Episode 57. Disconnected: A Conversation about Health Care, Broadband, Access and Economics with Sarah Jane Tribble, Caresse Jackman, and Joshua Seidemann
Michelle Rathman: Hello one and all and welcome back to a brand new episode of The Rural Impact. I'm Michelle Rathman and I mean it when I say I always say this 'cause I do mean it. Thank you for joining us for another conversation that aims to connect the dots between policy and rural everything. At least everything rural we can think of.
Alright, so speaking of connecting dots and connectivity on today's show, we are going to cover the subject of rural broadband and cover challenges and the impact that this has on the delivery of safe, high-quality healthcare. And of course there are many angles to this story, but, we're covering this for a reason, and you'll understand why in just a moment.
You know, as we know during the COVID-19 pandemic rural broadband challenges, although they existed before really rose to the top on the national stage, and we really got a glimpse of how challenging it is for rural broadband to reach so many rural places, and the implications that it was not just for healthcare, but on students, for example.
And we also know as a result of that, there were several calls to action to address these disparities. However, we know that these issues continue to persist and threats to funding today that aims to close the digital divide in rural places across the us. Now this is threatening another threat to rural America.
Losing those grants is going to be very significant. And you know, even though our legislators know, they know this, that internet connectivity, particularly access to broadband, is playing an increasingly important role in both healthcare and public health and local economies. And so, it's important that we make sure that this conversation reaches the legislators who are making decisions about whether or not this funding should continue.
And, you know, we also know that it's revolutionizing the delivery of care. So, as we're talking about healthier America. It's important for us to be honest about the fact that without connectivity, the delivery of telehealth, for example, is just not possible. So it's a very complex issue, and even though there's been, I think by my count, about a hundred billion dollars that have been allocated to fix the broadband inequity issues in rural America, over 130 programs that are being administered by 15 some odd agencies, we still have not arrived as sustainability of connectivity and solutions for all.
So, to help sort through all of it. I'm no expert. I've invited the experts to come to the table. First, I will tell you that we've invited Joshua Seidman, VP of Policy and Industry Innovation at NTCA, and that is the rural broadband Association to break some things down for us. But first you are going to hear from two very special guests, and they're incredibly important investigative reporting focused on rural dead zones. Which are of course areas across rural America where hospitals and patients have no connectivity, in fact, disconnected from modern care because of not having high speed and with that affordable internet access. So, in their series, dead Zones, KFF Health News Reporter Sarah Jane Tribble and Caresse Jackman from InvestigateTV, they cover this subject in great detail.
And they are going to share with us their investigative work about. Places where people live, and doctors don't practice, and telehealth does not reach. And with that said, I am glad that you have the bandwidth and the broadband to join us for this conversation today. So with that, I invite you to tune out that background noise and put yourself in that podcast listening frame of mind and listen to my conversations with Sarah Jane Tribble, Caresse Jackman and Joshua Seidemann.
Are you ready? You know I always am. So let's go.
>>>>>
Michelle Rathman: Oh my goodness. Sarah Jane Tribble, Caresse Jackman, thank you both for joining us. It's gonna be an excellent conversation because it is an issue that impacts so many people. One rural community is too many, in my opinion, so I'm grateful that you are here. I've done a little tee up for listeners to understand what this is about.
So, Sarah Jane, I'm gonna have you dive right in. But first I'm just gonna put this out there because on September 4th, 2020, you wrote a piece with the headline that read, "HHS planned to improve rural health focuses on better broadband telehealth services." That was about a million years ago, I think, maybe five.
And today so many people are still living without internet connectivity. It's nothing new, to so many rural communities. And you have decided to take that and turn it into something really important in a series. And I'd like for you to just kick off the conversation by talking about the project, what it's about, why you're doing it, and then we'll dive deeper in.
Sarah Jane Tribble: Michelle, thank you so much. And yeah, that seems like a different lifetime ago, 2020, doesn't it? So back in 2020 I was on, you know, NKFF Health News working on Capitol Hill and, and writing stories. And I was seeing a lot about telehealth. I think we all heard a lot about telehealth during the pandemic. It became a household word we learned about kids sitting outside McDonald's not being able to do schoolwork.
And I began to wonder, what does that mean for rural areas who need healthcare and can't access telehealth? So that was sort of the start of this idea. Knowing that the federal lawmakers are talking a lot about supporting telehealth and look, every administration has in some way supported broadband infrastructure.
In other words, said we need to increase high speed internet across the US whether it be the Obama, the Biden Administration, the Trump Administration, they've all made their efforts towards increasing infrastructure, for rural America. And I know we're on the Rural Impact Podcast, so I'm focusing on that.
