By Justin Leventhal, American Consumer Institute
Healthcare has entered the digital age—but state laws are still written for the rotary phone era. Providing healthcare for patients in their homes has become easier than ever thanks to telemedicine, but regulators are often failing to keep up. Telehealth improves patient outcomes in many circumstances, particularly in chronic disease management. It alsoreduces emergency room visits by providing a convenient alternative for non-urgent care. Beyond improving access, telehealth is less expensive to deliver and saves patients both time and money.
This is likely why Congress has repeatedly extended many pandemic-era Medicare telehealth waivers through 2027, ensuring Medicare beneficiaries can continue receiving care easily. But temporary extensions are not enough. Congress should make these waiver permanent and fully integrate telehealth into Medicare going forward.
Despite telemedicine’s clear benefits, many state legislatures continue to impose needless barriers to its use. Some states require patients to establish an in-person relationship with a physician before receiving any telehealth services. Others only require an in-person visit before a healthcare provider may prescribe medicine.
In the first category includes Kentucky, West Virgina, and Washington, D.C. which impose broad in-person requirements. The second category includes more complex restrictions. New York, for example, requires an in-person visit before certain prescriptions can be issued. Other states, such as Georgia and Minnesota, restrict tele-prescribing for specific categories of drugs—often opioids or other tightly controlled substances, such as Schedule I, II, or III medications.
Although these restrictions may appear to protect patients, they often harm them instead.
Blanket in-person requirements ignore the reality that many services do not require physical examinations to diagnose or treat patients effectively. Mental health counseling, chronic disease management, dermatology consultations, and medication management can often be safely and effectively provided purely via telehealth.
In-person mandates are also frequently burdensome, especially in rural areas where patients may live hours from the nearest provider. A 30-minute appointment can require a full day off work, lost wages, transportation costs, and childcare arrangements. For financially strained families, these requirements become real barriers to care.
Experience during and after COVID-19 demonstrated that many of these restrictions are unnecessary. Congress extended Medicare telehealth waivers because the evidence supports their effectiveness. Similarly, the Drug Enforcement Administration (DEA) has extended its temporary flexibility allowing DEA-registered practitioners to prescribe Schedule II-V controlled substances via telehealth without a prior in-person visit, provided standard safeguards are met. The policies reflect practical realities: telemedicine can safely expand access.
Telehealth specific laws are not the only obstacles to remote healthcare. Many states continue to restrict Advance Practice Registered Nurses (APRNs), including nurse practitioners, from practicing independently. These supervision requirements artificially limit the supply of telehealth providers. Telehealth cannot expand access if qualified clinicians are legally prohibited from providing care independently.
Interstate licensing barriers compound the problem. While most state have joined theInterstate Medical Licensure Compact for physicians, the APRN compact has not yet taken effect. Only four states have adopted it, and it requires seven to become operational. Just as restrictive supervision laws limit instate access, prohibiting APRNs from practicing across state lines reduces competition and patient choice.
Giving patients the ability to more easily see an APRN drastically expands the healthcare workforce available to patients. As of September 2025, there were more than 460,000 nurse practitioners working in the U.S. Given the lack of primary care in rural areas alone, allowing patients access to these healthcare providers would be a massive boon to some of the most medically in need communities in America.
The solution is straightforward. States should eliminate unnecessary in-person mandates for telehealth, align controlled substance prescribing laws with current DEA flexibility recommendations, grant full practice authority to APRNs, and adopt true interstate licensure reciprocity.
Healthcare has entered the digital era. Patients should not be forced to navigate outdated regulatory barriers simply to access care that technology already makes safe, affordable, and convenient. If policymakers are serious about lowering costs and improving access, telehealth deregulation is one of the simplest reforms available.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization. For more information about the Institute, visitwww.TheAmericanConsumer.Org or follow on Twitter @ConsumerPal.
