Abstract
As the rapid advancement of digital health technology has solidified telehealth as an essential component of modern medicine, its regulatory framework remains attached to a pre-digital patchwork of state requirements. While this fragmented licensing mechanism has been subject to significant criticism from industry advocacy groups and professional medical organizations, the role of jurisprudence in allowing this framework to persist remains obscured. This article examines how telehealth’s existing regulatory system imposes significant burdens on providers and makes patients’ access to specialty care increasingly dependent on ZIP code. Its analysis of the formalist and textualist reasoning in MacDonald v. Sabando (2025) reveals how courts, to uphold state police powers, use fig-leaf legitimacy to allow restrictive state regulations to evade scrutiny under the Dormant Commerce Clause. To reduce telehealth regulations’ existing burdens and equities, this article outlines a two-part solution: the adoption of functionalist jurisprudence in future telehealth cases that continues to balance state police powers while accounting for telehealth’s modern and dynamic realities, and a shift towards driver’s license-style reciprocity for medical licenses that state medical boards could enforce.
