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telemedicine
Southeast Abortion Clinic Wait Times Soared After Florida Ban
Before the ban, the average Florida resident lived 20 miles from a clinic and would need to wait five days to access an abortion; after the ban, the driving distance jumped to 590 miles and the wait time to almost 14 days.
May 24, 2024
Wait times have increased at 30% of the abortion clinics in the states closest to Florida after its draconian six-week abortion ban went into effect on May 1.
The data comes from a survey carried out by Middlebury University economics professor Caitlin Myers and her undergraduate students, which was reported by The Washington Post on Friday.
"Distance and wait times are up... but telehealth is helping meet demand," Myers wrote on social media, summarizing her findings.
Suspecting that the U.S. Supreme Court would overturnRoe v. Wade in the summer of 2022, Myers began to survey abortion clinics about their wait times starting in March of that year. In her new survey tracking the impact of the Florida ban, Myers and her students called 130 clinics in Florida, Georgia, South Carolina, North Carolina, Virginia, Maryland, and Washington, D.C. They made their first round of calls last month before Florida's ban went into effect, and the next round on May 13.
Before the ban, the average Florida resident lived 20 miles from a clinic and would need to wait five days to access an abortion. After the ban, the driving distance increased by nearly 30 times to 590 miles and the wait time expanded to almost 14 days.
The Post also conducted its own analysis and found that the ban has forced around 7 million reproductive-age women in Florida and nearby states to travel farther if they need an abortion after six weeks, with the average woman now needing to drive for over seven more hours than before. The paper also found that the ban impacted a larger proportion of Black and low-income women when compared with national demographics.
Further, the Post spoke to clinic workers who detailed some of the individual stories behind the data.
Fort Lauderdale clinic director Eileen Diamond recounted the story of one woman who had traveled from Houston to Florida in search of an abortion, only learning after an 18-hour drive that Florida had passed its six-week ban. The woman, who was nine-weeks pregnant, then had to drive at least another 12 hours to Virginia and another 17 home.
"This woman was desperate," Diamond told the Post. "She had used everything she had to come to us."
Sometimes, different state restrictions can interact to make life even more difficult for those in need of abortion care. North Carolina, the closest state to Florida where abortion is legal after six weeks, requires patients to wait 72 hours between an initial consultation with a physician and the actual procedure, which puts up additional barriers for out-of-state patients. As the Post explained:
One Florida patient recently traveled 23 hours on a Greyhound bus for a consultation appointment at A Woman's Choice in Charlotte, according to Lakeynn Huffman, the clinic manager—returning home that night because she could not find childcare to cover the full 72 hours she had to wait between appointments.
The woman made the same trip two days later, Huffman said—traveling for a total of 92 hours to get an abortion.
While Florida's ban has put an additional burden on neighboring clinics, the rush has been less dramatic than after Texas passed its six-week ban in 2021. Myers explained that this is because more women are accessing abortion pills in the mail via telemedicine consultations.
However, the U.S. Supreme Court heard oral arguments last month in Food and Drug Administration v. Alliance for Hippocratic Medicine, a case brought by right-wing anti-abortion activists that seeks to restrict access to the widely used abortion pill mifepristone. The court is expected to issue a final ruling in June.
"Telehealth is really a game changer for abortion access," Myers told the Post. "But it might be a fragile one."
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To Ensure Health Equity, Congress Should Renew the Affordable Connectivity Program
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the program has been the essential linchpin for creating access to lifesaving medications for opioid use disorder.
Apr 03, 2024
In an ironic twist, people recovering from opioid addiction recently gained permanently expanded access to telemedicine services through a new federal policy—but many are likely to be among the 22 million low-income households losing access to affordable internet.
The Federal Communications Commission recently began to wind down the Affordable Connectivity Program, the country’s largest, most successful internet affordability program. This government-sponsored benefit program, introduced during the pandemic, provides low-income Americans with a one-time subsidy to purchase an internet-capable device and monthly subsidies for broadband services.
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the Affordable Connectivity Program has been the essential linchpin for creating telemedicine access to lifesaving medications for opioid use disorder.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all.
