The Federal Communications Commission vote on Thursday to roll back regulations that uphold net neutrality has some healthcare organizations concerned that the move could have downstream implications for providers, particularly those located in and serving rural areas.

The five-member FCC voted 3-2 along party lines to eliminate its 2015 Title II Order that requires net neutrality, the principle that internet service providers must allow equal access to web content, regardless of the source. Proponents of removing the rules contend that the move will unfetter competition and thus boost economic growth.

However, critics—among them hospital organizations—contend that the move will set the stage for cable TV-like tiers of services that would force consumers to pay more for services. This may particularly be true in rural areas, where there is often little or no competition among Internet service providers.

Some say the FCC vote could prompt federal legislative action to reinstitute net equality, and New York State Attorney General Eric T. Schneiderman issued a statement Thursday saying his office will take legal action to block the rollback of net neutrality regulations.

Ajit Pai, the FCC chairman appointed by President Trump, has framed the repeal as getting the government to "stop micromanaging the Internet" and has stated that the move could benefit technology companies and could encourage technologies that support telemedicine and add bandwidth to underserved areas, enabling hospitals to have “fast lanes” of service that could improve Internet speeds.

However, many healthcare organizations have long opposed the removal of net neutrality regulations and voiced concern over the impact of the FCC vote.

The National Rural Health Association has long opposed the rollback of net neutrality provisions, and on Thursday confirmed that it fears the elimination of the rules could have negative effects on bandwidth for rural healthcare facilities, and will hurt efforts to provide telemedicine and telehealth services to residents in their service areas.

“NRHA supports broadband policies that acknowledge high-speed online access as a necessity, not a luxury. All communities deserve a chance to participate in our digital future,” the group affirmed.

Potential negative effects on Internet services comes at the wrong time for rural areas, where residents are victims disproportionately of deaths from certain chronic diseases and opioid addiction, says Tom Morris, associate administrator for rural health at the Health Resources and Services Administration, who says education and better access to healthcare can make a difference.

Also See: FCC, NCI to increase rural broadband access for cancer patients

Ending net neutrality will likely be bad news for healthcare providers, according to an analysis by Advisory Board, a consultancy.

“In theory, allowing an internet ‘fast lane’ for certain services could improve certain internet-enabled healthcare services, such as telemedicine and remote monitoring,” says Jim Adams, an executive director who leads the Health Care IT Research Suite for Advisory Board. “However, in practice, we're skeptical that ending net neutrality will be a positive development for patients and providers.”

Adams lists the following concerns:

  • ISPs may use their dominance in a region to pick winners and losers in other markets—to choose which providers of telemedicine, data centers, and cloud computing services have to pay far more for reliable connectivity and which do not. “This is important, as several ISPs either operate or have existing financial relationships with vendors of these services, creating a conflict of interest,” he says.
  • Costs could go up for providers, either directly or indirectly. “ISPs could charge hospitals, or more likely their cloud-based vendors, additional fees to deliver reliable service for their mission-critical applications.”
  • Increased costs and uncertainty about access to low-cost telemedicine services could have particularly negative effects for rural providers. He noted previous Advisory Board research that, “for telemedicine to be scalable and positively impact cost and outcomes, there must be a predictable infrastructure connecting patients, care providers, and technology...The undoing of [net neutrality] weakens the infrastructure of reliable low cost connectivity that telehealth systems depend upon."

The App Association, a trade association representing application software developers, has long been an advocate for net neutrality. "We believe in the principles that preserve the Internet as a platform for free speech, commerce, and innovation. And we believe open internet principles should not be subject to the differing agendas of various administrations," according to the organization's statement.

The removal of net neutrality also moves the governing body of Internet communications from the FCC to the FTC. This has some staggering ramifications, according to Morey Haber, vice president of technology at BeyondTrust , a cyber security company.

“The Internet itself is no longer viewed as a communications vehicle in the eyes of the government, but rather a trade vehicle for commerce and content,” Haber says. “This means that recent laws requiring the taxation of goods interstate, services provided that could be taxed, and premium fees for services can now be better enforced, and potentially new taxes to be levied. These are hidden possibilities with the changes voted on today.”

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