COVID-19 adds a new health care gap: internet disparity

When health care went online, millions couldn’t follow

In early 2020, health care in the United States pulled an extreme makeover. Doctor visits turned into video calls, waiting rooms became apps, and “You’re on mute” somehow joined the medical vocabulary. Telehealth surged from niche to normal practically overnight, with federal data showing virtual visits skyrocketing into the hundreds of millions during the height of COVID-19.

But there was a catch: you needed a reliable internet connection, the right device, and enough digital know-how to make it all work. For many Americans, that combo simply didn’t exist. While policymakers were focused on ventilators and vaccines, a quieter crisis was unfoldinga new health care gap driven not by biology, but by bandwidth.

This “internet disparity” doesn’t just mean slow Netflix. It shapes who gets timely medical advice, whose prescriptions are adjusted on time, whose chronic conditions are monitored remotely, and who can safely avoid crowded waiting rooms during a viral outbreak. COVID-19 didn’t invent the digital divide, but it exposed just how dangerous it is when access to care depends on access to the internet.

What “internet disparity” really means in health care

“Internet disparity” is the health care version of the digital divide: the gap between people who can easily use online tools and those who can’t. It has three main parts:

1. Availability: Is broadband even offered where you live?

According to recent federal broadband data, about 94–95% of U.S. homes and small businesses now have access to at least one fixed broadband provider offering speeds of 100 Mbps download and 20 Mbps upload. That still leaves millions of locationsdisproportionately in rural and Tribal areaswithout truly high-speed connections. In some rural communities, roughly 1 in 5 residents still lack high-speed internet access, compared with a tiny fraction of people in urban areas.

2. Affordability: Can people actually pay for it every month?

Access doesn’t always mean affordable access. Pew’s analysis of state digital equity plans found that every single state identified cost as the leading barrier to getting online. National reports estimate that about 15% of American households still lack high-speed internet service as of 2023, often because the monthly bill simply doesn’t fit the budget. When a family has to choose between groceries, rent, and Wi-Fi, telehealth loses every time.

3. Adoption and skills: Even if it’s there and affordable, can people use it?

Having a signal doesn’t equal being connected in a meaningful way. Surveys from Pew Research Center show that home broadband adoption drops sharply among people with lower incomes: while more than 90% of adults in higher-income households have home broadband, only a little over half of adults in households under $30,000 do. Older adults, people with disabilities, and those with limited English proficiency often face additional challengescomplicated portals, tiny buttons, glitchy apps, and instructions that read like they were written by a robot for other robots.

Who is most affected by the COVID-era internet gap?

The internet disparity is not random. It tends to hit the same communities that already carry the heaviest health burdens.

Low-income households

For families living paycheck to paycheck, broadband is sometimes treated as a “nice-to-have” instead of a necessity. Before it ended in June 2024, the federal Affordable Connectivity Program (ACP) helped more than 23 million low-income households afford their internet bills with a $30 monthly subsidy (higher in some Tribal and high-cost areas). When ACP funding ran out, many families downgraded their connection or lost internet altogetherjust as health systems were cementing telehealth into routine care.

Racial and ethnic minority communities

Structural inequities show up in both health outcomes and connectivity. A 2021 Pew survey found that Black and Hispanic adults are less likely than White adults to have home broadband or a desktop/laptop computer. More recent analyses show that about 32% of Black households lack home broadband, nearly double the national average of around 18%. When key COVID information, appointment portals, and telehealth visits move online, these gaps translate into lost opportunities for prevention and treatment.

Rural and Tribal communities

In rural areas, internet problems often start with geography. Sparse populations and difficult terrain make it less profitable to build high-capacity networks. Reports based on FCC data show that tens of millions of Americansmany in rural and Tribal communitiesstill lack access to broadband that meets modern speed benchmarks. During the pandemic, residents who lived miles from the nearest clinic were exactly the people who could have benefited most from telehealth. Instead, some ended up driving to parking lots outside libraries, fast-food restaurants, or schools just to catch a free Wi-Fi signal for a video visit.

Older adults and people with disabilities

Older adults are more likely to live with chronic conditions, and less likely to feel comfortable troubleshooting a frozen video screen. Digital health tools that rely on tiny text, complex passwords, or multi-step verification can be effectively unusable for people with visual, cognitive, or motor challenges. Without thoughtful design and support, telehealth can unintentionally exclude many of the patients who need it most.

