Ambulance plight requires state, federal fixes

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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The mayor of an Iron Range community has a stark warning for Minnesota lawmakers: The state's ambulance services are in need of emergency aid themselves to stem steep financial losses from assisting patients.

Calvin Saari has served as the mayor of Nashwauk, an Itasca County community with about 1,000 residents, since his 2018 election. One of his small city's biggest challenges is covering the shortfall between the cost of readiness — having ambulance and medical professionals ready to cover an area extending far beyond the city limits — and the inadequate reimbursement provided for this service, most notably by public medical programs.

For Medicare, which covers seniors, and medical assistance, which covers the needy, that deficit can run $1,000 or more per call in Nashwauk. Adding to the problem: There's no payment for calls that don't result in hospital transport. That leaves a city with an annual budget of $1.8 million "running $120,000-$130,000 in the hole every year," Saari told an editorial writer.

"You can't sustain that," he said, adding that "we can't wait any longer" for help. "It's critical we get quick action even if it's a temporary reprieve."

Unfortunately, too many Minnesota communities, many of them outside the metro area, are grappling with the same challenge, according to a Dec. 3 Star Tribune story. In 2022, ambulance services statewide billed insurers $1.2 billion but were paid about $450 million. Over 70% of ambulance services report financial losses, a disturbing reality requiring both short- and long-term remedies.

The breadth of the problem requires legislators to take a lead role on this, though Minnesota's congressional delegation also has a role to play. Many communities just don't have the financial bandwidth to continue subsidizing this service. Relying on volunteers, as many areas have done in the past, isn't realistic either, as populations age or shrink in many regions.

To their credit, Minnesota legislators have not ignored ambulance services' financial challenges. Some recent reforms are aimed at increasing interest in becoming a first responder and providing tuition assistance. But there's more work to do.

Short-term financial aid from the state, the policy equivalent of the emergency care that ambulance crews provide, is necessary while lawmakers consider systemic fixes.

Scrutiny of public medical programs' low reimbursement rates is clearly in order, though that would likely come with a daunting price tag. Another reform to consider: providing funding for ambulance calls that don't result in hospitalization. In Minnesota, emergency services providers "are not able to bill insurance for 28% of responses due to a patient not being transported," reports the emergency medical services regulatory board.

The state's congressional delegation also needs to act because Medicare, which primarily serves those 65 and up, is federally run and funded. Increasing reimbursement, or paying for service calls that don't result in hospitalization, would require changes in Washington. Minnesota Sen. Tina Smith has commendably joined forces with Sen. Bernie Sanders of Vermont on legislation that, if passed, would provide $500 million in emergency medical services grants across the nation. It would also require scrutiny of reimbursement gaps.

In an interview, Huot told an editorial writer that the task force must also consider broader oversight issues identified in a 2022 report from the legislative auditor. That's smart, as long as there's short-term aid while these reforms are under consideration. The Star Tribune Editorial Board also urges the task force to tap the expertise of the state's hospitals and insurers as solutions are explored.