Republicans like telemedicine now — just not for abortions


Donald Trump has bragged about his support for telehealth during the coronavirus, but Republicans won't back it for patients in need of abortion care.

During the coronavirus pandemic, the GOP has been very open to increasing the availability of telemedicine, the practice of providing medical services via video or telephone rather than in person. 

At the same time, it remains opposed to allowing people to receive medication abortion services via telemedicine. 

Republicans across the board have backed telehealth expansion during the pandemic. Trump even bragged about the expansion at a press briefing back in March. 

Relaxing restrictions on the use of telemedicine even appears in the most recent Senate Republican version of a new COVID-19 economic stimulus bill, sponsored by Senate Majority Leader Mitch McConnell.

The Centers for Medicare and Medicaid Services waived restrictions on reimbursing doctors for telehealth services starting on March 17. 

Previously, Medicare only paid for telemedicine when someone was in a "designated rural area" and went to a "designated location" — somewhere away from their home — to receive telemedicine.

Now, with restrictions waived, people everywhere who rely on Medicaid can take advantage of telemedicine to obtain vital health care without having to travel to a doctor's office, which health experts say could potentially increase their exposure to the coronavirus.

The GOP's newfound acceptance of telehealth does not, however, extend to abortion. 

Long before the pandemic, anti-abortion activists and state legislators had worked to ban telemedicine for the procedure. Ohio's GOP-controlled Senate passed such a ban earlier this year. Late last year, Pennsylvania tried to enact comprehensive telehealth legislation, but state Republicans attached an amendment that would prohibit the use of telemedicine for abortion. 

Seventeen other states have existing bans that require a clinician to be physically in the same room when giving a patient the drug for a medication abortion. The Guttmacher Institute, which examines reproductive health laws and policies, has said these laws are "effectively banning the use of telehealth" in those states. 

Medication abortion is one of the safest medical procedures available. According to the Kaiser Family Foundation, medication abortion has a complication rate of only 0.4% and a mortality rate of only 0.00064%. In contrast, knee replacement has a complication rate of around 2%.

States that do allow the use of telemedicine in medication abortions have seen increased access, and patients have been able to obtain abortions sooner than they would have otherwise. In 2011, Alaska and Hawaii started offering telemedicine abortions, and Guttmacher found this both increased patient choice and "resulted in patients being seen sooner and closer to home." 

The same is true for Iowa, which saw increased access to abortions when telehealth was offered. Guttmacher reported that this was particularly true for people who lived over 50 miles away from the nearest clinic.

Access to telemedicine may also decrease costs. Individuals needing care are not required to travel to a distant clinic, they are not required to make multiple trips to a clinic in states with waiting periods, and they are not obliged to find child care during those trips. And, of course, in-person visits present a special risk during the pandemic. 

Eight states enacted or attempted to enact bans on abortion during the pandemic. Litigation over the status of those bans led to confusion about access to the procedure. As litigation continued back and forth, there were reports of clinics having weekslong backlogs.

According to reports, it also likely resulted in people needing to travel out of state to obtain abortions. A clinic in New Mexico saw a three- to four-fold increase in patients coming from Texas. Clinics in Colorado and Nevada also saw an uptick in patients from Texas. 

The ACLU points out that lengthy travel for abortions, coupled with the fact abortions later in pregnancy can cost significantly more, can entirely prevent people from getting an abortion. Had telehealth procedures been more widely available during these bans, travel delays and the increased costs associated with later abortions could possibly have been avoided. 

The pandemic jump-started a shift to telehealth, one that can make a real difference in providing care to patients, particularly in rural areas. Given that access to abortion can be difficult, with 89% of counties having no abortion provider, allowing telehealth visits for medication abortions could reduce many of the costs and obstacles associated with obtaining an abortion later in pregnancy. 

Published with permission of The American Independent.