By Justin Leventhal, American Consumer Institute
Congress has once again extended pandemic-era telehealth flexibilities making it easier for patients and doctors to use—this time until 2027. That may sound like progress, but it isn’t. It’s another short-term patch that reinforces a growing problem: telehealth policy in the United States operates on a rolling expiration date. Instead of providing certainty, lawmakers are preserving regulatory ambiguity for patients and doctors.
That uncertainty has real consequences, especially in rural America where communities have fewer providers, longer travel times, and worse health outcomes than their urban counterparts. Eighty percent of rural counties are considered medically underserved. For these patients, telemedicine is not a convenience, it is often the only practical way to access care.
Instead of fully embracing telehealth, policymakers are holding it back. Temporary federal extensions and outdated state-level tele-prescribing rules are artificial barriers to a technology that has already proven its value. Making telehealth deregulation permanent eases doubt about investing leading to expand access, lower costs, and improve healthcare outcomes—especially in rural communities.
The underlying problem in rural healthcare is simple: supply is constrained. Rural areas havefewer hospitals, fewer pharmacies, and fewer healthcare professionals. For patients, this means hours of travel, missed work, and higher out-of-pocket costs just to receive routine care—and the problems are only magnified if a patient needs a specialist.
Telemedicine directly addresses this geographic mismatch. It allows providers to reach patients without the fixed costs of building new facilities or relocating doctors. In a market where healthcare supply cannot easily move, telehealth allows patients to access care.
The evidence is clear that it works. Studies consistently show that telemedicine improves access and reduces missed appointments, particularly for follow-up care. Per-visit costs are often lower than in-person alternatives, especially for routine and primary care services. This is not an untested innovation. It is a proven delivery model.
Telemedicine does exactly what policymakers claim to want. It increases competition by expanding patients’ choice of providers. It introduces price transparency, with many virtual care platforms offering upfront pricing that traditional providers avoid. And it lays the groundwork for future innovation—remote monitoring, virtual-first care models, and AI-assisted diagnostics all depend on predictable rules.
Instead, policymakers are doing the opposite. By extending telehealth flexibilities only in short increments, they are discouraging investment. Providers are less likely to build out telehealth services if reimbursement, prescription, or other rules may disappear in a few years. Insurers cannot design long-term benefit structures around a temporary policy. New care models that rely on remote monitoring or continuous engagement require regulatory certainty that simply does not exist under the current framework.
State regulations often make the problem worse. Many states still require in-person visits before a provider can prescribe medications or even initiate telemedicine services. These rules undermine the core benefits of telehealth by forcing patients back into the very system telemedicine is meant to bypass. For rural patients, that means more travel, higher costs, and delayed care.
These restrictions are also out of step with the evidence. During the pandemic, tele-prescribing was widely expanded—including for many controlled substances. The result was not a surge in unsafe prescribing or widespread harm. Instead, it demonstrated that tele-prescribing can be done safely. Despite this, many states have reverted to pre-pandemic rules that assume telemedicine is inherently riskier than in-person care—an assumption that has been proven wrong.
The solution is straightforward. First, Congress should make all federal Covid era telehealth flexibilities permanent, codifying expanded access to remote care. Second, states should eliminate blanket in-person requirements for telemedicine and instead allow doctors to determine if in-person visits are necessary. Additionally, states should ensure restrictions on tele-prescribing are targeted and risk-based, applied only where necessary. These changes would not require new spending or complex programs. They would simply remove barriers that prevent existing technology from reaching patients.
Telehealth has already proven its value. The only thing holding it back is public policy. For rural patients, the cost of delay is not abstract. It is measured in missed appointments, untreated or undiagnosed medical conditions, and preventable illness. Extending telehealth laws every few years is not a solution—it is a signal that policymakers still have not adapted to a healthcare system that has already changed.
Making telehealth reform permanent is one of the simplest, most cost-effective ways to expand patients’ access to care.
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 X @ConsumerPal.
