Category: Blog

The Telehealth Cliff: Implications of Expiring COVID-19 Waivers

During the COVID-19 public health emergency, the U.S. government enacted a series of telehealth waivers that significantly expanded access to remote healthcare services. These changes were designed to address barriers to care during a time when in-person medical visits carried heightened risks of infection. By relaxing long-standing restrictions and broadening the scope of telehealth, policymakers ensured that millions of patients could continue receiving essential medical care. However, because many of these waivers were temporary, the nation does face a policy crossroad as expiration deadlines approach.

Prior to the pandemic, telehealth under Medicare was restricted by geographic and originating site limitations. Patients typically had to be in a rural area and physically present at a medical facility to access telehealth services. The COVID-19 era waivers removed these restrictions, allowing patients to receive telehealth services from the comfort of their own homes and in any location. This shift significantly expanded access, particularly for vulnerable populations, including the elderly, individuals with mobility challenges, and those living in underserved areas.

The waivers also expanded the scope of providers eligible to deliver telehealth services. Physical therapists, occupational therapists, speech-language pathologists, and audiologists were temporarily authorized to bill for telehealth services. Federally Qualified Health Centers (FWHCs) and Rural Health Clinics (RHC) were permitted to serve as distant site providers, further expanding the pool of available telehealth practitioners. Behavioral health care received significant support as well, with relaxed requirements for in-person visits and broader acceptance of telehealth for mental health treatment.

One of the most transformative flexibilities was the inclusion of audio-only telehealth visits. Recognizing that not all patients had access to reliable broadband or video technology, regulators allowed providers to conduct visits via telephone. This proved particularly valuable for low-income and rural patients, helping to close the care delivery gaps.

Prescribing of controlled substances via telehealth also saw temporary adjustments. The Drug Enforcement Administration (DEA) relaxed requirements for in-person visits before issuing prescriptions, which allowed patients to continue receiving critical medications for conditions such as ADHD, anxiety, and opioid use disorder.

As the public emergency wound down, Congress took steps to extend many of these waivers. The American Relief Act of 2025 extended telehealth flexibilities through March 31, 2025, while the Full-Year Continuing Appropriations and Extensions Act pushed the deadline to September 30, 2025. Yet, unless further action is taken, and right now none has, these waivers are set to expire, which creates what some policy experts call a “telehealth cliff.”

If these waivers expire without replacement, access to telehealth will narrow significantly. Medicare patients may once again be limited to receiving telehealth only in rural areas and from specific originating sites, reducing the ability to access care from home. Audio-only visits would no longer be reimbursed, excluding patients without video technology. Non-physician providers may lose the ability to conduct telehealth visits, shrinking the range of available services. Additionally, the more flexible rules for prescribing controlled substances remotely would tighten, requiring more in-person visits.

Now that the expiration date has passed, critical questions about the future of telehealth remain. Supporters argue that the waivers demonstrated telehealth’s effectiveness and necessity, especially in addressing disparities in access to care. They emphasize that removing these flexibilities would disproportionately harm patients in rural, underserved, and low-income communities. Policymakers have responded by introducing proposals such as the Telehealth Modernization Act, which would extend many of these flexibilities through 2027.

The telehealth waivers enacted during the COVID-19 pandemic represented a historic transformation of the US health care system. They expanded access, reduced barriers, and highlighted the potential of telehealth as a permanent feature of modern care delivery. Yet, now with the expiration day has passed, the nation must decide whether to preserve these gains or return to a more restrictive system. The outcome will shape the accessibility, equity, and effectiveness of healthcare for millions of Americans.

The Role of Local Government in Dealing with Food Deserts and Food Insecurity

Zohran Mamdani’s recent victory in the New York City mayoral democratic primary has brought national attention to his proposal for city-run grocery stores and how to address the issues posed by food deserts and food insecurity. According to the US Department of Agriculture (USDA), approximately 2.3 million, or 2.2%, of households in the continental US live more than a mile from a supermarket and do not have access to a vehicle. The USDA’s Food Access Research Atlas notes that 18.8 million Americans, or 6.1%, live more than 1 mile (in urban areas) or more than 10 miles (in rural areas) from a supermarket. This lack of access to supermarkets and healthy food poses health risks to these Americans. 

Mamdani’s pilot plan to address food deserts and food insecurity in New York City is to build five city-owned grocery stores, one per borough, focused on keeping prices low rather than making a profit. This grocery store plan is not only about addressing the lack of access to healthy food, but also about affordability. The pilot program has a $60 million estimated cost and the stores would be exempt from rent and property taxes. According to polling done by Data for Progress, 66% of likely voters support Mamdani’s plan. A 2023 report by the New York State Department of Health found rates of food insecurity in New York City vary from 39% of adults living in food insecurity in the Bronx to 22.1% in Staten Island. Food deserts can presently be found in more than 2 dozen neighborhoods in New York City.  

