Is broadband a social determinant of health? Prominent health care leaders, practitioners, and researchers came together last week in Detroit to answer that question during a discussion that I co-moderated with Federal Communications Commissioner (FCC) Mignon Clyburn. The FCC Connect2Health Task Force’s Broadband Health Tech Forum was part of its “Beyond the Beltway” series, which is encouraging efforts to improve healthcare in communities across the nation.
According to the Centers for Disease Control and Prevention (CDC), your zip code is a greater indicator of your health than your genetic code. Why? The quality and availability of care is vastly different based on where you live.
Low-income Americans are at a distinct disadvantage for managing chronic diseases, for example. Heart disease and diabetes are among the top 10 causes of death in the African-American community, and Latinos are challenged by a 66 percent higher rate of diabetes than Caucasians. Thankfully, there’s consensus that technology can go a long way toward closing the health divide.
The digital divide is directly linked to the health divide. Without Internet connectivity, people lack the tools that they need to become educated on critical health issues, to find nearby healthcare providers, and to take advantage of the exciting health applications and tools that are available. While some Americans with diabetes are using Internet-connected devices like AgaMatrix to monitor blood glucose, others are left in the dark. Broadband empowers underserved populations to take charge of their health.
One panelist pointed out that the digital divide is creating health problems in unexpected ways. Many Americans who lack broadband at home are going to the local McDonald’s to use the Internet. To do so, they’re required to purchase at least one item. Imagine how your health would be impacted if you were drinking super-sized soft drinks and eating Big Macs every time you wanted to check your email.
During the discussion in Detroit, Commissioner Clyburn emphasized the importance of adding broadband to the federal Lifeline program as part of the Commission’s reform efforts. Making the subsidy available for high-speed Internet will help close the digital divide and – bonus – concurrently shrink the health divide. Modernizing the Lifeline program is a key to improving access to health care services, regardless of socio-economic background or geographic location.
The goal of the Broadband Health Tech Forum in Detroit was to start a critical conversation that translates into action – and it appears that the event did just that. Panelists and audience members alike were inspired, vowing to stay connected and work together toward solutions. Broadband is a social determinant of health. In fact, it’s foundational for health equity.
Originally published byBloomberg BNA. Republished here with their permission.
Net Neutrality: Washington’s Chance at a Bi-Partisan Win-Win Solution
By Rick Boucher
Rick Boucher served in the US House for 28 years and chaired the House Commerce Committee’s Subcommittee on Communications and the Internet. He is honorary chairman of the Internet Innovation Alliance (IIA) and head of the government strategies practice at the law firm Sidley Austin.
Net neutrality. It’s the longest standing communications policy debate of the 21st Century, and a decade after it started, it’s still raging and far from resolved.
I share these observations as a Democrat and long-standing supporter of strong network neutrality protections and as a deeply involved participant in the writing of the Communications Act of 1996.
I’m motivated by a desire to put this controversy to rest on terms that would allow both Democrats and Republicans to declare victory and realize their main policy objectives and, coincidentally, strongly benefit the public interest.
Title II Vulnerability
First, why do I say that the controversy is far from resolved? After all, in the name of network neutrality protection, the FCC just reclassified broadband as a Title II common carrier service. Doesn’t reclassification of broadband resolve the controversy and assure network neutrality protection?
Actually, no. It has only escalated the controversy and jeopardized the future for net neutrality guarantees. In fact, reclassification of broadband is perhaps the most tenuous federal agency decision in recent memory given that it suffers from severe potential legal infirmities and enormous political risk.
I’ll be specific.
First, the FCC’s reclassification order is legally vulnerable. For starters, it flies in the face of the Communications Act of ‘96. In that law, we specifically created the category of “information services” to ensure that Internet service providers who use telecommunications to make information available to the public will not be subject to monopoly-style regulation designed for the era of wired telephones. Until this year’s reclassification decision, the FCC had consistently treated Internet access as an information service. Suddenly, the FCC has now reversed ground, ignored years of precedent and reclassified broadband as a telecommunications service so that it can protect network neutrality through telephone regulations descended from the 1930s.