Of course, there's access problems in urban areas too. But I was very curious about telehealth and would it work in rural America without the broadband access? So that was the origination of the idea. And I pitched to the editors at KFF Health News, this idea of looking at where people in rural America could actually access telehealth and where they couldn't. And my editor, Nathan Payne, came up with the idea of mapping the counties across the US. So, what we did is we took FCC broadband data the latest, and that took a little bit of a trial and error to figure out what that, what was good there.
Michelle Rathman: Right.
Sarah Jane Tribble: Um, and so I'm sure your listeners are aware. And then we overlayed that with primary care and behavioral healthcare numbers, deserts, if you will, and found more than 200 counties, mostly rural across the US that lack kind of a high level of any three of those things.
Of all three of those things of high speed internet, primary care providers or behavioral healthcare providers. So that's sort of the gist of the project.
Michelle Rathman: And a recipe for the stories that you told, the outcomes that were, that we're seeing as a result. Real quick, we are gonna get into this a little, little bit later, but the map is, I love maps we just had on Ben Spoer that talked about, you know, kind of congressional health districts and so forth. I love how you overlay the data, and I think it's important, again, for us to connect the dots because there were, there was funds that were allocated to this. I think the number was like almost $42 billion.
Sarah Jane Tribble: $42.45 billion .Yeah.
Michelle Rathman: Uh, allocated and to it. And so, I take a look at, I don't print out the whole thing, but I take a look at the state, one of the states that you focused on was Alabama.
Sarah Jane Tribble: Mm-hmm.
Michelle Rathman: the stories that came from Alabama. And I see over a billion dollars. And I know there's some back and forth about if Sarah Jane, before we move on just a little bit about where we are with the funding that was allocated. Can you expand a little bit about what's happening to actually make projects happen?
Shovel ready in the ground. My understanding is that there's not a whole lot happening right now.
Sarah Jane Tribble: Well first lemme give you a little bit of context that Caresse and I have both talked about and reported about. And then I'll give you the latest news because just on the phone yesterday interviewing somebody from, well recently who left the administration.
And so the context is, you know, over the years so many different administrations have acknowledged the challenge, particularly in rural America for building infrastructure. When you talk to experts, you often hear this sort of comparison to rural electrification. You can't get it done in rural areas unless you have federal support. What's happened is a hodgepodge of 133 different programs across 15 different agencies at last count by the GOA, the Government Accountability Office, and billions of dollars.
I asked one expert in DC if they had a number of how many billions of dollars over the last few decades have been spent, and they sort of laughed. Because it's so hard to get to a number because there's so many different programs. And as you'll recall, during Covid there were billions of dollars spent on different kinds of infrastructure projects.
Some of that was pulled for broadband internet in different places. In fact, some of it's still being built out in different places with middle mile projects and capital funds.
Sarah Jane Tribble: So the context of the latest BEAD grant, if you will, the Broadband Equity Access and Deployment Act. Is after all those other programs have occurred. And so in 2021, Biden signed the infrastructure law, which included the Speed Act, the $42.45 billion roughly. It also included money for the ACP, the, you know, the program that gave, you know, subsidies to low income households across the US and some other programs like the Digital Equity Act.
So. It was supposed to be a package that really delivered internet for all. That is the tag word that the Biden-Harris Administration had.
Sarah Jane Tribble: Fast forward a few years, right? In 2025, the Trump Administration comes in and, and knowing as we do, because we just opened this episode with the Trump, you know, announced that he was gonna help fix, you know, access in rural America knowing he cares about this, we might be a little bit surprised now to see that the administration has announced that they wanna do arigorous review of the program.
And, um, really question where the money is being spent and why it took so long for that program to be in place. And from what I'm hearing right now, everything's a little bit on hold. States that we're supposed to get money to start hiring internet companies, ISPs, to deploy, haven't gotten that money yet.
So that's where we stand right now.
Michelle Rathman: So a big, big fat question marks all over the board and, and not just this funding, but so many other things that are connected to it. You know, Caresse, I wanna talk to you a little bit as well, because the data that Sarah Jane is talking. About the maps, you know, the, the shortages we're not, I, I wish we could be having a conversation that talks about the solutions and about how these lives are changing for the better. But at the end of the day, you had time to spend with those who are impacted directly, their health. Their quality of living, their access to healthcare as a result of not being connected.
So for those of our listeners who have not read or watched these stories, I encourage you to, we're gonna make sure we have the links, but give us a little bit about what your takeaways Caresse and about the stories that you heard and, the impact that you, that you hope that the storytelling, their experiences will make on, on those who have the ability to make change happen.
Caresse Jackman: Right. And I just wanna say it is just been an honor for InvestigativeTV Gray Media to partner with KFF Health News and Sarah Jane Tribble, Holly Hacker, who handled the data aspect of this. Because it's such a great partnership. You know, they did an amazing work with the data and the article.
