U.S. Senator Ben Cardin

Letters From Ben

February 3, 2024

How Is Everybody Doing

Like millions of Americans, my children, and now grandchildren, grew up watching Sesame Street. I appreciated that it could teach children rudimentary reading, writing and math lessons while tackling life’s complicated issues through lovable muppets. This week when, Elmo, one of Sesame Street’s most popular characters, tweeted a seemingly innocuous question, “How is everybody doing?” he got a litany of replies from thousands of adults who also grew up watching the show but are having a “rough time,” at best, learning difficult life lessons.  America’s most beloved red monster unleashed a tidal wave of responses that highlighted the concerning state of mental health in the U.S. and is teaching an important lesson in expanding health care.

Health care in America has historically been challenging to access and navigate. Skyrocketing costs and unreliable insurance coverage have made affordability one of the greatest barriers to healthcare. The Inflation Reduction Act, which has new provisions continuing to become effective over the coming years, and the Affordable Care Act, passed by Congress more than a decade ago, have helped millions of Americans access quality, affordable care. We still have more to do to unwind our complex health system. Additionally, many individuals busy with work and family responsibilities are unable to find the time to receive the care they need, and many more struggle to access care due to transportation issues.

Then there was COVID-19. The pandemic sparked a host of other health issues. We saw a rise in negative mental health and substance use and misuse. Americans were stressed, isolated, and feared for their wellbeing. Four years later, Americans haven’t fully recovered. While COVID came with significant health problems, it also proved how expanding telehealth can improve our health care system. 

My first experience with telehealth was eye-opening. A patient at the veterans’ affairs clinic in Pokomoke City on Maryland’s Eastern Shore received services through telehealth that he would have otherwise had to travel three hours to Baltimore to receive. I was surprised at how convenient it could be. Telehealth drastically eased many of the burdens to access, created a lower barrier of entry for treatment and allowed providers to reach patients they never could have before.

Expanding telehealth services was the best way to meet the demand for health care in the face of surging hospitalizations and health care worker shortages during the pandemic. Congress took actions to improve Medicare like waiving cost-sharing for telehealth services, allowing patients to receive care from providers across state lines, eliminating the originating site requirements and expanding telehealth across a swath of services like mental and behavioral health. Communities everywhere, particularly underserved and rural populations, saw notable improvements in access to care. But we still have a long way to go.

Parents have returned to work, but challenges related to transportation, paid leave, childcare, and broadband still exist. Additionally, persistent workforce shortages perpetuate huge gaps in access to behavioral health care. Over 75 percent of all counties in America are designated as Mental Health Professional Shortage Areas. In Maryland, these shortage areas include 16 of our 23 counties, with many other states facing similar if not worse conditions. Now, the telehealth provisions that helped expand access to mental health care are set to expire and threaten to exacerbate the nation’s mental health crisis.

Securing telehealth access has consistently been one of my top priorities. In 2022, I voted to help pass the bipartisan Safer Communities Act which included a provision to allocate funding to support school-based mental health service providers. Earlier this Congress, I held a hearing in the Senate Finance Health Care Subcommittee focused on making telehealth permanent in Medicare.  Last week, I joined my colleagues Senators Cassidy, Smith, and Thune in introducing the Telemental Health Care Access Act, which would remove the unnecessary barrier of the in-person requirements for Medicare coverage of mental health services provided through telehealth. Additionally, for a number of Congresses, I have been a co-lead of the CONNECT for Health Act, which would ensure permanent access to telehealth care for Medicare beneficiaries.

Telehealth played a significant role in supporting access to quality health care services for millions of patients during the COVID–19 public health emergency and continues to be essential. It makes access to behavioral health and other health care services more timely, convenient, less costly and should be a permanent fixture in our health care system.

Access to a complete network of care can help us get through life’s inevitable challenges whether they are physical or mental, at age six or 86. The work we continue to do to expand mental health and telehealth will ensure that the next time a furry, red monster does a mental health check on America, it may not always be “sunny days,” but all can be assured that they can access the professional help they need whenever they need it.

Thank you for your time. Please feel free to reply to this email with your thoughts on telehealth or any other issue that is on your mind. I appreciate all the feedback from constituents.


Ben Cardin