City-run grocery stores are not a novel idea. Many cities across the country have implemented plans similar to Mamdani’s with varying levels of success and city involvement. In the town of St. Paul, Kansas, where there had not been a grocery store for almost two decades, a city-run grocery store was opened in 2008 and continues to provide the town with healthy, affordable food. Madison, Wisconsin, and Atlanta, Georgia, have both implemented successful public-private grocery store partnerships where the cities have helped finance construction and provided tax incentives. Those plans both featured less city-government involvement than Mamdani’s, but still show that city government can play a role in combating food deserts and food insecurity.

There are differing opinions on whether Mamdani’s plan will be successful. Mamdani has famously drawn criticism from New York grocery chain CEO John Casimatidis, who sees the prospect of city-run grocery stores as a threat to private grocers that already operate on very small margins. Mamdani’s detractors also point to examples of city-run efforts gone awry. Not far from St. Paul, Kansas, a city-run grocery store, Erie Market, in Erie, Kansas, struggled to compete with the prices of other grocers that were at least a 15-20 minute drive away. Erie Market had been the only market in town, and after significant investment in the store by the town, its management and operation were transferred to a private company, and it subsequently ceased operations entirely.  

While the fact that there is a need to increase the access and affordability of healthy food in the US is clearly evident, there is still debate on what role city-run grocery stores and local governments at large have to play in solving the ongoing food insecurity and food desert crises.

Intentional Genomic Alterations: A New Development in Animal Biotechnology

The livestock industry relies on traditional breeding methods for desired traits, but this is costly and limits which animals can be bred. Intentional Genomic Alterations (IGAs) are being developed in animals to give desired traits faster. IGAs make targeted and random DNA sequence changes to an animal’s genomic DNA. This is especially helpful for the livestock industry because traditional breeding methods only give traits to offspring, but IGAs can give traits to an entire generation at once. Scientists found a gene called PRLR that, when altered, creates short, slick hair in cattle, more commonly referred to as SLICK. SLICK enhances heat stress tolerance and reduces disease susceptibility. This is especially useful for cattle farms in tropical climates because heat stress can affect milk yield and fertility. There are three cattle breeds with SLICK in the United States and Brazil. The Food and Drug Administration (FDA) approved SLICK cattle as safe for human consumption in 2022. 

The FDA regulates IGAs in animals by reviewing the product claim, how the IGA was produced and introduced to the animal, the characteristics given to the animal, the animal’s health, the durability of the desired effect, the environmental impact, whether it is safe for human consumption, and the effectiveness of the IGA. In May 2024, the FDA announced it would be collaborating with the EPA and USDA to ensure sustainability and safety in the biotechnology of IGAs. IGAs are being developed for uses other than for the livestock industry, including: biopharmaceuticals, research, xenotransplantation, therapies in companion animals, disease resistance, and food supply. There have already been drugs from IGAs approved by the FDA. A recombinant anti-thrombin drug was developed from the milk of transgenic goats. To create the drug, human DNA is inserted into the cells of goats and excreted from the offspring’s milk. The drug is in clinical trials and, if successful, will be more cost-effective than current drugs on the market for coagulation disorders.

Some IGAs are still in the developmental stage. Revivicor is a xenotransplantation company aiming to make pig kidneys and hearts viable for human transplant. Organs from another animal will be rejected by the body immediately upon implantation, but Revivicor is using IGAs to combat organ rejection. There are 10 genes in the pig genome that are edited through mutation and by adding human genes. 

Despite the benefits that IGAs may bring, there are ethical concerns for animal welfare. Making IGAs is inherently invasive and subjects the animals to surgeries, tissue sampling, and possible complications resulting in disability or death. IGAs are still in the conception stage and will have effects on the food supply, pets, pharmaceutical products, and other developments. There are areas of research of animals with IGAs that need more information, and there could be unanticipated results and concerns. For example, animal clones, copies of animals traditionally bred, have been limited recently because the offspring of the cloned animals developed varying abnormalities. Unforeseeable results are possible; however, the most recent development in IGA information is a new approval process for heritable IGAs released by the FDA. There are two parts, the first part categorizes IGAs based on their risk. Higher-risk IGAs will need the FDA’s full approval. The second part provides a guide for developers of higher-risk IGAs by giving guidelines of what is needed for the FDA to evaluate the products. This new approval process is an important step towards regulating IGAs, but it also emphasizes the need for continued research and ethical consideration.

