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Trumpcare May Harm Telepsychiatry

Trump telehealth in the garbage (1)

Trump care May Harm Telepsychiatry

The Patient Protection and Affordable Care Act (ACA), otherwise known as “Obamacare” currently insures over 20 million Americans and represents the largest increase in government subsidized insurance since the establishment of Medicaid and Medicare in 1965.  Under Obamacare, services for mental health conditions and substance use disorders were defined as “Essential Health Benefits” that health insurance plans are required to cover.

Donald Trump, Paul Ryan, and a portion of the Republican Party are attempting to “repeal and replace” this Act in order to fulfill campaign promises.   Unfortunately, a repeal of Obamacare will likely harm telemedicine and telepsychiatry.

According to Medicaid.gov, Medicaid and the Children’s Health Insurance Program provides health coverage to over 72.5 million Americans.  Since 48 state Medicaid programs and DC are currently reimbursing for live video telehealth (CCHP, 2017), many of the Americans losing coverage will be telehealth patients.

Medicaid creates opportunities for states to cover nearly all low-income Americans under the age of 65.  Under Trumpcare, Medicaid expansion will be phased out and Medicaid spending will be significantly reduced.  This will be a significant hit to millions of low income Americans.

According to the Unites States Department of Agriculture, “…the overall rate of poverty is higher in nonmetro counties than in metro…The nonmetro/metro poverty rate gap for the South has historically been the largest.”  Therefore, rural areas that need telepsychiatry are comprised of poorer individuals who rely more on Medicaid for their healthcare.

One of the chief benefits of telemedicine is the capability of connecting doctors in the cities to patients in rural areas.  Telepsychiatry is an especially effective and fast growing mode of healthcare delivery to reach patients who otherwise have little access to in-person doctors.  Without sufficient funding, telehealth organizations will lose incentives to bring services to rural areas.  Ironically, Trump supporters, who comprised most of the voter base in rural areas, will be the patients who suffer most from this change in healthcare policy.

Telepsychiatry will be one of the specialties of telemedicine most impacted by a change in Medicaid coverage. Low income Americans tend to have a higher rate of mental illness and substance use disorders.  Trumpcare, as currently proposed, will allow broad swaths of this population go without essential mental health and addiction services.  Again, this will affect areas that disproportionately voted for Trump.

Telemental health has been very successful in bridging doctors with patients in low income and rural areas.  If the patients lose their health insurance coverage due to an Obamacare repeal, telepsychiatry, telemedicine, low income patients, and rural areas will all lose.  The result will be higher mental illness, worsening of substance use disorders, and more suffering of people, particularly in the counties that handed Trump his election victory.


http://www.politico.com/story/2017/03/obamacare-repeal-mental-health-protections-235825 [Last Accessed 3-12-17]

http://www.cchpca.org/telehealth-medicaid-state-policy [Last Accessed 3-12-17]

https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/geography-of-poverty.aspx [Last Accessed 3-12-17]

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