We wanted to bring it to life visually. So, thanks to Sarah, we were able to travel down to Alabama and go to some of these areas and interview some of these sources. And what I found amazing was how humble these people are despite the issues that they face, despite the challenges that happen and many of the chronic illnesses that, that they're facing right now.
And I remember thinking after those interviews, okay, I wanna hold onto that emotion that I felt and bring it to life, and bring it to life visually. So, we sat down with Barbara and looked through her pills and had her bring out her internet connection. We sat down with Leroy Walker, who is battling kidney failure, and I just remember feeling the pride that they felt saying, I live in the country.
I don't wanna move anywhere else. This is home. But I want the same broadband access as any everyone else in the country. That's what struck me. And as somebody like Leroy, my dad didn't grow up in the country, but he battled kidney failure. So even after speaking with Leroy Walker, who's on dialysis, it was very emotional for me.
I left there and I teared up and I, I had to take a minute before I went back and listened to the interview because, I felt for him. And that's what I wanted people, regardless of if you live in a rural area or urban area or a semi-rural area, I wanted people to take that away visually. And then I worked with Owen Stein, we call him Chip on our team.
He's amazing at bringing cinematography type editing to life. So,
Michelle Rathman: I'll say,
Caresse Jackman: yes, he's just, he's a, he's tremendous. So, I have to give him his flowers and we just talked back and forth all throughout the time we were editing, like, how does that work? Should we put a line in here to bridge the, you know, the connection and bringing that map to life visually was amazing.
And so all around it was just a great partnership.
Michelle Rathman: You know, and I was also struck by hearing from a health CEO a leader of a healthcare organization down in the area. And what really struck me is, you know, brand new hospital, brand new, and Sarah Jane, you know, you also did a piece about, how rare it is for a community, you know some buck the system, but how rare it is for a community to be able to bring their hospital back.
But what struck me is, you know, the full context of that is that a brand-new hospital is built and is there an inference then it is closed because it didn't have the connectivity? There's no way to run a hospital today unless like it's, they're not meant to be field hospitals. You know, they need to be fully, fully equipped to, to deliver quality care. And that to me, Sarah Jane was another kind of glaring, what are we doing here moment for me?
Sarah Jane Tribble: I mean, I think the thing that strikes one, once they go out to these communities is one the thingsCaresse just said, they know what they don't have. We don't live in an insular world anymore, and we haven't for decades. So when you go to these communities, they understand that other cities have better access.
They understand that there are patient portals people can log onto. And they don't have access to log into a portal, check their labs or, you know, call into the doctor's office and get a video call instead of driving 45 minutes or, you know, or waiting three months for the specialist. They don't have any of those things.
They know they exist, they don't have 'em. So that's number one. Number two, what's striking is if you visit these hospitals, and I did a look at some of the federal funding mechanisms, that provide grants to hospitals, and extra funding to hospitals for internet access.
Because there has been support on the backend for that. And what you see is hospitals in rural America across the US that lack fast enough internet. Right? And I say that because part of the challenge has been defining the standards of what high speed internet is at a federal level that then requires internet service providers to meet those standards.
So, if you say the standard is this level, then. Your internet service provider, look at your bill. It says up to, you're gonna get up to that amount. Well, if you're a hospital that needs a central monitoring system and electronic health records and scans to move to other regional hospitals that can take care of the patients you're transferring, well that up to needs to be pretty darn high to meet all those needs.
And a lot of places in rural America, it's,
Michelle Rathman: You did a speed test, right? One of you did a speed test in one of them, and it was pitiful. I mean, most people, and so I, I think it's a really good segue because I've got the map in front of me and Sarah Jane, would you mind just kind of walking through. So you've got, you know, not just dead zones, but there's varying degrees connectivity issues that can be found in the map.
So there's the absolute, what we would give a big fat f to failure. So, talk a little bit about kind of the, and the rural, the rurality of those different zones.
Sarah Jane Tribble: Yeah, and so the, the hypothesis I went into this with was that rural areas were more likely to be lacking broadband access, the infrastructure access and what you're seeing on the map. don't have it in front of me, so forgive me if I, but what you're seeing on the map is that a certain percentage of the homes are meeting the current federal standard, minimum standard of a hundred megabits per second, over 20 megabits per second. You and I are probably using a lot more of that right now, but it’s kinda the baseline that a household can need, a household of four can use for like gaming and getting on the internet and so forth, and accessing like banking services. We talked to experts across the US and what you're seeing on the counties is the percentage of houses that have that high speed internet access.
