Alabama’s Rural Ambulance Support Bills Facing ALFA Opposition

ALFA and other insurers are opposing legislation working its way through the legislature that would purportedly help struggling rural ambulance services survive. The politically powerful insurance company alleges the bill would actually help big ambulance services in metropolitan areas rather that rural counties.

The Opposition

The company's March 13 Capitol Connection Newsletter makes two claims.

1. "Only $2 million of the $21 million this bill generates annually reaches rural Alabama. The communities this bill claims to save get a fraction of what the largest ambulance operators collect. The other 90-plus percent flows to big ambulance companies in cities and suburbs."
2. "KKR — the New York private equity firm that owns ambulance operations in Alabama — stands to collect roughly as much annually from this bill as every rural Alabama county put together."

The company says Alabama's EMS crisis is too serious and too complex to be solved by a single rate mandate. They support forming a Rural EMS Task Force to study the issue and suggest collecting revenue into a state-administered fund and distributing it as targeted grants to the small, rural, volunteer-dependent services.

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The Legislative Proposals

As passed by the senate, Greensboro Democratic Senator Bobby Singleton's, Senate Bill 269, would have five mandates:

• Set reimbursement rules for emergency ground ambulance services paid by health insurers
• End surprise billing for patients who call 911
• Limit what patients can be charged to their in-network cost-sharing amount
• Require ambulance providers and insurers to submit financial reports to the Alabama Department of Public Health
• Would be repealed on June 1, 2029.

Rural ambulance services are struggling to survive due to low reimbursement rates by health insurers and longer, more costly, response times resulting from the closure of many rural hospitals.

Singleton has defended the legislation as essential for keeping rural ambulance services operating, arguing that providers are "tired of arriving too late and people dying before we get there".

Pickens County is a prime example where they lost their ambulance service in the years after Pickens County Medical center closed. It took assistance from Lamar County, the Alabama Fire College in Tuscaloosa and area state lawmakers to return service. A bill by Rep. Ron Bolton (R-61) would add a surcharge to car tags in the county to help retain the service.

House Bill 400 is a companion bill to Singlton's senate legislation. It would accomplish much of what Singlton's bill is intended to do. Rep. Bolton has been working with other rural lawmakers on the bill for the last couple of years. He says it will help sustain ambulance service, specifically those that operate in rural areas.

"This bill when passed will increase insurance reimbursements to ambulance operations to help sustain their operations and pay paramedics and other staff," Bolton stated in response to a recent query by Tuscaloosa Thread.

Two Differing Solutions

ALFA disagrees with Bolton and Singleton and is encouraging policyholders to tell their legislative representatives to vote "no", "We didn't oppose this bill because we don't care about rural EMS. We opposed it because we do — and because a bill that raises premiums on farm families while sending nearly $4 million to a Huntsville hospital conglomerate and millions more to a company owned by New York private equity group is not rural EMS relief."

The company says Alabama's EMS crisis is too serious and too complex to be solved by a single rate mandate. They support forming a Rural EMS Task Force to study the issue and suggest collecting revenue into a state-administered fund and distributing it as targeted grants to the small, rural, volunteer-dependent services.

The Alabama Association of Ambulance Services, on their Facebook page, prompts public support for the proposed legislation and questions ALFA's opposition while praising Blue Cross Blue Shield of Alabama for not opposing it. They included a video from NBC News that they say depicts the problem. The post states if the legislation is not signed into law by Gov. Ivey, rural communities will continue to face longer response times, ambulance shortages, and reduced access to emergency care and people will die.