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FCC Commissioner Mignon Clyburn nailed it:
Lifeline has remained unchanged for 30 years. We need to retool, update and future proof this program, while preventing fraud.
January 21, 2016
Commissioner Clyburn tweeted this after last month's appearance at MMTC's Broadband and Social Justice Summit. That event focused on the crucial links connecting broadband adoption with empowerment and social equality.
MMTC and Commissioner Clyburn each deserve praise for their efforts not only to draw attention to broadband adoption but also for highlighting an obvious solution: reforming the FCC's outdated Lifeline program, which offers phone service discounts for low-income consumers.
As Commissioner Clyburn noted, Lifeline's goals are noble but the program itself has become ridiculously outdated. Its focus is entirely on phone calling instead of Internet service. Moreover, even granting changes in 2005 to include pre-paid wireless calling, the program still focuses on "solving" a problem that for most people hasn't existed in a decade or more.
Free phone calls and free texting long ago became staples of wireless service. On the wired side, bundles of broadband and entertainment services have for years included unlimited calling as a free add-on.
Yet Lifeline soldiers on with an outdated emphasis solely on phone calling. Fraud is a problem and by ignoring broadband adoption, the program effectively undercuts efforts to promote health care, education and social justice. (For more on the health care implications, see my Dec. 4 entry, "A lifeline for mHealth.")
The way to modernize Lifeline is obvious, particularly given the growth of discounted bundled services: allow the program's funds to be used for fixed or wireless broadband Internet service. A coordinated enrollment process managed by state agencies instead of providers would play the key role in determining eligibility for Lifeline. This approach will make Lifeline more efficient and reduce fraud.
Most important, it will give low-income consumers what's they truly need in today's society - an Internet link to opportunity, health care and a better life. Average broadband speeds in the U.S have tripled since early 2011 so today's access should be easily sufficient for most needs.
Technology and consumer preferences have both changed radically since the Lifeline program was created over three decades ago. It's time that Lifeline changed too.
"Net neutrality has become an illusion in that its rhetoric leads to the appearance of giving customers greater opportunity and controlling market power. The reality is that it is keeping the poorest and most economically vulnerable among us from getting the services the rest of us take for granted. Let's resolve to stop this."
The overlooked impact of last February's FCC vote to begin micromanaging the Internet with 1934 "Title II" rules is that it hits hardest on society's disadvantaged. First, they're less likely to have broadband service. Second, they have the greatest needs since broadband gives them access to services such as mHealth, and telehealth that they're less likely to have elsewhere.
The FCC's decision to saddle broadband technologies with Title II rules directly undercuts our ability to deploy high-speed broadband. Therefore it also directly undercuts any effort to expand health care access.
The latest evidence of these problems came last Tuesday, as an Arkansas Internet provider told Congress how the FCC's action had forced her company to delay plans to deploy across Central Arkansas. Elizabeth Bowles, head of Aristotle ISP, testified, "Before [the FCC's action], it was our intention to triple our customer base by deployment of a redundant fixed wireless network...." But the firm had to pull back because of what she called "the risks [and] expense" of complying with the FCC's rules.
So tens of thousands of residents in Central Arkansas lost a broadband option that could have linked them to quality health care access.
To put this in perspective, consider the health care challenges faced in that state. Arkansas ranks 48th in overall healthcare, according to a 2015 survey. Nearly 40% of rural residents are obese, and there is a growing health disparity among the less educated.
Nor is Arkansas alone in these problems. Rural healthcare access remains a crucial issue across much of the U.S., particularly in areas without public transportation. A 2013 study found that transportation barriers limit health care access, especially for those living in lower income communities. These individuals are more likely to miss appointments which leads to delayed care and an inability to properly manage chronic illnesses.
Telehealth and mHealth will not solve every healthcare problem. But they can solve many - and at an affordable cost.
The FCC should stop undercutting online health care access - and broadband deployment in general - in a misguided attempt to regulate the Internet.
