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Of all the things government should and could fund, we would argue that emergency medical service should be at the top of the list.

Sadly, it is not.

An in-depth report in last Sunday's Mankato Free Press showed small-town and rural emergency medical services are suffering from a compound illness: lack of funding paired with lack of personnel. And of course, rural residents who need the service suffer most.

EMS has typically been funded by the fees charged for each call, but Medicare and Medicaid reimbursement rates have not kept up with the increased costs of providing the service and the increased number of people lacking insurance coverage.

EMS services statewide lost $66 million last year. The city of Lake Crystal funds up to 50% of operational costs for its local ambulance crew. Other cities, such as St. James, serve outside areas with uncertainty about getting paid. Lake Crystal doesn't have enough staff for nights and weekends, and must rely on Madelia or Mayo Clinic ambulance services.

St. James City Manager Amanda Glass says the city's ambulance service faces tough decisions. One is closing the service, which, she says would only put the burden on other ambulance services. Burdening local taxpayers would not be sustainable either.

Officials from the League of Minnesota Cities plan to lobby the Legislature for stopgap funding to fill the losses and then create some type of permanent funding. That makes sense to us. The state provided $300 million last year to nursing homes to stop some from closing. The justification for that funding should apply to EMS also.

The permanent funding mechanism needs change, and such change needs to come from state and local governments. The federal government is unlikely to boost Medicare and Medicaid reimbursement rates.

One key to getting state funding would be to define EMS as a "public service" for purposes of state law. While police and fire services are considered "public service," EMS is not, according to Rep. Jeff Brand, DFL-St. Peter. One could argue that EMS is a fee service paid by various medical insurers, but the gaps are growing for that fee service to cover everything EMS does. It seems incongruous that public safety funding would not include emergency medical treatment.

The cities and counties should participate in this funding mix. Last year's legislative session sent significant increases in local government and county aid their way.

Rural EMS appears to be on life support. The $66 million in emergency funding should be the minimum, and some form of permanent funding or cost sharing should be established. Emergency medical care is more than a function of taxing and spending or economics. It's a matter of life and death.