And I'll tell you, when I first started this reporting in Green County, Alabama, where Leroy Walker and Barbara Williams live. When I first started at only 6% of the homes had federal standard of high-speed internet. Now I went back, you know, almost a year, you know, almost a year later if my date’s correct. And at least six months later. And it was more like 50% of the home still well below the average county in the us. So, they still are in what we define as a dead zone, but that's because federal grants from ARPA and the Covid money had finally started having built out in the area. And so, you're seeing the build out. The hospital itself though in Green County is still waiting because the building mechanism, the funding mechanism for that hasn't reached them yet.
Michelle Rathman: Will it reach them?
Sarah Jane Tribble: They've been told, and I've talked to the companies, they have a deadline, where they have to meet it and the companies say they're going to meet it. And that will be early next year.
Michelle Rathman: So you both done a lot of research on this. You've released two really comprehensive pieces. Sarah Jane, you've been doing this for a while. I think about the other disparities that you're able to expose through this. I mean, you know, Caresse, the patients, the individuals, the brave, courageous individuals who share their experiences.
They are, they are dealing with, know, chronic illness, uh, and the technical, the connectivity piece is just one big piece to it. So is there any, either one of you could shed some light on maybe some other things that you uncovered where, you know, these all intersect. I know the focus has been on the connectivity, but what else might have you discovered or, or gleaned from this experience?
Caresse Jackman: Well, one thing I discovered too is just not only are we talking about people with chronic illnesses, but also the fact that they are stuck in many times food deserts. Right? And food insecurities. When we were there and we were interviewing Barbara Williams and the Mayor Hattie Samuels, we said, “Hey, where can we grab a bite to eat?”
And even Sarah told me that before we went down and they said, well, there's that one cafe that's closed but you can stop at the gas station if you'd like. And it really hit me. And like there's not only is there a lack of broadband access, but you look at food insecurities that can continue to allow, some of these chronic illnesses to fester in these communities.
That was the sad part to me. It's, you know, we ended up going to the gas station and grabbing some food, but you have this correlation again, you have this intersection of lack of internet access, healthcare opportunities, lack of healthy foods. So, you have this vicious cycle that continues to go on and it's heartbreaking that even just things that you take for granted in urban communities that it's just not there in our rural areas where our family and friends are, and, that also struck me.
So, when we were getting images of the, the town, uh, I made sure I said, Hey, to please make sure that you get that closed cafe, that closed cafe for the day. Please make sure you get these areas because that's the reality that so many people face. It's all intertwined and that's what struck me out.
So when I was out there.
Michelle Rathman: It's challenging. I heard the, the leaders from the healthcare organization say, what, what's the solution? Money. We need money. And Sarah Jane, I wonder if you have any in, in insight into, you know, I hear about the hospital closing. I mean the, just the cost, the economic impact, the cost to the communities that then will lose their hospitals because they don't have the, because they're in a dead zone.
It makes no sense to me whatsoever.
Sarah Jane Tribble: Lemme just go back to one thing that we were talking about previously, and that is in our stories, we just to sort of emphasize your point on social disparities. We're not saying the internet caused these social disparities. What's happening is the internet isn't helping places that desperately need it, that we know as a society have been left behind for years.
So, these are places with higher stroke incidences, higher diabetes, higher obesity incidences, higher blood pressure problems, higher problems with heart disease. If you look at the map, you can go to each county and see some of those instances and we have a downloadable database that you can do the spreadsheet.
So just sort of a, to say, we're not saying it's causation, but it's definitely, you know, they're correlated and these are places just have been left behind, um, for place, for, for decades now for so, so that's one thing. And when you talk about the hospital closures, you know, Michelle, and I think your audience probably knows I've written a lot about rural hospital closures.
Over the last four or five years, and the Thomasville Hospital in Alabama did close after it was reopened. The Green County Hospital in Alabama is still open, but its struggles to stay open. They lost revenue on serving patients in their last cost report like many rural hospitals. So, this is just building on top of the challenges they have.
If you don't have a fast internet connection for your hospital, it just makes it more challenging to get the right staff to come in, right? Like, 'cause that staff has to do double time to do the work. So, it just compounds the problems that compound upon themselves. I think you asked me about the money and right now in DC I've been told you don't ask for money right now. That's not the conversation we're doing in DC right now.
Michelle Rathman: Yeah, absolutely. And it's why it's so important, which means, which doesn't mean that we can't talk about it because the need is gonna be there, the gaps are gonna grow wider, there's no way around it. Um, before we close out and I just wanna say that was an excellent point about what you just shared.
And I wanna just. Go on that and say hospitals wanna deliver really high quality, safe care.
Sarah Jane Tribble: They do.