Substance use disorders are life-threatening chronic conditions, but they’re treatable. More than 70% of people with substance use disorders transition into recovery. However, early recovery is fragile. When people are ready to engage in care, low-barrier, rapid access to care is vitally important to support treatment success, especially during reentry from incarceration when the overdose risk is up to 129 times greater than community-based populations. Nearly half of people using opioids in rural areas were recently incarcerated, emphasizing the need for expanded rural access to treatment.
Yet, in-person addiction care is disproportionately limited in rural communities, requiring long drive times to access care. This is simply not an option for most of my patients, particularly those in early recovery. Most are trying to rebuild their lives while confronting significant financial debts incurred during past periods of expensive, prolonged substance use and incarceration. Stigma locks them out of high-earning positions, effectively segregating them to low-wage positions with limited opportunities for advancement and usually no access to benefits like paid time off to engage in care.
Many of us can get a leg up during hard times from family or peers. However, most patients in early recovery are at the starting line of repairing social relationships weakened by trust lost during active substance use and prolonged absence during incarceration. Often, the social supports they can access are facing similar resource-limited circumstances, with minimal ability or bandwidth to help with transportation or finances.
Every day, my patients choose what they can afford from a menu of necessities.
What will you have today?
- Food
- Transportation to work
- Cellphone access
- Savings toward rent
- Fees to obtain a driver’s license
Rarely can they cover more than one or two at a time. How could expensive, time-intensive travel to distant healthcare ever compete?
It shouldn’t have to. And thanks to the relaxation of telemedicine rules and the Affordable Connectivity Program, it hasn’t had to.
While the Affordable Connectivity Program’s $30 monthly subsidy sounds inconsequential, the true value of costs saved is much higher, as the collateral costs (e.g., transportation, lost-wages) of in-person services are avoided. With reliable access to data plans, my patients attend their medical appointments from their worksites during their lunch breaks or easily negotiate alternative breaks with their bosses, who are more willing to be flexible because work can quickly resume when patients remain on-site. This has allowed patients to consistently receive addiction treatment without incurring lost wages and transportation costs during the two-to-four-hour long process of in-person care. With their financial distress tempered, my patients have more quickly transitioned from survival mode to future planning.
The Affordable Connectivity Program also enabled internet access to key social resources that promote health and stability. My patients have taken online classes, searched and prepared for jobs, and built healthy social connections with online recovery communities, the latter particularly key for rural patients with limited in-person social options.
Funding for the Affordable Connectivity Program is projected to run out in April unless Congress acts quickly to renew funding. Amidst the Affordable Connectivity Program’s wind down, my team has begun switching patients to the remaining alternative telecommunication benefits for low-income households, like the Lifeline program. However, this inferior program provides only $9.95 monthly toward internet service—insufficient to cover the entire cost of a plan—and limited options of qualifying service providers. For my patients battling homelessness living in tents, cars, and motel room rentals while working tireless hours to survive and endeavor toward stable thriving, a $20 increase in monthly expenses is insurmountable.
The communities with significantly limited internet access—rural, low-income, Black—are also disproportionately impacted by the opioid crisis and low access to in-person treatment. Their precarious internet access falsely positions the internet as a luxury, rather than an essential resource for healthcare, education, employment, transportation, and social belonging. Internet access is a health equity issue.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all. Without swift action, I fear that losing the Affordable Connectivity Program will lead to more lives lost to treatable substance use disorders.
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How to Protect US Reproductive Rights in 2024
We need more people who believe in abortion as a human right to stand up for telemedicine abortion and protect access to mifepristone.
Dec 31, 2023
To paraphrase Charles Dickens, 2023 has been the “best of times and the worst of times” for abortion rights in America. Where you live, how much money you have, and whether you’re more than six weeks pregnant determine whether you can access your human rights.
The best news this year is that telemedicine abortion shield laws came to full fruition in five states. These new laws provide medical providers with protection from criminal and civil charges or license revocation so they can provide abortion pills by telemedicine nationwide.
As a result, telemedicine from a licensed clinician is now available in all 50 states. After speaking to providers across the country, I learned that more than 6,000 women per month are using this method in the states where it’s the worst of times for abortion rights.