The courts do not look kindly on abrupt agency reversals where long-held interpretations are suddenly thrown out the window without a clear indication of changed circumstances warranting the regulatory about-face. In this case, the underlying facts have not changed, and consistent with judicial precedent, the courts will hold the FCC’s feet to the fire on its decision to ignore and reverse a long-standing interpretation that defines broadband as an “information service.”
The courts will also examine the FCC’s deficient notice prior to the rule change, in which the agency failed to put a possible reclassification at the center of its rulemaking proceeding. That shortcoming may well have deprived interested parties of the opportunity to provide informed comments and presents a very real legal risk that the FCC’s decision will be overturned.
Avoidance of Political Risk
Yet, the ultimate risk to the FCC’s net neutrality decision may be political. Current polling indicates roughly a 50 percent chance that a Republican will win the presidency next year. If that happens, the FCC would revert to a three-to-two Republican majority, and it’s virtually certain that a new Republican FCC would return to the classification of broadband as an information service. Network neutrality protections would be lost, and philosophically the Republicans would have little interest in finding an alternate means to continue them.
The FCC’s reclassification order rests on a bed of sand, but one thing it has done is open the door to a legislative opportunity for Democrats to achieve their long-held goal of statutory permanence for network neutrality protections.
During the telecom debates of the past decade, Republicans have consistently opposed net neutrality legislation. Now, in the interest of obtaining lighter regulatory treatment for broadband as an information service, Republicans have signaled their willingness to enshrine meaningful network neutrality protections in a statute in return for not applying common carrier regulation to the Internet.
By accepting the Republican offer, Congressional Democrats would achieve their long-held goal of statutory permanence for network neutrality in exchange for a return of broadband to the information services status it has enjoyed since its inception for all but a few months of this year. Net neutrality guarantees would be virtually immune from legal challenge and far removed from political risk.
Why wouldn’t Democrats want to take advantage of this unique opportunity? It’s a true compromise: net neutrality regulations in statute, enforceable by the FCC, in exchange for a return to information services regulatory treatment of broadband, also in statute, as Republicans want. There’s no reason not to take the deal for either party and also thereby remind the FCC that no matter which party controls it, Congress is the ultimate arbiter of telecom policy.
The issues are crystallized. For the moment, both Democrats and Republicans enjoy roughly equal leverage, and each can give to the other the thing it wants the most. In that circumstance, even in a Congress not prone to legislating, the passage of a law is clearly possible.
As a Democrat and network neutrality proponent, this is a deal I hope the Democrats will accept.
In chart form, that gap in investment looks like this:
Downes also explores the levels of competition on either side of the pond, once again finding the U.S. — with its light-touch regulation — is far ahead of the E.U.:
Most damaging to an argument in favor of continuing the European policy of mandatory unbundling is the devastating impact that policy has had on infrastructure investment. Since 1996, and even during the most recent recession, private network operators in the U.S. have spent freely, racking up investments of $1.4 trillion — over 20% of the world’s total Internet infrastructure. The result is that the U.S. now has multiple high speed networks using a variety of wired and mobile technologies, including fiber optics, high-speed cable, VDSL (high-speed fiber/copper hybrid), 4G LTE and satellite.
Downes goes on to examine the differences in availability and adotion between the U.S. and E.U., so you should head on over the Harvard Business Review to get the full story. But for now, this section of his story sums matters up nicely:
The U.S. doesn’t have a perfectly functioning broadband market (or any other market), but a bi-partisan decision by Congress to leave broadband Internet access largely unregulated since 1996 has clearly worked better than the opposite approach taken by the Europeans. The European Commission is right to be working quickly to overhaul an obviously failed strategy.