The Impact of Tariffs on Drug Pricing and Accessibility

At the beginning of the new administration, there have been threats of tariffs on a wide variety of imported goods and against multiple nations. One such suggested tariff is that on imported pharmaceuticals. In February, the new administration suggested a 25% tariff could be imposed on imported pharmaceuticals. The impact on the healthcare industry will be far-reaching if the tariffs go into effect, as 61% of adults and 20% of children in the United States fill at least one prescription each year. Tariffs are expected to affect both drug pricing and availability, creating higher prices, increasing drug shortages, and affecting health outcomes.

Tariffs on pharmaceuticals are expected to increase drug pricing for consumers. Insurance companies are not designed to handle a twenty-five percent increase in the cost of medications, due to restrictions on pricing from programs like Medicaid, and that will result in a downstream effect on their patients. This could result in reductions in coverage or the removal of certain drugs from insurance coverage. The resulting changes in coverage and costs will fall to patients.

In part, drug pricing would also go up because it could take years and be more costly to create domestic productions for medicines that are currently being produced abroad. Drug pricing is a complex system because drug production involves multiple layers of manufacturing and steps. Some pharmaceutical companies may be better equipped to handle a pharmaceutical tariff because of existing manufacturing facilities responsible for producing active ingredients while others will struggle more because of a high proportion of active ingredients produced internationally. Those that do not have domestic facilities encounter the additional barrier of FDA regulatory requirements in creating new domestic manufacturing plants.

Drug availability is also in question under the proposed tariffs. In response to the tariff threats, some companies have already expedited shipment to the United States for certain drugs. Coupled with chronic shortages of some generic drugs in recent years, tariffs would put pressure on an already fragile industry. Tariffs could result in supply chain disruption. It is also predicted that fragile generic injectables will go into shortage.

The efficacy of tariffs is as yet unclear, but research is being compiled on possible implications. The Brookings Institution compiled research on pharmaceuticals and found tariffs will provide an incentive to increase domestic manufacturing for brand-name drugs only. This would not affect off-patent generic drugs which make up 90% of the volume of drugs and only a fraction of the costs. The study anticipates that a cut into the already small profit margins will lead to products being discontinued and a loss of some quality standards.

It is unclear precisely what tariffs will do to the pharmaceutical and patient care industries, but it is widely expected that changes will come. At a White House event on April 2, reciprocal tariffs were announced, which would have an impact on the pharmaceutical industry. The White House stated there would be “no exemptions.”  On April 9, a 90-day pause on the tariffs was instituted against most foreign countries except China. This pause is a lower reciprocal tariff, at 10%, except in industries with 25% tariffs, like aluminum and steel. Tariffs are expected to impact the pharmaceutical supply on a global level, which may result in “an extreme burden on the patient.”

The Organ Shortage Crisis: Are Pigs the Answer?

As of April 4, 2025, there are 103,223 people in the United States waiting for an organ transplant that could save or greatly improve their life. Of those 103,223 people, seventeen of them will be dead by the end of the day. Tomorrow, seventeen more. Every eight minutes, another person is added to the transplant list at the United Network for Organ Sharing (UNOS), the only organ procurement and transplantation network in the United States. Eighty-six percent of those on the list need a kidney, but livers, hearts, lungs, pancreases, and other organs are needed as well. While over 170 million people in the United States are registered donors, only three out of a thousand people will die in a way that allows for deceased organ donation. The simple truth is this: we do not have enough organs. 

The need for organs has only grown in America, largely due to increased longevity and higher rates of obesity associated with organ failure. Both science and public policy changes have offered a variety of creative potential solutions. One concept adopted in parts of Europe is known as “presumed consent,” where citizens choose to opt out of being an organ donor upon death, as opposed to the American system of opting-in. Another idea is to broaden the pool of cadaver donors by expanding the brain death requirement to a “persistent vegetative state” or allowing a potential donor who is soon to die to choose to donate their organs and experience a “death by donation.” While these potential solutions are ripe for controversy and ethical concerns about consent, they only slightly expand the donor pool—and, still, very few people are likely to die in a manner conducive to organ transplantation. A newer idea offers a different set of questions and controversies while having the capacity to almost completely solve the organ shortage crisis: xenotransplantation. 

Xenotransplantation is already progressing in the United States. On March 21, 2024, Mass General Hospital performed the first successful kidney xenotransplantation into a living recipient, done under compassionate use for the recipient with no other option, and extended his life by two months. Furthermore, just recently on February 3, 2025, the FDA approved a clinical trial for patients with end-stage renal disease and the first transplant is expected to take place mid-year 2025. So, what is it? 

