The Telephone Consumer Protection Act (TCPA) was put into law in 1991. The first smartphone was launched by IBM the following year in 1992 known as the IBM Simon. Then Steve Jobs unveiled the iPhone in 2007.

Now in 2025, smartphones are ubiquitous, landlines more cut than connected, and texting is the way people communicate.

But for many patients, caregivers, health plan members, and health citizens, whichever persona we are in our individual health care journeys at a point in time, the TCPA remains a barrier for people in the U.S. trying to connect with their health care.

 

 

 

 

 

 

The initial intentions of TCPA were important consumer protections against telemarketing scams as one of the key benefits of the law. But over the years, some health plans and providers do not use texting due to concerns of regulatory and litigation risk stemming from the TCPA limitations set out over 30 years ago – such as prohibiting automated text messages without obtaining a beneficiary’s prior consent.

I connected with Abner Mason, Chief Strategy and Transformation Office with Ground Game Health, about this critical juncture leading up to the U.S. Senate’s 2025 Reconciliation legislation. A longtime advocate for addressing health equity and the social determinants of health, Abner has collaborated with stakeholder organizations to join the Medicaid Texting Coalition which Lisa Fitzpatrick, MD and CEO of Grapevine Health, one of the many collaborators, wrote about in Forbes.

The U.S. Senate’s reconciliation process includes Medicaid work requirements that would increase the need for States, Counties, Medicaid Managed Care Plans, and contracted vendors to effectively communicate with prospective, current, and former Medicaid members.

I wanted to know more about the Medicaid Texting Coalition through Abner’s eyes, and asked him a few questions to get these insights at this critical juncture for U.S. health citizens.

First, I asked Abner why texting is the “now” channel or on-ramp for health and, especially, among people enrolled in Medicaid?

He answered: “Texting is the way most Americans communicate today. Other modalities like US mail (called snail mail for a reason), phone calls (who answers calls anymore?), and email (likely to go without a response for days or weeks) are dramatically less effective. Because they earn lower incomes, many Medicaid recipients do not have a landline or a laptop. They rely on their mobile phone for all their communication, including healthcare related communication. Texting is their preferred, and often only way of communicating.”

 

 

 

 

 

 

 

 

 

I asked him to share a story or case study where texting made “the” difference for a health outcome or population health result. For context, here are some 2025 statistics from a recent Telnyx study into SMS messaging int he U.S. 

“As Founder and CEO for SameSky Health, I spent over a decade working with Medicaid Managed Care Plans to help them engage their members and navigate them into healthcare at the right time and the right place. Again and again, we found when we could navigate around the outdated restrictions TCPA placed on Medicaid plans, we got higher engagement which translated into more well child visits, more breast cancer screenings, more diabetes (a1c) screenings, and so on. Using modern tools of communication is a way of meeting people where they are. It builds trust and leads to better health outcomes. But sadly, because of TCPA, we were not able to text members in most instances,” Abner recounted, bolstering how trust can be re-built using the simple tech of texting.

So then what is the most important takeaway for Health Populi readers to act on?

Abner’s call-to-action: “The most important takeaway for readers goes beyond modernizing communication in Medicaid. Even more important is for each of us to know for sure that positive change is always possible. Even in a moment when things are changing in ways we don’t support, there is opportunity to make progress. In this moment, modernizing communication in Medicaid is the opportunity — so let’s not miss it,” he implores.

 

 

 

 

 

 

 

 

 

Health Populi’s Hot Points:  My first lightbulb-moment on texting for health was through the book of that title, Texting 4 Health, by B.J. Fogg, long known for his research and wisdom on behavior change in health care. When B.J. published that book in 2009, it was a revelation to me and put me on the path to understanding the crucial role of connectivity and eventually WiFi for health, well-being, and making a living.

We learned, viscerally, that without our ability to connect via mobile phones and platforms during the COVID-19 pandemic, that we couldn’t go to school, work from home, attend faith services, or read stories to our grandchildren – whatever persona we are in a moment, we will inevitably need to connect. Texting is the way millions of people communicate in life- and work-flows. Let’s make sure one way we continue to modernize American health care includes this mainstream form of communication as peoples’ on-ramp to health and well-being.