Ambulance funding a difficult sell in St. Paul

Despite bipartisan support from both of the Ely area’s representatives in St. Paul, legislation that would pump more than $120 million into struggling rural ambulance services faces several hurdles.

That emerged this week even as legislation in the State House - co-authored by State Rep. Roger Skraba (R) of Ely - had its first hearing.

Similar to a proposal offered by State Sen. Grant Hauschild (D-Hermantown), Skraba’s legislation would provide emergency funding to ambulance services such as the one in Ely, which has teetered on the brink of insolvency and needed cash infusions from local governments to stay afloat.

But Skraba indicated this week that “it doesn’t sound like it has legs,” while Gov. Tim Walz (D) offered a supplemental budget that provides far less money - about $16 million in total - for rural ambulance services.

Walz’s proposal would give $10 million to ambulance services and provide $6 million for the creation of pilot zone programs establishing innovative EMS response models.

“I’m grateful that Governor Walz recognizes the critical need to address this crisis in our state, and his budget provides both immediate and long-term support to fixing it,” said Hauschild. “While the emergency aid for communities is far from enough, getting it into the Governor’s supplemental budget is a big win for negotiations at the end of the legislative session. What we know from the Governor today is that he has heard us loud and clear on the need to address the EMS crisis and we will continue to fight for the aid our local communities need.”

Both Skraba and Hauschild have pressed for the $120 million allocation from the state, contending that the current fee-for-service model of ambulance funding hasn’t worked for some time, leaving rural areas of the state with dwindling access to ambulances and other EMS options.

“This short-term funding would act as a bridge to address the real-time concerns with access,” said Skraba. “In addition to this emergency funding, I continue to work with my colleagues to find long-term solutions that address the root causes of the problem in hopes of providing structural support to make sure EMS services remain strong in the Northland and across rural Minnesota.”

Skraba said there will be competing, DFL-sponsored legislation in the House that would provide state funding for a “demonstration project,” perhaps in northeastern Minnesota, that would call for a new model related to ambulance operations.

The plan would also create a new oversight authority for ambulance and EMS operations led by an appointee of the governor.

Skraba said he is skeptical of that approach.

“I’ve had local doctors who have approached me and said it’s not a good deal,” said Skraba. “They believe it should be led by a (health care) professional.”

Skraba pointed to the financial woes facing ambulance services across the states and said “we all recognize it needs to change.”

An EMS Task Force was convened over the fall and winter and identified the $120 million figure as one that would make ambulance services whole and serve as one-time assistance for those services.

Shortages in Medicare and Medicaid reimbursements have been identified as one of the sources as ambulance operations face continued financial challenges. Many services are also struggling to come up with revenue to match the expenditures caused in part by rising wages.

Some EMS Task Force members have suggested that EMS be classified as an essential service, such as police and fire, with a dedicated source of public funding.

Locally, public bodies including the city of Ely have resisted requests for massive increases in subsidies provided to the non-profit Ely Area Ambulance Service.

The ambulance issue has dominated local political discussions for months, with Ely-Bloomenson Community Hospital commissioning a study to look at options.

Until the late-2000s, Ely’s ambulance was under the umbrella of EBCH. That changed at the request of the hospital, and the non-profit was subsequently formed.