Telehealth, health care through technological services, has been an increasingly used form of care since the COVID-19 pandemic when digital health care became increasingly necessary to limit in-person interactions. Telehealth is conducted completely online and, therefore, has the potential to be revolutionary for disabled folks who would benefit from the convenience of a digital platform. The digital aspect of telehealth would allow patients to avoid barriers to accessibility that come with in-person appointments, such as issues like transportation and mobility or the need to avoid potential exposure to communicable diseases.
While patients could avoid the barriers to in-person care through telehealth, telehealth has proven to come with digital barriers of its own, largely stemming from a lack of digital accessibility. Telehealth, in theory, would expand access to health care for disabled individuals. In practice, telehealth has not realized its potential because of the inequities associated with online access, such as website inaccessibility. This has resulted in an increasingly inequitable healthcare landscape, where disabled people continue to bear the brunt of systemic inaccessibility. The health care costs are higher for disabled folks with intersecting identities, whereas disabled Black and Latino folks are more likely to suffer from poor health outcomes.
Telehealth is usually inaccessible for several reasons that the Department of Justice (DOJ) has outlined, including poor color contrast, use of color alone to give information, lack of text alternatives on images, no video captions, inaccessible online forms, and mouse-only navigation. In an age where access to information and health services is a health determinant, inaccessible internet access is unacceptable. Digital accessibility is a civil rights issue.
While the Americans with Disabilities Act (ADA) does not explicitly discuss digital accessibility, courts have interpreted Title II of the ADA, a section on discrimination based on disability by state and local governments, to include protecting digital accessibility. This precedent supports protecting digital accessibility for government healthcare agencies. Despite this precedent, legislative action should establish enforceable website accessibility requirements under Title II.
Title III of the ADA, which discusses private businesses and public accommodations, is less resolved when it comes to its protections on website accessibility, creating a lack of uniform protections. Some courts have held that telehealth platforms are places of accommodation, meaning that they fall under ADA requirements of protection, but others have found that they do not qualify. Protections for disabled folks are therefore different by location and private telehealth services can have digital accessibility barriers without consequence. Because Title III lacks enforceable digital accessibility standards, these barriers remain unaddressed.
Given that telehealth is an increasingly relevant mode of healthcare, we should advocate for improved access to its services for everyone by enshrining digital accessibility into the ADA. The exclusion of disabled folks through digital barriers is unacceptable when they are a group that could benefit the most from its benefits. Disabled folks already disproportionately receive less health care because many are disproportionately below the poverty line, making payment impossible, and face issues with accessible in-person services, transportation, and communication. Making healthcare access more difficult by not improving accessibility in all spaces, including digital spaces, leads to more negative outcomes for disabled people, especially for disabled people with intersecting identities. Without stronger enforcement of compliance with digital accessibility guidelines, disabled patients will continue to face digital barriers to healthcare.