with employer-based insurance pay out of pocket for audio-only telehealth while those with Medicare or Medicaid don’t?

And why Senate Bill 2798 include telephone treatment in the definition of veterinary telehealth, giving dogs better access to health care than humans?

There is no doubt that HB 1980 will hurt people and increase profits for insurers.

Please request this veto. Otherwise, Governor David Ige will join the lawmakers who smuggled this through.

If telephone telehealth is good enough for Medicare – and dogs – it’s good enough for private insurance.

Editor’s Note: This community voice was written in collaboration with the Hawaii Psychological Association, the Hawaii Chapter of the National Association of Social Workers, the Hawaiian Islands Association of Marriage Therapy, and families and several organizations, providers and public health advocates.

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