What’s at stake in the 2024 presidential election is the tiny abortion pill that makes a big difference.
Telemedicine abortion from shield states is a bright light that contrasts with the grim reality of abortion access.
Since Roe v. Wade was toppled in 2022, the majority of American women of reproductive age live in states that are hostile toward abortion rights. Fourteen states have banned abortion in almost all circumstances. Other states such as Georgia and South Carolina give the illusion of allowing early abortion before six weeks when in practice many women do not even know yet that they are pregnant.
When abortion is criminalized, even lifesaving exceptions are generally useless. In Texas, 22 women have come forward to sue after they were denied care when their lives were at risk. In a second Texas lawsuit, the state Supreme Court allowed a hospital to deny a woman an abortion after severe fetal anomalies threatened her health and future fertility.
We have seen that when abortion is banned, women in Ireland, Poland, El Salvador, Kenya, and elsewhere did not survive. Already the U.S. has one of the highest maternal mortality rates among wealthy nations in the world, particularly for women of color. The bans simply exacerbate this risk.
The good news is that the majority of people know this is just plain wrong.
More than 60% of Americans supported legal abortion before Roe was overturned, and that number has only grown since the Dobbs v. Jackson verdict that overturned it. Americans have consistently voted in favor of abortion rights such as on ballot initiatives in Ohio, Kansas, and Michigan. Voters also have turned out in droves to support Democratic candidates who prioritize abortion rights such as in Virginia’s general legislative election and Wisconsin’s Supreme Court race this year.
But what’s at stake in the 2024 presidential election is the tiny abortion pill that makes a big difference. Next year the Supreme Court is expected to rule to significantly restrict access to mifepristone, a key abortion medication. So, whoever the next president puts in charge of the Food and Drug Administration will either sink or save us.
Mifepristone is the first pill in medication abortion, a proven safe and effective way to terminate a pregnancy through the first 11 weeks or possibly even later. The pill has been used globally for decades.
It is as safe as surgical abortion, less expensive, and allows a woman to have her abortion at home. That’s why more than 50% of American women having legal abortions chose it before Dobbs—and anecdotal evidence is that many more are doing so now—and more than three-quarters do so in Europe. Mifepristone provides essential abortion access.
Yet, before this year, only women who lived in, or could travel to, abortion-friendly states were able to get pills; geography was destiny. Now five abortion-friendly states—Colorado, Massachusetts, New York, Vermont, Washington, and soon California—have telemedicine abortion shield laws that are leveling the playing field nationwide.
As a result, for only $150 women can receive certified medications from a licensed provider without having to travel hundreds of miles, make child care arrangements, miss work or school, or make excuses for leaving the state. Telemedicine’s safety, convenience and lower cost make it an extremely popular alternative—even in states where abortion clinics still exist.
I’ve long known telemedicine abortion is essential because I’ve seen women in Ireland, where abortion was once illegal, forced to travel abroad to access safe services on what was euphemistically called the “ Irish Journey.” That same kind of difficult, expensive, and isolating journey is now happening for women in America.
A woman from Mississippi whose advocate I spoke with fled domestic violence and was living in a motel with her toddler and a baby when she realized she was pregnant. By using telemedicine, she avoided leaving her children behind for a six-hour drive to pick up her abortion pills in a neighboring state. Telemedicine abortion offers an option for those who desperately need it, as well as for those who simply choose it.
But doctors in states with shield laws still need help operating under current conditions and amid the continued threats to their practices and mifepristone’s availability. They need affordable, comprehensive, medical malpractice insurance; legal defense support to navigate the novelty of these shield laws; and political support from additional states passing shield laws. Most of all, they need help covering the cost of the pills for the many patients who can’t afford $150 and are not eligible for Medicaid or traditional abortion fund support.
Telemedicine abortion is at the forefront of what modern abortion access could look like, and it’s an exciting moment. We need more people who believe in abortion as a human right to stand up for telemedicine abortion. And we must all vote and work to protect access to mifepristone regardless of how the Supreme Court rules next year.
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