chronic conditions (4.6 percent). Adults with public insurance coverage were also more likely to not want telehealth than adults with ESI (14.9 percent versus 7.0 percent). Figure 5. Share of Adults Ages 18 to 64 Who Avoided Seeing a Provider at Least Once since the Coronavirus Outbreak Began All adults Race/ethnicity White^ Black Hispanic/Latinx Other Health insurance coverage ESI^ Public Nongroup Uninsured Urban/rural residence Lives in MSA^ Does not live in MSA Health status Excellent/very good^ Good Fair/poor Chronic condition(s) None^ One Multiple URBAN INSTITUTE Source: Urban Institute Coronavirus Tracking Survey, wave 2. Notes: ESI is employer-sponsored insurance. MSA is metropolitan statistical area. “Other” is adults who are not Hispanic/Latinx, Black, or white and adults identifying as more than one race. Black and white adults are not Hispanic/Latinx. The survey was conducted September 11 through 28, 2020, and 91 percent of respondents completed the survey by September 17. */**/*** Estimates differ significantly from the reference group (^) at the 0.10/0.05/0.01 level, using two-tailed t-tests. 8 | Telehealth and Unmet Health Care Needs During the Pandemic Most commonly, adults who avoided seeing a provider because they did not want a telehealth visit did so because they needed care that could only be provided in person (45.9 percent). The next most common specified reasons were not being comfortable with using technology required for that type of visit (33.2 percent) and being concerned about privacy (13.4 percent). Table 2 presents a complete tabulation of respondents’ reasons for not wanting telehealth. Table 2. Reasons for Not Seeing a Provider Only Taking Telehealth Visits since the Coronavirus Outbreak Began among Adults Ages 18 to 64 Who Did Not Want a Telehealth Visit, September 2020 Reason Share of adults Needed test, treatment, or medication that could only be provided in person 45.9 Not comfortable with using technology for that type of visit 33.2 Other reason 13.7 Concerned about privacy 13.4 Did not have technology needed for this type of visit 11.3 Could not afford out-of-pocket costs 10.8 Visit would not be covered by insurance 6.2 Did not want to use too much data under cellular data plan 4.9 Source: Urban Institute Coronavirus Tracking Survey, wave 2. Notes: N = 342. When answering this question, respondents were asked to consider the most recent time they did not see a health care provider because the provider was only taking telehealth visits. Percentages total more than 100 because respondents were asked to select all responses that applied. The survey was conducted September 11 through 28, 2020, and 91 percent of respondents completed the survey by September 17. Discussion In September 2020, one-third of nonelderly adults reported having used telehealth since the coronavirus outbreak began, and the majority were satisfied with their experiences. Health status had the strongest association with telehealth use; adults in fair or poor health were the most likely to have used telehealth. Telehealth use was also more common among adults living in metropolitan areas than adults living in nonmetropolitan areas and among Black and Hispanic/Latinx adults than among white adults. Our findings suggest telehealth was generally accessible for adults during the first six months of the pandemic, consistent with other work documenting considerable increases in telehealth use over this period (Mehrotra et al. 2020; Patel et al. 2020; Ziedan, Simon, and Wing 2020). However, adults in fair or poor health, Hispanic/Latinx adults, and adults with public health insurance coverage were more likely to have wanted but not gotten a telehealth visit. And adults who wanted a telehealth visit but had not had one were more likely to have an unmet health care need than all other adults. People who did not use telehealth cited barriers such as long wait times, difficulty finding a telehealth provider, and lack of access to or comfort with using the required technology, suggesting more efforts are needed to ensure equitable access to telehealth. Many view telehealth as a low-cost alternative to in-person care. When the pandemic began, policymakers strongly incentivized its use to minimize exposure to the virus from inperson care. However, continued reliance on telehealth could exacerbate health inequities. Further, traditional fee-for-service payment methods present many challenges in telehealth, and persistently high rates of telehealth use, even as in-person care resumes, would likely lead to long-term increases in health care utilization and spending (Ashwood et al. 2017).3 Policymakers must carefully consider these trade-offs when drafting regulatory and payment policies for telehealth use after the pandemic. 9 | Telehealth and Unmet Health Care Needs During the Pandemic Notes 1 Robert Berenson and Adele Shartzer, “The Mismatch of Telehealth and Fee-for-Service Payment,” JAMA Health Forum, October 2, 2020, https://doi.org/10.1001/jamahealthforum.2020.1183. 2 June-Ho Kim, Eesha Desai, and Megan B. Cole, “How the Rapid Shift to Telemedicine Leaves Many Community Health Centers Behind during the COVID-19 Pandemic,” Health Affairs