In his debut post at Medium, our Co-Chairman Larry Irving writes about bringing the Lifeline program into the digital age. An excerpt:
The Lifeline Program, which was extended to wireless phones in 2005, now provides phone service to 14 million people. But times have changed, and the telephone no longer is the principle tool of communication for many Americans. Broadband Internet is now a critical part of our communications infrastructure. In 2015, broadband Internet is as essential as basic telephone service was in 1985. It is time that our Lifeline policies reflect that reality.
Fortunately, members of the FCC recognize the need for updating Lifeline policies. Commissioners Mignon Clyburn and Jessica Rosenworcel, in particular, have outlined thoughtful approaches that can help bring the Lifeline Program into the 21st Century.
In conjunction with the 2015 Congressional Hispanic Caucus Institute Hispanic Heritage Month Policy Conference, our co-chairs Jamal Simmons and Larry Irving have penned a memo for participants highlighting recommendations for Lifeline reform that ensure 21st century connectivity for low-income Americans. Here are those recommendations:
1. Safeguard Lifeline by taking eligibility determinations away from self-interested service providers.
The FCC’s proposal to remove the responsibility of consumer eligibility determination from Lifeline providers is the right one. Determining eligibility for receiving benefits from a government program is an inherently governmental function; as such, eligibility determinations should not be left to service providers that may have improper economic incentives to increase enrollment.
2. Simplify and protect the Lifeline program by vesting administration in a state agency using a “coordinated enrollment” and de-enrollment process.
Rely on state governmental agencies as the neutral entities charged with using a coordinated enrollment process to verify consumer eligibility and administer the enrollment and de-enrollment processes. Under this process, consumers determined eligible to receive Supplemental Nutrition Assistance (SNAP) by the State would automatically be deemed eligible to receive Lifeline assistance. A reformed federal Lifeline program should link eligibility determination to a single, mature assistance program – SNAP – which would increase administrative efficiency, promote participation by both consumers and service providers, and reduce the potential for waste, fraud, and abuse.
3. Empower consumers with a “Lifeline Benefit Card” – a direct-to-consumer benefit.
Lifeline program benefits should be transferred directly to the consumer using a “Lifeline Benefit Card” or similar approach (e.g., coordinated enrollment taking advantage of existing SNAP EBT cards and adding the Lifeline benefit to that EBT card). Eligible consumers could use the “Lifeline EBT Card” as a voucher to buy whichever communications service meets their needs from authorized and registered providers, whether broadband, wireline, or wireless voice service (on a standalone or bundled basis). For further convenience, service providers could offer Lifeline customers an automatic payment feature that allows low-income customers the ability to electronically activate their recurring discount, thus bypassing the need to visit a service provider on a monthly basis to swipe their EBT card.
4. Incentivize voluntary participation in the Lifeline program by cutting red tape.
Delinking the ETC designation from the Lifeline program would enable subsidy recipients to receive the complete benefits of robust competition that full service provider participation could offer. Removing existing regulatory roadblocks will make it easier for service providers to participate in Lifeline and incentivize them to compete for the
purchasing power of Lifeline consumers.
Our Honorary Chairman Rick Boucher sat down with RCR Wireless to talk about two pressing issues facing the FCC. Check out the video:
RCR Wireless’ Jeff Hawn also penned an article about the conversation with Boucher. An excerpt from the piece:
While the [Lifeline] program has been successful in achieving its limited initial purpose, Boucher is a proponent of it not only being expanded but also reformed. “Today Lifeline is outdated because it doesn’t cover broadband. Broadband is now the way Americans prefer to communicate and it is absolutely essential.”
Boucher explained IIA has three basic tenants of how it would like to see Lifeline reformed: “First, the program should be expanded to include broadband; second, we believe that carriers should no longer have a role in determining who is eligible for Lifeline. Today, the carriers determine who is eligible for Lifeline and the carriers have every incentive to qualify as many subscribers as possible.”
This method of allowing the carriers to determine qualification has often led to a large number of people who did not qualify for the program. Boucher would rather see the individual state governments determine Lifeline qualification the same way they determine if people are qualified for other federal welfare programs like food stamps.
