The future of ambulance care in the U.S. and what it means for your community
By Meg Cunningham, Kansas-Missouri Health Reporter Fellowship
At Health Journalism 2025 earlier this month, emergency services experts discussed the rising cost of emergency medical care and the potential solutions to ensure equitable access and reimbursement.
Panelists examined how billing for ambulance service works in the U.S. and how insurance coverage for EMS care varies significantly across plan types.
Patients can face hefty out-of-pocket costs when their insurance denies coverage due to questions around medical necessity, or when policies don’t cover nonemergency transports — such as trips to nursing homes or behavioral health centers.
“There is $129 million spent annually by patients on surprise ambulance bills,” said Patricia Kelmar, senior director of health care campaigns for the U.S. Public Interest Research Group. Currently, 19 states have legislation protecting patients from surprise medical billing on plans that are not employer sponsored, Kelmar said.
Kelmar and Timothy Dienst, the CEO of the Ute Pass Regional Health Services District in Colorado, both underscored how current reimbursement models pose challenges for tEMS operators. In many cases, EMS providers only get reimbursed if they are transporting a patient to or from a hospital, which could create an incentive for providers to bring patients to an emergency room even if they may not need that care.
“We have to think about ways to get better insurance coverage for emergency transportation and other other medical transportation,” Kelmar said.
Dienst described the complex funding model required to keep his rural Colorado district operational, including property and sales taxes, patient billing, grants and a contract with the state.
“My biggest challenge for me is my payer, because I have a very, very poor payer,” Dienst said.
The panel also highlighted ongoing workforce challenges in EMS.
“There are many other significant systemic issues, a lot of which settles on manpower and effectively having an adequate workforce,” said Dia Gainor, the executive director of the National Association of State Emergency Medical Services Officials.
Factors such as long shifts, limited advancement opportunities, and rural staffing difficulties continue to strain the EMS workforce.
What reporters should look for
Kelmar and Gainor encouraged reporters to examine how broader health care changes — such as rural hospital closures or hospital consolidations — are reshaping EMS demands.
“When a hospital closure occurs in a rural community, rural EMS agencies often report an uptick in either 911 calls, or calls to the non-emergency phone at the ambulance station,” Gainor said.
She also recommended tapping into the National Emergency Medical Services Information System (NEMSIS), a dataset that collects uniform national information on EMS calls.
Dienst advised reporters to dig into workforce issues, volunteer shortages in rural areas, and the expanding role of community paramedics — especially in behavioral and mental health response.
Meg Cunningham is the rural health reporter at The Beacon, a digital news nonprofit in Kansas City, Missouri.