Telehealth: lifeline for some, locked door for others

The promise of telehealth is huge. Studies show that virtual visits can improve access for patients with mobility limitations, reduce missed appointments, and make it easier for people to manage chronic diseases like diabetes, heart failure, and depression. Mental health care, in particular, saw a surge in video and phone-based visits, helping many patients continue therapy during lockdowns.

But when connectivity is shakyor missing altogethertelehealth becomes a source of frustration, not relief. Common problems include:

• Video visits that freeze or drop repeatedly
• Patients burning through limited mobile data to connect with their doctor
• Families sharing one smartphone among several children and adults
• Online forms that won’t load on older devices or slow connections

Research on telehealth during COVID-19 has found clear inequities in who uses it. For example, recent studies report that rural residents, people with lower incomes, and some racial and ethnic minority groups were less likely to use video-based telehealth, even when they did seek remote care. In cancer care and other serious illnesses, digital barriers can mean fewer follow-ups, delayed symptom reporting, and more complications.

Availability vs. affordability: the policy plot twist

If you look only at national availability maps, the story almost sounds like mission accomplished. Federal reports boast that more than 90% of locations have access to high-speed internet through at least one provider. But that rosy picture gets fuzzier when you ask, “At what speed? At what price? And who’s actually subscribed?”

Several key policy threads are pulling in opposite directions:

• BEAD program (big infrastructure build-out): The Broadband Equity, Access, and Deployment (BEAD) program is investing $42.45 billion to connect unserved and underserved areas with networks capable of at least 100/20 Mbps speeds. Great news for communities that have never had real broadband, but these large-scale projects take years to complete.
• End of the Affordable Connectivity Program (ACP): ACP, which helped low-income families pay their monthly bills, ended in June 2024 when funding ran out, leaving more than 23 million households without that crucial discount. Many downgraded their plans or simply disconnected.
• Other safety-net programs: The long-standing Universal Service Fund, which supports low-income consumers, rural health care providers, schools, and libraries, survived a major legal challenge in 2025, allowing it to keep operating. But its benefits typically don’t match the scale and simplicity of the now-ended ACP.

In other words: we are investing huge sums to build more pipes and cables, while simultaneously letting one of the major affordability programs expire. From a health-care perspective, that’s like building more hospitals while quietly charging admission at the front door.

How internet disparity shapes COVID-era health outcomes

Digital exclusion doesn’t just make life inconvenient; it can worsen health outcomes. Research has linked lack of internet access to higher COVID-19 case and death rates, in part because people without reliable connectivity have fewer opportunities to work from home, access timely information, or use telehealth services.

During surges, patients without internet access faced several obstacles:

• Difficulty scheduling testing, vaccines, and boosters when systems moved online
• Limited ability to consult a clinician quickly about new symptoms
• Challenges managing chronic conditions safely from home
• Less access to online health education materials and support groups

Meanwhile, those with fast, stable connections could video chat with their doctors, refill prescriptions through apps, join virtual support communities, and receive remote monitoring for conditions like heart failure or COPD. The gap between these experiences isn’t just technologicalit’s a gap in safety, convenience, and sometimes survival.

Closing the internet gap: what systems and communities can do

The good news: internet disparity is a policy choice, not a law of nature. Governments, health systems, and communities all have levers they can pull.

Make internet access a health priority, not a side project

Health systems can treat digital access like a social determinant of health, the same way they screen for food insecurity or housing instability. Asking patients simple questions“Do you have reliable internet?” “Do you have a device that works for video visits?”can guide decisions about visit type, follow-up, and support services.

Design telehealth for low-bandwidth reality

Not every appointment needs a high-definition video feed. Clinicians and health systems can:

• Offer both phone and video options whenever clinically appropriate
• Create patient portals that function on older devices and slow connections
• Minimize heavy graphics, auto-play videos, and unnecessary log-in hurdles
• Provide instructions in plain language and multiple languages

Invest in digital literacy and trusted community hubs

Libraries, community centers, and faith-based organizations can serve as digital health hubs, offering Wi-Fi, devices, and help with navigating portals and telehealth tools. Many already do; the challenge is sustaining these services and making sure residents know they existespecially as some federal support for off-site connectivity has been rolled back.

What individuals and families can do right now

You can’t personally fix federal broadband policy (unless you happen to be in Congress reading thishi, welcome), but you do have options:

• Ask for the kind of visit that works for you. If video is impossible, tell your clinic. Many health systems can still offer telephone visits for appropriate concerns.
• Check for state or local programs. Some states, cities, and counties offer discounted plans, loaner devices, or community Wi-Fi initiatives that partially fill the gap left by ACP.
• Use community resources. Libraries and community centers may offer quiet rooms or kiosks where you can attend telehealth appointments more privately than from a busy home.
• Advocate. Patients and caregivers can share their stories with local officials, school boards, and health systems. Policymakers get a lot of charts; they also need human stories.

