Flawed federal programs maroon rural Americans in telehealth blackouts

David and Billi Belcher’s double-wide modular home sits near the top of the ridge past Adkins’ home. Inside, an old hunting dog sleeps on the floor. Belcher pointed out a window toward where he said Frontier’s cable has remained unrepaired for years: “It’s laying on the ground in the woods,” he said.

Frontier is West Virginia’s legacy carrier, controlling most of the state’s old landlines since buying them from Verizon Communications in 2010. Twelve years later, the company won nearly $248 million to install high-speed internet to West Virginia through the Rural Digital Opportunity Fund, an initiative launched during President Donald Trump’s first term.

“Big Daddy,” as local transit driver Bruce Perry called Trump, is popular with the people of Lincoln County. About 80% of the county’s voters picked the Republican in the last election.

The Trump administration awarded Frontier money to build high-speed internet to Upper Mud River Road residents, like Adkins, according to state mapping. Frontier has until Dec. 31, 2028, to build.

But the Belchers needed better internet access for work and could afford to pay $700 for a Starlink satellite internet kit and insurance, they said. Their monthly Starlink bill is $120 — a price many cannot manage, especially since Congress sunset an earlier program that helped offset the cost of high-speed plans for consumers.

Meanwhile, the latest broadband program to connect rural Americans is ensnared in Trump administration policy shifts.

The National Telecommunications and Information Administration, which administers the program, in April announced a 90-day extension for states to finalize their plans during a “comprehensive review” of the program.

West Viriginia Gov. Patrick Morrisey, a Republican, announced his state would take an extension. The move, though, doesn’t make a lot of sense, said Evan Feinman, who left the agency in March after directing the broadband program for the past three years.

Calling the work already done in West Virginia an “incredible triumph,” Feinman said the state had completed the planning, mapping, and the initial selection of companies. The plan that was in place would have brought high-speed fiber lines to homes ahead of schedule and under budget, he said.

“They could be building today, and it’s just deeply disappointing that they’re not,” Feinman said.

When Feinman resigned in March, he sent a lengthy email stating that the new administration wants to take fiber away from homes and businesses and substitute it with satellite connections. The move, he said, would be more expensive for consumers and hurt rural and small-town America.

Morrisey, whose office declined to respond to requests for comment, said in his announcement that he wants to ensure West Virginia spends the money in a manner “consistent with program changes being proposed by the Trump Administration” and “evaluate a broader range of technology options.”

Commissioners from Grant County responded with a letter supporting fiber-optic cables rather than satellite-based connections like those provided by Elon Musk’s Starlink. Nationwide, 115 lawmakers from 28 states sent a letter to federal leaders stating that changes could “delay broadband deployment by a year or more.”

For Adkins and others, the wait has been long enough.

While legislators in Washington and across the country bickered over the broadband program, Adkins went without phone and internet. By late March, she said, her 42-year-old son was increasingly worried, noting “you’re getting up in age.” He told her: “Mom, move out, get off of that hill.”

Worst-Case Scenario

A few miles from Upper Mud River Road, past the McDonald’s and across the road from the local library, Brian Vance sat in his downtown Hamlin, West Virginia, office. He said his company has been trying to “build up there for a while.”

Vance is a general manager for Armstrong Telephone and Cable, a regional telecommunications provider that competes with Frontier. He grew up in the community, and parents of a high school friend live off Upper Mud River. But he said “it’s very difficult” to build fiber along the rocky terrain to homes where “you are hoping that people will hook up, and if they don’t, well, you’ve lost a lot of money.”

A 2022 countywide broadband assessment found that stringing fiber-optic lines along telephone poles would cost more than $5,000 per connection in some areas — work that would need big federal subsidies to be feasible.

Yet Vance said Armstrong cannot apply for the latest BEAD funding to help finance connections. And while he likes that the federal government is “being responsible” by not handing out two federal grants for the same area, Vance said, “we want to see people deliver on the grants they have.”

If Frontier hadn’t already gotten federal funds from the earlier Trump program, “we definitely would have applied to that area,” Vance said.

The 2022 assessment noted the community’s economy would not be sustainable without “ubiquitous broadband.”

High-speed internet brings more jobs and less poverty, said Claudia Persico, an associate professor at American University. Persico, who is also a research associate with the National Bureau of Economic Research, co-authored a recent paper that found increased broadband internet leads to a reduction in the number of suicides as well as improvements in self-reported mental and physical health.

More than 30% of Lincoln County’s population reports cases of depression, according to data from the Centers for Disease Control and Prevention. The rate of opioid prescriptions dispensed in Lincoln County is down about 60% from 2014 to 2024 — but still higher than the state average, according to the West Virginia Board of Pharmacy.

Twenty percent of the county’s population lives below the poverty line, and residents are also more likely than the national average to experience heart disease, diabetes, and obesity.

Lincoln Primary Care Center offers telehealth services such as electronic medical records on a patient portal and a pharmacy app, said Jill Adkins, chief quality and risk officer at Southern West Virginia Health System, which operates the clinic.

But because of limited access, only about 7% of patients use telehealth, she said.

Della Vance was a patient at the clinic but said she has never used a patient portal. If she could, Vance said, she would check records on the baby she is expecting.

“You can’t really get on if you don’t have good service and no internet,” she said. “It makes me angry, honestly.”