“The third reform, [which] we think makes a great deal of sense,” Boucher said, “is to send the Lifeline subsidy directly to the consumer, not to the carrier.” This would make the subsidy portable and allow consumers to select the carrier best suited for their needs.
Late last week, our Co-Chairman Bruce Mehlman penned an op-ed for Morning Consult on the need for the FCC to rely on data as it reforms special access. An excerpt:
For a decade, the FCC has had an effective policy of “new wires, new rules.” Relying on that policy, the Incumbent Local Exchange Carriers – even though forced by the special access rules to subsidize a second network of non-competitive older technology – eagerly invested billions to roll out the faster broadband network people want to compete with cable, wireless and fiber networks. Now, some CLECs want to toss deregulation out the window, changing the rules in midstream without a formal data analysis and imperiling that needed investment.
That’s just wrong. Why would the FCC want to re-impose regulation on a competitive environment without understanding the marketplace? And what about the ILECs’ reliance on the FCC’s regulatory promise of “new rules” for new wires – does that just get washed away?
In an opinion piece for Multichannel News, our Honorary Chairman Rick Boucher makes the case for shifting Lifeline into the world of EBT:
To spur competition by encouraging a larger number of carriers to participate in the program and to give consumers the most flexible way to choose from among competing carriers, we support moving the Lifeline subsidy to an electronic benefit transfer (EBT) card.
Putting the Lifeline benefit on an EBT card and asking the states to confirm eligibility would empower consumers in the marketplace and help prevent fraud. Yet even as many states have adopted the convenience and accountability of moving government-provided benefits to an EBT card, some still resist this change for Lifeline.
They contend that EBT cards would burden certain beneficiaries, such as the elderly, disabled and rural poor, based on an incorrect assumption that the cards would have to be swiped at a retail location on a regular basis.
Let’s review how eligibility determinations and EBT cards would work in practice under a new Lifeline program.
Recently, our Co-Chairman Bruce Mehlman talked with Amir Nasr of the Morning Consult about the problems with the FCC’s pricing rules for high-grade network lines. An excerpt:
FCC Chairman Tom Wheeler said the rule “preserves competitive choices as the technology transitions move forward… Competitive providers rely on these inputs to serve hundreds of thousands of businesses and other enterprise customers at competitive rates, often offering customized services not offered by incumbents.”
Mehlman said some in the industry are frustrated at the FCC’s apparent shift in thinking after the agency left the matter alone for over a decade. “They promised no regulation for over 10 years, and now they’re proposing to fundamentally change the game,” he said.
FCC Commissioner Ajit Pai, a Republican and outspoken adversary to the agency’s Democractic majority, decried the pricing proposal in a recent speech at the center-right American Enterprise Institute. “These regulatory roadblocks are bad for consumers, bad for infrastructure investment, and bad for our nation’s economic competitiveness,” he said.
Mehlman concurred. “As long as you have regulations on some providers, forcing them to help their competitors at regulated rates, you will have less investment because there is a meaningfully lower return,” he said.
Over at CNBC, Co-Chairman Jamal Simmons highlights the role of broadband access in closing America’s “homework gap.” An excerpt:
One way to make sure students from all backgrounds have the strongest start is by closing what Federal Communications Commissioner Jessica Rosenworcel calls the “homework gap,” which impacts students in five million American households. These students from low-income families have less regular access to broadband Internet at home than their peers from wealthier households, making completing homework assignments tougher.
FCC Commissioner Mignon Clyburn has proposed revamping the Lifeline program as one way to help close this gap. Started during the Reagan administration, Lifeline was created to help low-income Americans get access to telephone service. As mobile phones became more ubiquitous, the George W. Bush administration expanded the program to allow Americans to choose wireless phone service under Lifeline. Today, broadband is the critical service that connects Americans to jobs, health care, entertainment and family, and the current FCC should allow the Lifeline program to evolve again.
In addition to expanding Lifeline to cover broadband, you can read IIA’s specific recommendations for modernization of the Lifeline program in the full op-ed at CNBC.
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