Michelle Rathman: And without that technology, it makes it really difficult. Not for, not for will not for want, but because of they don't have the resources. So I think that's an important point to make. Okay. From you both, I'm sure this isn't it, there's more to say on this conversation. What can we tease? What do you got? What do you have going on? What can we expect to see
Sarah Jane Tribble: Caresse, I'll let you take that one.
Caresse Jackman: Alright, well, we, there is another installment coming up soon, and this time we traveled West Virginia and we spoke with family members there. I mean people there who are battling that, that inner fight with trying to get broadband access and what happens to the funding when it comes to building broadband and the challenges that they face.
So the work continues, we're headed we headed to another state to really hit home. And Sarah and I both actually traveled there together recently to talk to people and to interview people who are in Appalachia and are dealing with these problems every single day. So, we wanted to show that it's nationwide, and that's what we did and we're committed to it.
So Sarah, I also have you take over.
Sarah Jane Tribble: Yeah, I mean, I think the biggest goal and what I love with working with Caresse about is, you know we understand that the people in rural America are no different than people elsewhere. They have the same wants, hopes, desires. You want good internet access. They're not caricatures of, you know, any one thing. People in rural America, they work hard, they're proud, they're strong, and they want to have a fair shake. They can't get that without internet access.
Michelle Rathman: And it shouldn't be about volume, really. I mean, that's kind of the essence of this. It shouldn't be 'cause the multipliers, but this makes a difference for one community, one hospital, one family. Thank you to you both so much. We welcome you back anytime because we want to hear about your road trip. I could be, I could be your groupie. I could go in the back seat of your car. Nobody wants that.
But listen for the rest of you. Don't go anywhere again. We'll be, making sure the links of the conversation that we had and the resources and the great data map that we talked about and the YouTube videos that you can watch. But this conversation is going to continue.
But first, I'm gonna ask you to sit back and listen to a very important message from our partners at the American Heart Association for Rural Health Leaders. This one is very important for you to join in on this conversation. We'll be right back.
>>>>>
Michelle Rathman: Hey, Joshua Seidemann, VP of Policy and Industry Innovation at NTCA, which is the Rural Broadband Association. We welcome you to The Rural Impact. We're really happy to have you join us this morning. Thank you.
Joshua Seidemann: Thank you for having me.
Michelle Rathman: Okay, Josh, before our break you know, our listeners heard a conversation that I had between Sarah Jane Tribble from KFF Health News, who's on the rural beat and Caresse Jackman with InvestigateTV. And we were discussing their really wide-ranging in-depth reporting in a series that they're doing called Dead Zones. And these, of course, are areas across rural America, other places too, but the focus is rural America where hospitals and patients are quite literally disconnected from modern care because of not having high speed internet that so many of us take for granted. I know that I do most of the time. So, I thought, what better way to kind of round off this episode than hearing directly from an organization that's representing, as I understand it, about 850 independent family owned, and community-based telecommunications companies working to build and deliver broadband connectivity.
So Josh, let's just get started by covering this challenge. Why in the year 2025 in the United States of America are rural communities still in dead zones? What say you?
Joshua Seidemann: Location, location, location. A lot of it depends on population density and the really the per user cost for getting the network out there. In urban areas of the United States, the population density is about 2,500 people per square mile. In rural areas of the United States, the population density is about 19 people per square mile.
And an NTCA member service areas, the population density is about nine people per square mile. So, if you're thinking about a capital-intensive network, the more people who are using that network in a square mile or on a linear road mile, the lower the cost per user. So, I'll throw out some numbers at you.
Your electronics per location to provide broadband is about $700 to $1000. Not a huge, not a huge amount. In a rural area where a house has a long driveway figure, a $1000 to $2,000 to get from the mainline up to the house itself.
Again, not terrible, but when you're talking about deploying broadband, it's going to rely, that's going to depend on the type of soil in the area, access to poles if you're doing aerial construction. If you're trenching, then it's going to be the existence of other utilities, the availability of contractors. So once you're talking about the main line construction, it can be $20,000 to $60,000 per mile. So, now we're gonna talk why we have some dead zones.
Michelle Rathman: That’s right.
Joshua Seidemann: As you mentioned, NTCA member companies are locally operated locally, either family- owned or community cooperatives. Uh, we are currently, our members are currently reaching more than 88% of their locations to fiber to the prem.
Michelle Rathman: Okay.
Joshua Seidemann: Because they're locally operated companies. If you are a publicly traded company, you really need to make the case to your shareholders. And there's a difference between shareholder incentives and sociological incentives. And for a large publicly traded company, it's a difficult business case to make, to pour that sort of investment into a small community. So, I think that's where you begin to see the difference in deployment levels between, companies that are served by large national scope firms and areas that are served by locally operated cooperatives who family owned businesses.
