the telecommunications industry (Andrews, 1996). Among other changes, it allows long-distance telephone companies, cable companies, and other firms to compete with local phone companies, and local phone companies can, under some conditions, compete in the long-distance markets. Most rates for cable television will be deregulated within a period of three years.

Of greatest immediate relevance for telemedicine are provisions of the legislation directed specifically at assuring universal communications services at affordable rates for rural, high-cost, or low-in-come areas. One provision (Section 101 of the bill) states that "a telecommunications carrier shall … provide telecommunications services which are necessary for the provision of health care services in a State, including instruction relating to such services, to any public or nonprofit health care provider that serves persons who reside in rural areas" at rates comparable to those charged in urban areas. Telecommunications providers in rural areas are to be compensated through a fund designed to promote universal access to modern telecommunications services. This provision will be interpreted by regulations developed by the Federal Communications Commission. Other more general provisions of this major legislation may have quite significant implications for telemedicine, but their effects are difficult to predict very precisely at this early point.

Congressional interest in telemedicine is reflected in Senate/House Ad Hoc Steering Committee on Telemedicine, which sponsors brown bag lunches and other events for members and staff interested in telemedicine. The group cosponsored a 1994 conference to develop a consensus agenda for telemedicine and health informatics (Bashshur et al., 1994).

During the 103rd Congress, at least 22 pieces of legislation specifically related to telemedicine were introduced (Telemedicine Monitor, 1995). Most explicitly or implicitly supported telemedicine in one way or another. In the first 15 months of the 104th Congress, telemedicine figured in at least 15 pieces of proposed legislation (Arent Fox, 1996). These proposals would, among other things, fund additional pilot projects, establish a commission on telemedicine, and include some telemedicine applications in health insurance reforms. Despite such positive signs, telemedicine was still targeted for a share of budget cuts as part of House and Senate proposals to eliminate the federal deficit.



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