Black, Latino and Asian adults are more likely than their white counterparts to use audio telehealth services rather than video, according to new federal data released Wednesday.

Telehealth usage was similar across demographic groups, but white people, young adults, people earning at least $100,000 and the privately insured were most likely to use video services, according to national survey data analyzed by the Health and Human Services Department. People of color, people with lower incomes, adults without a high school degree and seniors skewed toward using audio-only services.

The analysis, which is based on a Census Bureau survey of 675,000 adults between April and October 2021, underscores the equity concerns providers, plans and advocates have raised as Congress debates the next steps on telehealth expansion.

“Investments in internet access, video-enabled devices and culturally competent care are needed to ensure equitable use of telehealth services,” HHS’ report said.

The survey found 54% of Black respondents who had a recent telehealth visit used video, compared to 62% of white respondents and 51% of Latino and Asian people surveyed.

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The analysis’ authors noted that video visits can require better internet and more equipment than audio appointments. Patients with lower-incomes might favor audio-only visits because they lack privacy at home or are at work during appointments.

Medicare vastly increased its coverage of telehealth services during the pandemic, but that can only last through the COVID-19 public health emergency. Before the pandemic, Medicare only covered telehealth services for beneficiaries receiving them from a healthcare facility in rural areas, which comprised less than 1% of total Medicare-paid visits.

Congress is considering permanently waiving those restrictions and others that limit coverage of audio-only telehealth, citing inequities in internet access, especially in rural areas and among people of color.

President Joe Biden signed a $1 trillion infrastructure bill late last year that includes $65 billion for improving broadband access in rural areas but those projects could take several years to complete.

Census data estimates that more than 13% of US households do not have internet, largely among those that make less than $75,000 annually. Research from the Pew Research Center says that 97% of adults in the US have a cell phone, but video access varies by income and demographic. Broken down by race, 15% of Black people reported not having a smartphone, compared to 11% of people who are white.

A study published last year in the Journal of the American Board of Family Medicine said the current telehealth reimbursement rules might exacerbate health disparities further by excluding people without internet access or those with a disability.

Telehealth has improved healthcare access for non-English speakers or patients without reliable transportation, according to Jennifer Stoll, executive vice president of external affairs at health IT nonprofit OCHIN, which serves predominantly Medicaid and uninsured patients.

“It’s not an issue of funding anymore, it’s an issue of implementation and execution,” Stoll said. “How does the money move from the federal government down through the states to be deployed in a thoughtful way to reach the last mile, or underserved urban areas? We’ve got to get that money from DC into the community to connect the care. If we don’t, it just feels like a big waste.”