Fifty Billion Dollars, and Patients Who Can’t Log In

Fifty billion dollars is now flowing to states to transform rural healthcare. For communities that have endured decades of hospital closures, provider shortages, and dwindling options, that money is welcome and long overdue. But every dollar of it is assuming patients and their caregivers can navigate digital systems—and a lot of them can’t. The Rural Health Transformation Program, authorized under P.L. 119-21, is designed to modernize care delivery through telehealth expansion, remote monitoring, digital patient portals, and data-sharing infrastructure. These are good investments. But they are supply-side investments. They build the bridge without asking if residents know how to drive. Rural adults were 42 percent less likely to use telemedicine than their urban counterparts, according to a 2023 analysis of National Health Interview Survey data—a gap that held even after controlling for income, insurance, education, and health status. That gap isn’t primarily about broadband coverage. It’s about what happens after the signal arrives. Getting online doesn’t automatically mean someone can log into a patient portal, troubleshoot a video visit, or manage a remote monitoring device. Consider a 72-year-old with diabetes whose daughter handles her online accounts but works two jobs and isn’t always available. Or a veteran who knows of too many people who have been scammed online and is hesitant to trust “click here” to schedule an appointment. For a lot of rural patients and the people helping them—older adults, lower-income households, families stretched thin—the digital health system being built around them is one they’re not yet prepared to use.