Michelle Rathman: So, in the absence, I mean, let's just say it out loud, it's the math. If the math doesn't work in, in so many cases, it's not for, for lack of, of will or wanting to. The investments are important and so much so, that's why grant funding and, you know, those are some of the things and subsidies are so darned important to make sure that we close those gaps.
And wanted to mention to you, you know, we just talked a little bit before we started here that we know, I read a piece this morning that says that. You know, of course. In addition to dead Zones, we, we have other digital divides, if you will, other challenges. And, they were being addressed.
Uh, were, still not certain what's gonna happen here, but through the bipartisan policy, the Infrastructure Act, and on May 8th, President Trump said that the government would be ending the, a quote “ending digital equity grant funding, which is funding of, as I said, made possible by the Digital Equity Act attached to the bipartisan infrastructure bill, calling it a giveaway.”
And, you know, there were a lot of shovel-ready projects on the ground and so forth. So, at the end of the day what do you anticipate happening without this already promised money, but in the future, where do we go if we don't have these federal dollars? What, what can we say to those? You know, those hospitals, those communities who are relying heavily on support where they don't have the funding to support, there's their municipalities, their counties don't have the funding to make up for simply what's not there.
Joshua Seidemann: Right. It's a great question. It's a difficult question. Uh, you know, there's certainly a, there's certainly an era of uncertainty over certain aspects. On the, on the bright side, NTCA has a program, and I think maybe we'll chat about it later, called Smart Rural Community.
We, we produced a paper a few years ago that looked at digital engagement in rural spaces, and we did comparisons of national statistics and findings in terms of adoption and usage rates. And what we found to be remarkable, and we pulled numbers from a variety of sources, is that the gaps in broadband adoption and digital engagement are closing over time. And we looked at numbers based on age, sex, race, these major demographic categories, and all those gaps that we saw in the first years of the broadband becoming popular are slowly closing, and they're getting to the point where we're not seeing the gaps.
The remaining gaps we see are related to household income and educational attainment, and they're related because household income is correlated to educational attainment. So when we talk about broadband engagement, the single biggest factor holding people back is affordability.
So.
Michelle Rathman: And, that was perfectly illuminated in the Dead Zone story as well, because what we also looked at, of course, if you read the piece, the first that have come out is that those, those dead zones also overlap with health profession shortage areas as well. And so, it's just like this double, triple whammy for these communities in particular highlighting those in, in Alabama.
I do wanna talk about these other programs. Before we go there, though, I know that, you know, from a federal policy standpoint, you all are, you know, in front of the Supreme Court, you've been very active USF and the Supreme Court fight about ending some of that programming, which of course enables, it's a fund that enables broadband deployment in rural and implications for upholding the Fifth Circuit Court in New Orleans.
I mean, what, where are we gonna go from here? Talk a little bit about that. For those who don't understand the background, this is really important.
Joshua Seidemann: Sure. So Universal Service Fund is a program that is administered, it's overseen by the Federal Communications Commission. The nuts and bolts of it are administered by a private company called the Universal Service Administrative Company, and money is collected based on assessments to providers of interstate telecommunication services, which is, sounds a different, you know, mix of between Latin and Greek.
But, essentially it is any telecommunication service, like a telephone call that crosses state lines, so the revenues that the companies earn from those services. Then there's an assessment. They pay that into a fund, and that pot of that pot of money is then divided up among different types of providers who provide critical internet and telephone services in rural areas.
Uh, there is an organization that took the FCC to court and they claimed that the system of collecting and distributing these funds is unconstitutional. So, we can dig into the, we can dig into the illegal arguments, but the case eventually made its way to the Supreme Court and the Supreme Court heard arguments at the end of March, and we expect a decision in July.
NTCA participated actively in the case along with other industry organizations.
Michelle Rathman: To maintain that fund, to continue to maintain that fund.
Joshua Seidemann: Certainly to maintain the program.
And, we'll have to see what the Supreme Court does. But you raised an excellent point and it's one that the justice has noticed also among the many, among the many things that the court needs to consider. Uh, there's a theory that they call consequentialism. So, what happens if this fund goes away?
We presented the, you know, we've presented and we've surveyed our members the number of investments that would be canceled. $850 million in rural broadband investments would be canceled in 2026 and $730 million would be anticipated to be canceled in 2027.
And we talked about the high cost of providing networks and broadband services in rural areas. And these small companies are able to do that based on universal service funding, based on the loans from the Department of Agriculture, based on assembling private capital. But many, many companies said that if this funding goes away, the USDA loans and those programs, I think the highest default rate in those programs was about 15 years ago. It was like 1.26%. The loans have an iron-clad repayment record among the small companies. But we had over 60% respondents that they would have serious difficulties in, in making payments on those USDA loans.