Xenotransplantation is a process that uses organs from genetically modified pigs rather than human organs. The genetic modification is done using CRISPR/Cas9, the leading gene editing technology. Pigs are an ideal candidate for xenotransplantation for multiple reasons, including the similarities between pig and human organs, their short gestation period, their large litter sizes, and the present common acceptance of pigs being used as meat animals. Furthermore, the widespread use of pigs for organ transplants would present numerous benefits, including providing a near-unlimited supply of organs, reducing illegal organ trafficking, and allowing “borderline” candidates who would otherwise be denied a transplant an opportunity to have a new organ. 

All this being said, xenotransplantation certainly presents a slew of complications and concerns. On the medical side, there is a possibility of transmitting animal viruses to the recipient and loved ones near the recipient. Furthermore, while pig kidneys are similar to human ones and both filter waste from blood and make urine, human kidneys have many important roles and it is currently unclear if pig kidneys can fulfill these functions long-term (though the longest-living recipient of a pig kidney says she is currently doing very well, months after the transplant). As for the pigs, they must be raised in sterile conditions to reduce the likelihood of infection to the human recipient. The pigs are also genetically modified to make their organs more suitable for humans and reduce the likelihood of animal viruses being transmitted, which has presented a debate on the ethics of using animals in such a way. 

With the FDA giving the green light to clinical trials and the purported success of recent kidney xenotransplants, xenotransplantation appears to be gaining speed. It may present a unique solution to the organ shortage crisis while posing interesting questions about the consequences of using such technology. 

NIH: A Freeze on Funding and Answers

The National Institutes of Health (NIH) is part of the United States Department of Health and Human Services (HHS). It consists of twenty-seven organizations known as Institutes and Centers. The NIH aims to foster creative discoveries and innovative research strategies; develop, maintain, and renew scientific human and physical resources to prevent disease; expand the knowledge base in medical and related sciences to enhance the nation’s economic well-being; and exemplify and promote the highest levels of scientific integrity, public accountability, and social responsibility. Although each Institute and Center has its own research agenda, they all receive their funding directly from Congress. 

The NIH allocates the majority of its $48 billion budget to medical research. A significant portion of this funding is awarded to universities, medical schools, and other institutions to conduct extramural research through grants. One major category supported by the NIH is cancer research, which receives approximately $8 billion annually. Since President Trump took office on January 20, 2025, he and his administration have implemented substantial cuts to federal health agencies. His administration, as of last week, has sent termination notices to thousands of federal health workers, including those at the NIH, which anticipates a loss of 1,200 employees. 

In addition to cuts affecting federal employees at the NIH, the Trump administration has stalled grant authorization and funding. The NIH cannot consider new grant applications because President Trump has blocked it from posting new notices in the Federal Register, a requirement before any federal meeting can be convened. As a result, the agency had to cancel planned meetings to review thousands of grant applications. Due to the freeze, the NIH has reportedly stalled over 16,000 applications, all competing for approximately $1.5 billion in NIH grant funding. An anonymous committee member who reviews grant funding meetings states that even though the freeze remains in place, “applications still come in, and essentially they go into a black hole, and nothing can be done with them.” In addition to workforce cuts, the Trump Administration has hit the NIH with a cap of 15% on the rate they pay for the indirect cost of medical research. This is much lower than many other federal institutions get to maintain buildings and equipment.

Anjee Davis, the CEO of Fight Colorectal Cancer, expresses her fear regarding employee cuts and a funding freeze: “We are scared that these blanket mandates could erase decades of progress in the fight against cancer. This isn’t about politics. It’s about protecting the advancements we’ve fought so hard to achieve in cancer care and research over the past two decades.” Dr. Celine Gounder, CBS News Medical Contributor, explained that the NIH is “how we end up with new drugs and other advancements in medicine.” CBS further explains that while there are immediate impacts from the freeze and firings, concerns grow among individuals that there are both immediate and long-term worries about a slowdown in biomedical research and potential delays in drug approvals. Davis and her company surveyed patients currently being treated for colorectal cancer, and 75% of respondents indicated they were worried that these government actions would delay their care and hinder new research into their cancer. 

While the funding freeze is new, and the federal workforce cuts at healthcare agencies are even newer, there is not much to say to ease the fear and anxiety felt by individuals, more specifically cancer patients. It is very concerning regarding the immediate impact on health care and public health and the longer-term implications for whether we will maintain our leadership in the health space.