The Federal Communications Commission voted to repeal net neutrality on Thursday, a move, its Chairman Ajit Pai said, that will allow internet providers to speed up services for some websites and apps -- and block or slow down others.

Net neutrality has been one of the biggest topics of conversation since Pai announced his plan to rollback the Obama-era regulation. The repeal has been Pai's goal throughout his 11-month tenure, despite the overwhelming majority of the population who believes net neutrality is good for the country. 

If you lean only on Pai’s comments, it would appear that “Restoring Internet Freedom” is a relatively helpful move to fuel competition and spur infrastructure development. In recent comments, Pai even claimed a repeal of net neutrality -- and the current ban on paid fast lanes -- will boost telehealth.

“By ending the outright ban on paid prioritization, we hope to make it easier for consumers to benefit from services that need prioritization, such as latency-sensitive telemedicine," Pai said during a speech on Nov. 30. "By replacing an outright ban with a robust transparency requirement and FTC-led consumer protection, we will enable these services to come into being and help seniors.”

If true, a repeal of these regulations might actually help an industry reliant upon technological innovations and services to provide telehealth to rural and outlier populations. However, current policies allow providers to create telemedicine fast lanes. Further, the current 400-page document states telemedicine services could be structured in a way that it could fall out of the open internet rules.

Some healthcare professionals, like the American Academy of Pediatrics, have already argued in favor of a ban on paid fast lanes, as it may let providers charge higher fees for services.

“The general public, including parents and caregivers of children, use web-based platforms to access children’s medical records, make appointments and find health information,” AAP wrote. “Having slower access to these tools could potentially result in delays in care and seeking information, and place an undue burden on ready access to quality healthcare and health information.”

And the National Journal described another potential future if the net neutrality repeal is passed: The internet could become a “dystopia run by the world’s biggest, richest companies.”

If these concerns are accurate, a repeal of net neutrality may have some undesired consequences.

A researcher’s verdict

“It’s hard to say exactly what will happen. If you listen to ISPs they claim it won’t hurt customers. If you listen to content providers, they say it will,” said Mark Gaynor, Associate Professor of Health Management at Saint Louis University.

For telemedicine, this could have big repercussions. Gaynor said that many are worried about certain traffic slowing down, whether it is a medical provider or network -- especially if a clinician needs an image from another location and is relying on telemedicine to get the information it needs. Consider that scenario in a trauma or emergency care setting. 

Pai’s comments that repealing net neutrality would be good for telemedicine are a bit of a stretch, explained Gaynor. But what he’s probably getting at is the prioritization of traffic. At the moment, ISPs aren’t really allowed to prioritize.

“You can probably find individual cases where it would enhance some vendors or some patients,” Gaynor said. “But overall it will not and will certainly not allow the innovation we need, as the little guys won’t be able to compete with the big players because they won’t be able to afford the better service.”

For one, the FCC is trying to move regulation from its agency to the FDA, Gaynor explained. 
The FDA doesn’t have the same clout as the FCC, which means the agency wouldn’t be able to come in to stop an issue until after an ISP has done something wrong -- whereas the FCC can regulate ISPs slowing down traffic.

“They’re going to have to pay for speed. And we know that cost will be passed to the patient,” Gaynor said. “The FCC is trying to deregulate too heavily. It seems like a general trend for this current administration. Maybe things were too heavy-handed and they want to go in the opposite direction.”

Gaynor added that one could argue the FCC is trying to put ISPs in the same category with phone companies. 

“It gave them powers to regulate,” he added. “The FCC argued they weren’t going to force them to set rates. Who do you believe more? Do you believe the FCC … or do you believe ISPs that they won’t interrupt services?”

From the view of an ISP

Mimosa Networks Founder and Chief Product Officer Jaime Fink said what was likely on the mind of many ISP executives in suggesting that less regulation is better. 

“Broadly speaking, it’s difficult to say whether net neutrality will have an impact on the healthcare sector,” Fink said. “Either side of the argument about net neutrality has been lop-sided: one side says it’s the end of the world, the other side says it’s fine. However, I can see two factors in the broadband market that are affecting telemedicine today: a lack of competition in the marketplace and the ability to stimulate new telco infrastructure.”

From an ISP perspective, Fink said the move could help with the under-connected rural areas who need to get low-cost services and the urban areas that need faster connectivity. The idea is spectrum policies, which won’t be solved today. But traditional approaches have left a gap in suburban and urban markets.

“New providers will require infrastructure, as well as access to the cell companies,” said Fink. “That’s the big issue -- it’s the first time we’ve seen mobile and ISP in the same realm -- that tech is fundamentally changing.”

There are two different effects: strength in investment into the rural areas and competition in the suburban and urban markets.

“We’re going to get a lot of strength in investment into the rural areas... Net neutrality isn’t what stimulates the markets,” said Fink. “You have to assume they’re not just doing it for fun. Largely this will entirely depend on whether there is practical availability of spectrum.”

"In urban and suburban markets, there will be little impact of net neutrality one way or the other, as the regulations do not stimulate competition," he added. There are a lot of other policy decisions that stimulate deployment of infrastructure."

Fink explained that wireless tech will be crucial in those markets, especially in low income areas. The belief is that in competition in wireless markets “to get speed in underserved areas will be the practical reality.”

“Competition just has to keep things in check,” Fink said. 

In other words: The U.S. is going to need a system in place to hold ISPs accountable for fair pricing. 

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com