Michelle Rathman: And so we connect more dots here on this show. As we do, we connect the dots between quality of life and policy, the implications for hospitals, for schools, for commerce, for households. It goes on and on and on. So we'll be watching that. And certainly know, from where I sit, this is something that we should all be paying attention to.
Again, we take it for granted, but this is all things that are happening. You know, when we're sleeping, people are making these decisions about whether or not we're gonna have connectivity. All right. Let's maybe kind of. Move on to some, some positive news because I've been following you guys for quite some time, and I know that you have a great program through your foundation for a rural service called the Virtual Living Rooms.
And again, we're talking about meeting the unmet needs of so many of our rural populations. And correct me if I'm wrong, this one is to serve our veterans.
Joshua Seidemann: Yes.
Michelle Rathman: Talk about that.
Joshua Seidemann: Department of Veterans Affairs has an outstanding telehealth network. And it's not just the sort of telehealth network that contemplates video calls with your doctor. They have a team that is really taking a look at the use of virtual reality platforms for telehealth. But they have an outstanding network for telehealth and to reach veterans and to provide medical services to them.
What we found was that a lot of the older veterans who have not really used internet or broadband when during their working years were not very familiar with the technology and may or may not have had those connections at home. So, the virtual living room replicates your personal living room at home, and it's, they're, they're in fire stations, they are in libraries.
Uh, the rooms are deliberately furnished, not like a sterile office environment, but much the way you'd walk into at your home. And our member companies provide broadband connectivity. They provide the equipment. There are usually people on hand to help veterans navigate the technology. And it enables veterans to access the VA's Telehealth and other online services as well.
Michelle Rathman: And these are, these are just lifeline programs. And you know, I, on kind of on the other side of that, I did read a blog that you wrote about mental health with youth, with, you know, because again, we're talking about in rural communities, we have a no shortage of mental health care deserts.
Joshua Seidemann: Right.
Michelle Rathman: Period. End of sentence.
A lot of, you know, schools are working on trying to come up with programs and I, I've interviewed several folks on this front to make sure that there's, you know, uh, telehealth for students for behavioral health and so forth. But you wrote a blog about the use of AI and mental health, and I know this is a conversation that we're having as a nation about the use of AI and its appropriateness and the, and the danger zones and so forth.
Can you give us a little bit of a summary of what your findings were from that from your own research and trying out the technology yourself.
Joshua Seidemann: Sure. So we always have to, I think it's important to think of AI as a tool and not a substitute. So, and we say this all the time, whether it's even just in, in standard telehealth practice. That telehealth is, is a tool in the toolbox, but it's not a substitute for in-person encounters in-person therapy.
Having said that, if you're in a shortage area it can be a remarkable resource and what the AI platforms for mental health therapy are doing, is a communications platform, very often text base, which is a modality or a medium with which many teams are teams are familiar. And the AI engine is not providing counseling or therapy to the teen user.
What it is doing, it is reading, it is triaging, it is summarizing, and then it is passing off critical information to a human caregiver. And human caregivers then can access the information more quickly. More critical needs rise to the top of the platform through a triage, and then they can respond. Sometimes the AI can actually craft a draft response that the therapist can then tweak if necessary.
The therapist can you know, ask, you know, would you like to speak in person over the phone or would you prefer to text? But that's really the platform. It just accelerates and expands the opportunity for involvement and access.
Michelle Rathman: And, you know, it's promising in so many ways. And if we circle back to the very beginning of this conversation, at the end of the day, telehealth, patients being able to, you know, plug in and report whatever their glucose or whatever their, know, their blood pressure. All of these things are hospital electronic health records.
They all require connectivity and not just any, it requires a certain speed. I'm not a tech geek, but I understand as a, I was reading in the story that, you know, just there are some hospitals and other institutions that just are not even meeting modern day standards for connectivity and in broadband speed.
So before we close out this conversation, as someone who's got your eyes right there on what's happening at the federal policy level, let's talk a little bit about your recommendations. I know that your members also are provided with advocacy tools as well. Let's talk about advocacy efforts that create policy that does allow for broadband equity.
I'm gonna say the word it will never leave my vocabulary because what we are talking about here is truly making sure that millions of Americans across this country have access to broadband for, for a variety of reasons. So what are some of your recommendations for us to, come alongside you and help to advocate for that which is a benefit for our rural communities, which is broadband.
Just basic, what most people say is a basic should be a utility these days. How can we make sure that that is protected at a federal and state? And what can local officials do to help advocate for their communities as well? It's gotta be bit more voices than one, right?
