Protect air ambulance services that fill the health care access gap in rural America
© Greg Nash

As the Senate examines the status of rural health care in America, with a focus on what’s becoming a crisis in this country – rural hospital closures - access to quality and affordable health care is at risk in rural communities. So it is appropriate that the Senate is taking steps to address it.

An important facet to this issue is the role air medical service providers play in ensuring these communities can access the quality care they deserve. Unfortunately, proposals in Congress are threatening access to these vital services. Sen. Claire McCaskillClaire Conner McCaskillTrump rallies in Nevada amid Supreme Court flurry: 'We're gonna get Brett' Trump boosts Heller, hammers 'Wacky Jacky' opponent in Nevada Google says senators' Gmail accounts targeted by foreign hackers MORE (D-Mo.) has proposed legislation that, while well-intentioned to address patient costs, would impede access to life-saving air emergency medical transportation and do absolutely nothing to lower costs for patients. This would have a devastating effect on health outcomes across the country. The good news is there’s a better way for Congress to preserve these emergency air medical services, while also reducing patient bills -- the Ensuring Access to Air Ambulance Services Act (H.R. 3378/S. 2121).


Imagine that you and your loved ones are hiking through the Appalachian trail in North Carolina, sitting by the fire at your family farm in Iowa or working on your ranch in Montana. Suddenly, you start to notice you’re having trouble speaking, your arm feels a bit weak, and one side of your face is drooping – you are having a stroke.

In times of medical emergencies like this, where minutes can mean the difference between life or death, it’s critical to access the right kind of care as quickly and as safely as possible. If you’re living in one of the country’s major cities, you’re probably surrounded by hospitals with trauma and critical care centers. But if you’re one of the 85 million Americans who live in our nation’s rural communities, you might not be so lucky. Since 2010, more than 80 rural hospitals have closed, according to the University of North Carolina Center for Health Services. The National Rural Health Association, a non-profit that advocates for rural issues, estimates that there are as many as 700 additional rural hospitals at risk of closing in the next 10 years.

As hospitals continue closing their doors or limiting certain services, rural communities will be farther and farther away from critical care facilities. Air ambulances fill the gap caused by these closures, transporting those in need to the nearest and most appropriate health facilities. It’s a critical emergency service for those Americans – almost one in four – that live more than an hour away from an emergency room by ground ambulance. Scarily enough, the American Stroke Association lists not arriving at a hospital in time as the key reason people miss brain-saving treatment and have a much poorer chance of recovery.

Unfortunately, air medical services are severely under-reimbursed by Medicaid and Medicare, and these patients, as well as those with no insurance at all, make up 70 percent of air transports. The Centers for Medicare and Medicaid Services (CMS) hasn’t evaluated what it pays for air medical transport in nearly 20 years, and increasingly, private insurers base their rates on a percentage of what Medicare pays. This often leaves patients stuck with bills for transports that were critical in saving their lives.

McCaskill’s proposed legislation threatens to make access to these services even worse.

While intended to protect patients from large bills for air medical services, McCaskill has introduced legislation, similar to the language found in Section 412(h) of the Federal Aviation Administration Reauthorization Act of 2018 in the House, which would allow each state to regulate air medical services themselves, instituting a maze of regulations that would create “borders in the sky.” So, if you’re having a stroke in Virginia, and the closest and best hospital to treat you is in Washington, D.C., the air medical provider might be forced to take you to a hospital further away in Virginia due to differing state laws or requirements.

Nationally, more than 30 percent of air ambulance transports cross state lines every day –for some states, like Missouri for instance, almost 50 percent of air ambulance transports are interstate. McCaskill’s legislation would make it even more difficult for those living in rural communities to receive the health care they need– and does nothing to actually address their medical bills.

There is a better way for Congress to address the issue of consumer bills for these life-saving services. The Ensuring Access to Air Ambulance Services Act (S. 2121/H.R. 3378), introduced by a bipartisan group of lawmakers in both the House and Senate, would require CMS to develop an accurate payment system based on the actual costs of providing air medical care, establish a mandatory quality reporting program, and improve transparency of costs among providers, patients, and insurers. It does all this, while making sure all communities can still access this critical service.

An emergency can happen at any time, to any person, anywhere. Your health care outcome should not be determined by your zip code. The answer lies in Congress fixing the insurance reimbursement – not by instituting state regulation of air ambulances.

Richard Sherlock is President and CEO Association of Air Medical Services