Community Engagement in the Digital Age

The Affordable Connectivity Program (ACP) ends today, potentially leaving 1 in 6 (23 million) American households without access to high-speed internet. The program was born from the Infrastructure Investment and Jobs Act that was passed in 2021. This milestone legislation dedicated $1.2 trillion to the improvement of public utilities, transit networks, and energy systems in the United States. From that fund, $14.2 billion was dedicated to helping low-income households access high-speed internet. Consequently, households with annual earnings below 200% of the Federal Poverty Guideline were eligible for a $30 monthly credit towards their internet bill. For American Indians and Alaska Natives residing on Tribal lands, that amount was up to $75. The program also allowed households to qualify for a one-time discount of up to $100 towards the purchase of a laptop, desktop computer, or tablet from approved vendors, provided they contribute between $10 and $50 towards the cost of the device.

According to the White House, the ACP provides its beneficiaries monthly cost savings of over $500 million on internet bills. As a result, on Oct. 25, 2023, the Biden-Harris Administration sent the US Congress a supplemental request for $6 billion to extend program funding through December 2024. This attempt was unsuccessful and although White House press secretary Karine Jean-Pierre recently emphasized the current administration’s hope of persuading large telecommunication corporations to continue honoring the ACP, millions of Americans will likely lose their internet access as a result.  

The Digital Divide

A recent survey by the Federal Communications Commission revealed that 68% of American households had inconsistent or 0 internet connectivity prior the ACP—with 80% citing cost as the reason why. As funding for the ACP comes to end, these figures suggest that the digital divide (unequal access to modern telecommunications technology among different demographic groups and regions) will continue to widen. That is a concern for patients with cancer as the oncology landscape has seen an increase in the use of telemedicine.  

“We have helped 186 patients receive home internet through the ACP,” said Francesca Gany, MD, MS, chief of Immigrant Health and Cancer Disparities Services for Memorial Sloan Kettering Cancer Center (MSK), while delivering a keynote address at a National Comprehensive Cancer Network Patient Advocacy Summit last December. By leveraging the ACP, Dr. Gany and her team at MSK implemented an initiative that reported a 99% patient satisfaction rate after 6 months.

Tomorrow, many of those patients at MSK and others like them who benefit from the ACP may lose their internet access. This change will cause some patients to lose access to online resources such as the Association of Cancer Care Centers (ACCC) Patient Assistance & Reimbursement Guide. Others will lose access to platforms that provide a sense of community and hope like the one Let’s Win Pancreatic Cancer offers. While more may be disconnected from their patient navigators, which will likely negatively impact their treatment journey.  

“Internet services often form a critical component of cancer care, enabling patients with cancer to receive certain services through telehealth and connecting them with key members of their cancer care team,” said Nicole Tapay, JD, director, Cancer Care Delivery and Health Policy at ACCC. “This is especially true for those who live in more remote locations or face transportation or other barriers to reaching providers in-person. The expiration of the ACP represents a backwards step in the progress to reduce disparities in access to care for all patients with cancer.”

Reimagining Community Engagement

In a world without the ACP, cancer programs and practices must find new ways to ensure patients are engaged in their communities. Understanding the importance of this, ACCC President Nadine J. Barrett, PhD, MA, MS, senior associate dean for Community Engagement and Equity in Research at the Wake Forest University School of Medicine and Atrium Health, centered her President’s Theme on Reimagining Community Engagement and Equity in Cancer. “The community plays a critical part in cancer care across the spectrum—from education and screening to survivorship,” she said. “Let us find what innovative programs can be developed or enhanced to improve access to care within the context of our cancer centers, no matter how small or large.”