JAMA Health Forum Study Finds 11.9 Million Americans in Broadband Deserts That Cannot Support Telehealth

Telehealth is often described as a way to close gaps in rural and underserved care, but a new peer reviewed study puts a number on how many Americans cannot use it because their internet is too slow. Writing in JAMA Health Forum on September 18, 2026, researchers from the University of Southern Maine and the University of Vermont estimate that 11.9 million people live in what they call broadband deserts, populated areas where connection speeds sit below the level regulators consider adequate for a reliable virtual visit.

What the study measured

The paper, titled 'Geographic Disparities in Access to Broadband, Ambulance Services, and Health Care and Implications for Telehealth,' is a population based cross-sectional study. The authors combined the Federal Communications Commission's 2024 Broadband Data Collection, the 2020 US Census, ambulance location data collected between September 2021 and February 2022, and American Community Survey estimates for 2019 through 2023. They defined a broadband desert as a populated census block that cannot support telehealth because available speeds fall below 100 Mbps download and 20 Mbps upload, the current FCC benchmark for high speed fixed broadband.

How many people live in broadband deserts

Across the 41 states in the analysis, home to 249.1 million people, the study estimated that 11.9 million residents (4.8 percent) live in broadband deserts. The burden falls heavily on rural communities:

• 10.5 million of the affected residents, or 88.1 percent, live in rural areas.
• By region, the South had the largest count at about 6.5 million, followed by the Midwest at 3.0 million, the West at 1.4 million, and the Northeast at roughly 393,000.
• Measured as a share of each region's population, the West was highest at 6.9 percent and the Northeast lowest at 1.3 percent.

When broadband, ambulances, and clinics all fall short

The study is unusual in layering three kinds of access gaps: broadband deserts, ambulance deserts, and health care deserts. About 649,000 rural residents sat inside all three at once, with the West carrying the highest overlap. Those communities have neither a fast enough connection for a virtual visit nor easy physical access to emergency transport or in person care. The authors also identified about 946,000 rural residents who lacked nearby ambulance service and local health care but did have sufficient broadband, a group for whom telehealth could plausibly help close a gap today.

Access is more than a connection

Even where fast internet exists, using it for care is not automatic. The study reported that 91.7 percent of households overall had both a computing device and a broadband subscription, but the rural rate was 88.5 percent against 92.6 percent in urban areas, a gap of 4.1 percentage points. Twenty states had rural household broadband subscription rates below 90 percent. The researchers wrote that broadband availability is a prerequisite for telehealth but does not by itself guarantee that people use it, pointing to affordability, digital literacy, device quality, and the availability of telehealth services as additional barriers.

The FCC benchmark behind the numbers

The 100/20 Mbps line the study uses is not arbitrary. On March 14, 2024, the FCC raised its benchmark for high speed fixed broadband to 100 Mbps download and 20 Mbps upload, a fourfold increase from the 25/3 Mbps standard set in 2015. The same report set a longer term goal of 1 Gbps download paired with 500 Mbps upload. Because the new threshold is higher, more areas now count as underserved than they did under the older definition, which shapes how large the estimated broadband desert population appears.

What this means

The authors conclude that broadband remains a critical determinant of health care access and that telehealth's potential to fill gaps in primary, specialty, and emergency care is constrained by infrastructure and subscription rates. They argue that federal and state initiatives, including targeted infrastructure investment and expanded reimbursement policies, are needed for telehealth to reach the people who stand to gain most, and that regions where broadband, ambulance, and health care deserts overlap should be a priority. The findings land alongside separate state and federal spending on rural connectivity, such as Mississippi's rural health grants, and ongoing FCC proceedings on telehealth in rural America.

Limits of the analysis

The estimates come with caveats the authors state directly. The model assumed that population is spread evenly across broadband serviceable locations, which may not hold in practice. It classified a block group as rural using a 50 percent or greater cutoff, which can blur mixed areas. American Community Survey estimates carry large margins of error for small populations, and the Census Bureau's privacy protections add statistical noise in sparsely populated places. The analysis also covers 41 states, leaving out 9 that lacked usable ambulance location data, so the national picture is incomplete. This article is general information about a research study and is not medical or legal advice; people with questions about their own care should consult a licensed clinician.