Joshua Seidemann: Right. So I think the primary word is to engage, and to speak with your local policy members to visit with your congressional delegations to find partners. So it's, you know, it's an entire community rising to make the case. One resource that I would, I would point people toward is NTCA’s Smart Rural Community Program, and it's a very, very easy url.
It is ntca.org/smart.
Michelle Rathman: Okay, we'll put that in our show notes, everybody.
Joshua Seidemann: Okay, and scroll down to resources and this is a program we have produced a number of research papers. They are not advocacy pieces. They do not argue for one well, except for the fact that we all want more broadband, but they don't argue for any particular policy one way or the other.
What they do is they present the facts. They offer the documented, data-driven academic evidence of better patient outcomes through telehealth and reduced healthcare costs through telehealth. How broadband can support workforce training and educational development for K through 12 students and beyond. The role of broadband in farming and how it can reduce the cost of inputs and create greater yields and you know, reduce incidences of help, help farmers battle crop or animal disease.
Those are the numbers. And then we pair that with on the ground examples, what we have seen in our NTCA member communities where close to 90% of the locations are served by fiber. And that that approach, I call it numbers a narrative. I think that that can make a sticky story for policy makers. And if you're in a community that has broadband.
You get to tell the policymaker this is what we have, and we we'll continue to build on it, and we risk losing it if these programs go away. And if you're in a community that doesn't have it, it helps make the case. Look what's possible with this technology.
Michelle Rathman: Yeah. We talk so much about rural thriving, and we, you know, broadband should not be the thing that barely helps us survive. I mean, this is what we can, this is what we need to thrive. So my goodness, Josh, I do appreciate you spending some time with us again. This is a really important multifaceted, complex issue, and there's a lot of legislation and policy and a lot of moving parts right now.
So, we appreciate you keeping in touch with us. Anything that you think we need to know in the future, you are welcome back to talk with us anytime.
Joshua Seidemann: Thank you very much. I appreciate the opportunity to visit with you today.
Michelle Rathman: It's my pleasure, right, everyone, stay tuned. I'll be back with a closing message. We'll be right back on The Rural Impact.
>>>>>
Michelle Rathman: Well, my thanks goes out to Josh, Caresse and Sarah Jane. I'm so grateful for their time and I always say these are not light subjects, but we do hope that you've been enlightened, and as a reminder, you will find the links from these conversations on our website. TheRuralImpact.com. Really easy to find us, including Dead Zone series links, as well as that, which Josh mentioned to us about smart Community Tools.
So again, we'll make sure that you can find those on our show notes and resources before we close out today on this subject, I do wanna share with you, it's kind of ironic. Moments after my conversation ended with Josh yesterday, my internet went out for six hours. I felt like a caged animal, when it happened, I thought truly that it was a sign from the universe to really reinforce how important connectivity is to function.
And then it made me think about what my life would be like without having connectivity, what would it be like if I lived in a dead zone? So maybe you can think about that. What would your daily life be like without access to internet or phone service? How might it change the quality of your life and your ability to access care as but one example.
Now, as you heard today, and as you'll learn when you watch and read the Dead Zone series. There are far too many people in communities that don't have to imagine not having connectivity because it's their reality. And here's another reality, eliminating funding for digital equity will deepen the divide and worsen health outcomes for rural Americans. There is absolutely no way that that is not the path that we're headed down should this happen.
And what I'm talking about is that you heard me reference in my conversation with Josh that President Donald Trump has called for the Bipartisan Digital Equity Act, he's called it a woke handout based on race, and that's a quote directly from the president. Woke handouts based on race. However, as we know, if you read the act, it hardly mentions race at all.
In fact, the eight covered populations that are included in this act are older Americans, veterans, people with disabilities, anyone living in rural areas and members of, and again, this is directly from the act of a racial or ethnic minority group. That is 80% of the country that fits one of those groups and most of these states where the digital Equity Act is providing funding, well has provided funding that was already allocated.
Most of those states have very large, the largest rural population, so. Something to keep in mind. If you have a story about how funding for broadband equity has impacted your community in a positive way or negative, we wanna hear from you. So, we encourage you to reach out to us and share, and you can find us again at theruralmpact.com.
We always appreciate it when you leave your comments. We love it when you subscribe so that you can get our post series e-blast. We send those out about every six weeks or so, and I just also wanna mention to you look for me on the road next month because I'll be recording from two locations in Nebraska and I invite you to send us a note if you'd like to bring our show on the road to your location.
We really do enjoy having opportunities to meet you where you are. All right. My quick thanks to Sarah Staub and Brea Corsaro for all their hard work on this podcast. In the meantime, until we meet again, I invite you to take as the best care that you can of yourself and to the best of your ability, everyone around you.
Okay, we'll see you soon on a new episode of The Rural Impact.