Real-world experiences from the digital divide (about )

Statistics are important, but they don’t capture the stress of watching a loading wheel spin while you’re trying to ask a doctor if your cough is “normal COVID” or “get-to-the-ER-now” COVID. Here are a few composite storiesbased on real patterns reported in communities across the U.S.that show how internet disparity feels on the ground.

Maria: juggling shifts, school, and a blinking router light

Maria is a single mother working hourly shifts at a grocery store. During the pandemic, her 8-year-old son attended virtual school on a borrowed Chromebook, often using the same prepaid mobile hotspot Maria needed to check her work schedule. Their apartment building had no wired broadband options at a price she could afford. When Maria developed COVID-19 symptoms and her asthma started acting up, her clinic offered a video visitgreat in theory, except her data plan was nearly maxed out for the month.

She tried to connect anyway. The video stuttered, froze, and dropped. The clinician could barely hear her wheezing. After a few failed attempts, they switched to an audio-only call. The doctor adjusted her inhaler regimen and reviewed warning signs that would require urgent care. It wasn’t the seamless telehealth experience advertised in the commercials, but it was better than nothingand it highlighted how much depends on that tiny bar of signal strength at the top of her phone screen.

Mr. Johnson: rural roads, long drives, and limited options

Mr. Johnson, a retired truck driver in his early 70s, lives in a rural county where cows outnumber people and “broadband” often means “maybe if the weather is good.” He has diabetes and heart disease, both of which need careful monitoring. When COVID-19 hit, his local clinic started pushing video visits for routine check-ins to reduce in-person exposure.

The problem? His home satellite connection dropped unpredictably, and every minute of data cost extra. The clinic’s telehealth platform struggled to function on his old tablet. After a frustrating attempt that ended with an error message and a very polite but very unhelpful support chatbot, Mr. Johnson gave up on video visits entirely. Instead, he drove 45 minutes each way for in-person appointments that could have been safely handled remotelyburning gas, time, and energy he didn’t really have.

A clinic’s view: three waiting rooms, one invisible

From the health system side, the digital divide shows up like a split-screen dashboard. One group of patients logs in early, checks their blood pressure readings from home, and messages their doctor through the portal. Another group joins from smartphones, sometimes bouncing between work, caregiving, and spotty Wi-Fi. A third group simply doesn’t appear online at allmissed appointments, outdated contact information, disconnected phone lines.

Clinicians often say they worry most about that third group. Those patients may not answer reminders sent through apps or email. They might not see public health alerts about surges or new vaccines. They may be relying on emergency rooms or urgent care centers instead of stable primary care, not because they don’t care about their health, but because the health system increasingly expects them to navigate online.

Community connectors: librarians, outreach workers, and neighbors

In many towns, the most practical COVID-era “digital health workers” weren’t tech companies; they were librarians, outreach workers, and neighbors who knew “the good Wi-Fi spots.” Librarians helped people print vaccine cards and reset patient portal passwords. Community health workers showed older adults how to tap the right button to join a video visit. Neighbors shared connections, sometimes literally handing over a password and folding chair on porch days when someone needed to talk to a doctor.

These stories show that internet access isn’t just about cables and towers. It’s about relationships, trust, and the everyday improvisation that happens when systems are built for people with perfect connectionsbut real life is anything but perfect.

Conclusion: treating connectivity as care

COVID-19 turned the internet into a front door for health caresometimes the only door. For millions of people, that door was locked, jammed, or opened only halfway. Internet disparity is now a genuine health care gap, sitting right alongside insurance status, transportation, and neighborhood safety as a factor that shapes health.

Bridging this gap will require more than one-time programs or inspirational slogans about innovation. It means aligning infrastructure investments with long-term affordability, building telehealth tools that work in the real world, and recognizing that digital access is part of basic health access. When we design systems assuming everyone has fast, reliable internet, we bake inequity into the very tools meant to expand care.

The lesson from the pandemic is clear: the next time health care needs to move online quicklyand there will be a next timewe can’t afford to leave people behind simply because they live in the wrong ZIP code, have the wrong income, or use the “wrong” device. Closing the internet gap is not just a tech project. It’s a public health imperative.