For anyone who follows health care, this week's Congressional hearing on the Internet had disappointing news. As FCC Commissioner Ajit Pai testified with evident exasperation halfway through the 3-hour hearing, "The FCC has impeded the IP transition, making it harder for carriers to leave behind the fading copper networks of yesterday and focus on building next generation networks."
The health care implications of this problem are huge. "Internet Protocol" is a revolutionary system for transferring data. Exactly two years ago, FCC Chairman Tom Wheeler called America's transition to this technology the "fourth network revolution." He enthusiastically talked about the "innovation, investment, ideas, and ingenuity" that IP would create and "spillover effects [that would] transform society...."
Nowhere will the spread of IP do more good than with healthcare. IP systems will allow the next generation of health care monitoring and treatment. The technology will facilitate medical specialists' abilities to give real-time advice in operating rooms a thousand miles away. It will give new hope and access to those who can't leave home.
But now this progress is delayed and so is the mass adoption of the amazing healthcare benefits that IP makes possible. Why? Because the FCC inexplicably seems to be turning its back on the smart regulatory policies created by President Clinton. Those policies, which helped drive so much progress and investment in the Internet, are one of President Clinton's great legacies.
Instead, as the hearing made clear, the FCC now seems focused on regulating tomorrow's Internet with rules from the early twentieth century. As Congress heard, these rules are confusing and legally questionable. The matter is now in front of a federal court, which will hear the case next month but probably not rule until well into 2016.
This is puzzling, dismaying and incredibly disappointing. We are delaying some of the greatest advances in health care history while Federal lawyers try to figure out how to apply an 80-year-old telephone law to a world in which a surgeon could be offering real-time help on a complex operation taking place in a different state.
The problems with this situation are so evident and so severe that Congress must step in. The last time Congress passed a communications law was in 1996, when Internet access for most people involved a 56 kbps connection over a phone line.
There should be no more delays to either health care or the IP transition. Congress, you need to take action.
Last week's two-day FCC telehealth event in Detroit was a testament to the Internet's empowering ability to deliver health care. Start with this eye-opening statistic from the Detroit Medical Center and Wayne State University: A mobile pediatric crisis team with access to an on-call psychiatrist equipped with telemedicine capacity reduced the emergency visit hospitalization rate from 82% to 20%.
Other sessions focused on digital inclusion, advances in online health care and using the Internet to spur health care entrepreneurship. Doctors presented documentation of an Inpatient Diversion Program that used telemedicine to reduce unnecessary hospitalization and save Michigan's Medicaid program nearly $8 million in one year.
In short, the event offered the latest evidence of the Internet's potential for direct personal health care empowerment.
For federal policymakers, this bears directly on the FCC's misguided effort to begin regulating existing high-speed broadband services instead of promoting better forms of access. That effort has already sparked a noticeable pull-back in investment and deployment of new broadband services, which undercuts telemedicine's growth.
This issue is especially noteworthy since many of society's most vulnerable, including seniors, the physically disabled and those unable to afford their own transportation, have become dependent on telemedicine advances.
For federal policymakers, the common denominator linking Detroit's results and the ability of communities nationwide to adopt similar programs lies in the rapid deployment of broadband service. Few people understand this better than Jamal Simmons, who moderated a session last week on how broadband has become a "social determinant" of health.
For Jamal, tele-healthcare offers the chance for millions of people to finally gain the affordable health care access they need. But the FCC's decision to regulate the Internet slows down our progress to this desired end.
Earlier this year, he explained this issue perfectly when he called on Congress to take action on Internet deployment.
Noting that the FCC's expensive "utility-style regulations... would increase costs on low- and middle-income people," Simmons urged Congress to protect Internet users in a way that doesn't add billions in new taxes and fees on our monthly service bills.
Jamal is right. The Internet is far too important to allow the FCC to tie it down with expensive rules that we have to pay for. No one benefits from that, least of all those who rely on Internet-based solutions in healthcare.
The FCC was wrong to overturn rules begun during the Clinton Administration that have served us well. This week's events in Detroit should give further impetus to Congress to step in and pass a bipartisan solution.