The roadway from western North Carolina to northeastern Georgia remains bleak at five in the morning. One of my long-standing patients grasps the steering wheel, driving for two hours just for a brief 15-minute consultation with the doctor she relies on. She could have connected with me via video from her kitchen, but regulations prevent it. Once she crosses that state boundary, I lose the authority to care for her. That’s not healthcare. That’s insanity. We encourage patients to leverage technology, maintain involvement, and seek early medical attention. Yet, when they do, our regulations convert that effort into a risk. This isn’t merely an issue of paperwork. It’s a nationwide access emergency concealed beneath archaic bureaucracy. Millions of Americans live near state lines or commute for work, education, or caregiving. They are entitled to consistent care, irrespective of their location. Instead, our health care infrastructure is bound together by red tape rather than connections.

Many individuals believe that if a doctor holds a license in the U.S., it is a national license. This is not the case. Each of the 50-plus state medical boards governs its own entrance. To operate across borders, a doctor must pay numerous fees, undergo identical background checks repeatedly, and submit applications to every state where a patient might be during a telehealth consultation. The Interstate Medical Licensure Compact was created to simplify this procedure, but it hasn’t achieved that. It remains multiple applications, distinct fees, and individual approvals; bureaucracy posing as advancement. Then there are additional layers. Medicare specifies the location a patient must occupy for coverage eligibility. The DEA links prescribing rights to a physician’s registered address. Private insurers require independent credentialing in every state. State insurance regulators establish their own telehealth guidelines. No singular organization oversees the framework. It is a labyrinth that drains time, resources, and morale. It safeguards interests, not patients.

And just as progress seemed attainable, we reverted. The withdrawal of federal telehealth coverage and pandemic-era flexibilities marks one of the most myopic choices in contemporary health policy. Throughout COVID, we demonstrated that cross-border telemedicine operates safely, effectively, and efficiently. Patients received timely treatment, chronic conditions remained stable, and access expanded. Now, with those flexibilities eliminated, we have reverted to an outdated model that penalizes innovation and convenience. Medicine must adapt with the times or risk obsolescence. Technology has already advanced significantly. The law must keep pace. A doctor trusted to prescribe, diagnose, and treat should not become unqualified the instant a patient traverses an invisible boundary. Each physician already passes the same national examinations, completes accredited training, upholds federal DEA registration, and is monitored through the National Practitioner Data Bank. For physicians in border regions, this obstacle defies reason. These doctors treat cross-state patients daily and should never hesitate about whether assisting them is legally acceptable. We have established a licensing framework for a reality that no longer exists. It was devised a century ago when medical practice was local. Today, technology, mobility, and telehealth have erased these divisions. The law simply hasn’t caught up.

The cost of inaction is staggering. Delayed appointments result in missed diagnoses and avoidable hospital admissions. Rural and frontier areas lose access to care that could be delivered easily through virtual means. Physicians waste months awaiting redundant approvals or completely abandon cross-state practice. Patients are stranded without the physicians who understand them best. Taxpayers suffer as well. Billions are squandered on sustaining overlapping licensing and credentialing systems. Congress invests in telehealth expansion while antiquated laws obstruct its implementation. One hand of government fosters innovation while the other tightens restrictions.

Then there are the unforeseen disruptions, such as government shutdowns that halt progress at a moment’s notice. When the clock strikes midnight, the darkness doesn’t just envelop Washington. It dims in clinics, hospitals, and telehealth platforms nationwide. Approvals stagnate. Reimbursements halt. Startups and hospital networks that poured millions into secure telehealth infrastructure are left in uncertainty. Behind every suspended program is a team that believed they were creating something enduring. Behind them are the patients who relied on it: the elderly man whose remote monitoring data stopped functioning because a CMS server is offline, the rural mother unable to contact her specialist due to lapsed coverage, and the veteran whose mental health app is in limbo awaiting renewal. A shutdown doesn’t merely interrupt care; it fractures it. It reveals a painful reality: much of American healthcare depends on choices made by individuals who will never meet the affected patients. We cannot build a contemporary system on unstable political foundations.

Indeed, licensing has historically been a state function. However, this dilemma has surpassed the states, and the framework governing it is too delicate to withstand continuous resets. Congress must establish continuity. It can instruct CMS to permit any physician licensed and in good standing in one state to offer telemedicine services to Medicare and Medicaid beneficiaries nationwide. It can act under the Commerce Clause to create a national telehealth license,