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In rural communities, Covid relief and broadband investment can’t be competing priorities

Funding to keep hospitals solvent through the current crisis must continue unabated. At the same time, though, without the proposed investment in broadband infrastructure, rural hospitals and the communities they serve are destined never to rise above the crisis state in which they currently and barely exist.

battle, fight, money

Recently, the federal department of Health and Human Services (HHS) announced that it is distributing $178 billion to hospitals and healthcare providers on the front lines of the coronavirus response through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. At the same time, the Bipartisan Infrastructure Framework allocated $65 billion for broadband improvements in rural communities. For those keen on boosting the prospects of people dispersed over rural areas, this is most welcome news.

Except for this detail… A good chunk of that $65 billion broadband infrastructure investment could come from money being reallocated from the CARES Act. And that’s a problem, because the very concept behind this approach sets up an implicit battle between Covid relief and broadband investment.

Given the near-nationwide increase in Covid infections, the ongoing financial pressures rural hospitals have been facing for years, and the burnout crisis among clinicians and other patient-facing personnel, it’s clear that Covid relief spending is an enormous acute need.

At the same time, the White House states that the large-scale investment in broadband will “connect every American to reliable high-speed internet, just as the federal government made a historic effort to provide electricity to every American nearly one hundred years ago. The Framework will also drive down prices for internet service and close the digital divide.”

President Biden was speaking directly to those who live in sparsely populated areas. But here are a few reasons why broadband expansion will also improve the prospects of struggling hospitals serving these communities:

  • Telehealth can be a long-term revenue source, but only if remote patients have high-speed internet through which to access quality virtual care. Currently, more than 30% of rural residents don’t.
  • Broadband can help rural hospitals — many of which suffer from acute staffing shortages — with recruiting. Hospitals that don’t have access to the foundational infrastructure that underlies today’s digital economy find it difficult to compete with better-resourced facilities.
  • High-speed Internet access for all opens economic opportunities that enable patients to get off Medicaid, resulting in higher reimbursement rates for providers.

We know that equal access to broadband across the country will have far-ranging benefits beyond ensuring a level playing field for access to online content. Equal access to broadband will help improve population health across the board. So, funding expansion of broadband is vital, but it mustn’t be accomplished by robbing Peter to pay Paul. And some influential organizations have lined up to express that sentiment, as well.

Opposition from the AHA

The American Hospital Association (AHA) along with eight other healthcare organizations are opposed to the Bipartisan Infrastructure Framework’s proposal to repurpose unused Covid relief funds to finance the infrastructure improvements. The AHA reports that the Provider Relief Funds and the $8.5 billion allocated for rural healthcare providers are fully needed to support healthcare providers serving their patients and communities.

The basis of their objection is the ongoing need that providers are, and likely will continue to be, experiencing as new waves of the pandemic continue to wreak havoc on communities and economies. They say that assuming there will be “unspent COVID-19 provider relief funds” that can be used as financing sources for any infrastructure package is unwise.

Broadband Access Is Far from Equal

While arguments from both sides are well-intentioned, the need for pervasive broadband is clear. According to a report from the Pew Research Center published earlier this year, the digital divide persists among lower-income Americans despite gains overall in technology adoption.

According to the study, 24% of adults with annual household incomes below $30,000 don’t own a smartphone. Roughly 40% of adults with lower incomes don’t have broadband services or a computer at home. These numbers stand in stark comparison to those from households earning $100,000 or more annually where adoption is pervasive.

There’s no overstating the direct and indirect impacts of that digital divide in healthcare. The Covid-19 pandemic revealed the inability of many to access or use online systems. Despite this glaring gap in services, healthcare organizations continue to increase their online presence at a staggering pace — 90 percent now offer patient portal access. The disconnect has worsened during the pandemic as more patients struggle to navigate complex online systems to obtain access to vaccines, testing, appointments and other care.

Covid Aid Offers Limited Relief to Rural Providers

Additional help could come from the CARES Act and $100 billion appropriated “to reimburse, through grants or other mechanisms, eligible healthcare providers for healthcare-related expenses or lost revenues that are attributable to coronavirus.”

In addition to $8.5 billion that AHA cites in the relief funding, $11.3 billion of that $100 billion CARES Act appropriation is allocated specifically to rural providers; $10.2 billion will go to rural hospitals, rural health clinics, and rural community health centers, with each provider receiving a base payment (that varies by provider type) and an adjustment for the provider’s operating expenses.

The CARES Act, however, doesn’t address the more entrenched issue of poor broadband in less-populated areas, which can be attributed to a variety of factors, according to the “Why is Rural Internet So Bad?” research report compiled by BLINQ Networks:

  • Broadband networks are expensive to build.
  • Harsh weather conditions and rough terrain present logistical challenges to building and maintaining networks.
  • The small number of potential customers in rural areas makes it difficult for ISPs to justify investment.
  • Internet service mapping policies by government agencies are unclear and inaccurate, often overestimating coverage.

Internet access tied to good health

Journal of Medical Internet Research (JMIR) cites a direct correlation between internet access and high-quality healthcare: “The digital divide between urban and rural populations has important implications for the health of rural residents, particularly those who are limited in their ability to travel.”

“There is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to be excluded from them,” JMIR reports.

The Bipartisan Infrastructure Framework offers the best chance to address that digital inequity, which is hurting both patients and healthcare providers. In today’s America, no one should be shut out of quality healthcare, and no one should experience exclusion because the infrastructure to deliver that care doesn’t exist. Funding to keep hospitals solvent through the current crisis must continue unabated. At the same time, though, without the proposed investment in broadband infrastructure, rural hospitals and the communities they serve are destined never to rise above the crisis state in which they currently and barely exist.

Photo:, Getty Images



Baha is the Co-founder and CEO of Azalea Health, a leading healthcare IT company whose mission it is to help underserved healthcare providers improve patient care and profitability. Under Baha’s leadership, Azalea has established itself as a high-growth innovator and leader, developing a comprehensive, cloud-based health IT platform for ambulatory practices and hospitals -- including introducing the industry’s first fully-integrated proprietary telehealth solution with its EHR.

Azalea Health has achieved Inc. 5000 rank of fastest-growing companies in the U.S for three consecutive years and has been named a Top 40 Innovative Technology Company by The Technology Association of Georgia (TAG).

Baha has been recognized in the industry with a number of awards including the Phoenix Award by the Metro Atlanta Chamber Bioscience-Health IT Leadership Council in conjunction with the Health IT Leadership Summit for his outstanding contribution to the growth of the health IT industry in Georgia. He is also a 2018 recipient of the Atlanta Business Chronicle’s 40 Under Forty Award and a 2019 recipient of their Most Admired CEOs Award.

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