The House Ways and Means General Fund Committee held a public hearing on a bill that seeks to address ambulance shortages by increasing reimbursement rates and allowing payment for certain services that currently go uncompensated.
House Bill 400, sponsored by Representative Ed Oliver, R-Dadeville, would require health insurers to reimburse ambulance providers at a set percentage of the federal Medicare rate and establish coverage for “treat in place” services, when emergency medical personnel provide care on scene without transporting a patient to a hospital.
The bill also would prohibit balance billing, preventing providers from billing patients for amounts beyond their required cost-sharing once insurance has paid.
Emergency medical services providers delivered emotional testimony during the hearing, while some lawmakers and business owners raised concerns about rising health insurance costs.
Representative Arnold Mooney, R-Indian Springs, said he is concerned about a growing number of mandates moving through the Legislature.
“We have had more mandate bills come through in 13 days than I can remember any time in the 12 years I’ve been serving. Are the people that we represent, who elect us and put us in office, are we not gonna be concerned about what the effect this is going to have on their healthcare costs? Absolutely. This is going to increase their health care costs. Fundamentally, it cannot not increase them,” Mooney said.
He said he supports rural ambulance providers but objects to shifting costs to policyholders.
“The transfer of the cost to the insurer—the insured—is what I have a significant issue with,” Mooney said.
Stephen Wilson, an emergency medical services operations director who works in multiple rural counties, told lawmakers the system is at a breaking point and described staffing shortages that leave some communities without coverage.
“This morning … I didn’t even have a crew available in Lowndes County,” Wilson said. “I had to send a crew out of Montgomery … just to staff that ambulance to make sure they have coverage.”
Wilson said increased reimbursement would allow providers to raise wages and upgrade equipment.
“We are grossly underpaid in EMS. This bill will help with those competitive wages. It’ll also help with the much needed equipment that we need to serve and take care of these patients,” Wilson said.
Vicki McElroy, a paramedic with decades of experience in Pickens County, urged lawmakers to consider the human toll of long response times. In counties without hospitals, she said, transport times can exceed an hour.
Eric Pendley, president of the Alabama Association of Ambulance Services, said Alabama ranks near the bottom nationally in ambulance reimbursement. He said the state reimburses at roughly 140 percent of the Medicare rate, compared with neighboring Mississippi at 325 percent.
“We are losing paramedics and EMTs on the west side of Alabama going to Mississippi to work,” Pendley said. “We’ve tried to turn over every stone and try to figure out different ways that we can put more ambulances in these communities.”
Pendley said a recent federal study found the average cost of an ambulance run is about $1,100.
“We’re not even close to that. That’s why we think it’s very important that we get a reimbursement rate that’s set,” Pendley said.
Supporters also pointed to the bill’s balance billing protections. Sonny Brasfield, executive director of the Association of County Commissions of Alabama, said the legislation would bar ambulance providers from seeking additional payment from patients once insurers and required co-pays have paid.
“What that means is, after you’ve paid your co-pay, and your insurance has paid that benefit … they can’t come back against the people in your district for that additional amount of money,” Brasfield said.
He said the cost impact would be minimal. For participants in the Local Government Health Insurance Program, estimates show the bill would increase premiums by about 67 cents per month.
“It’s not very often that we stand before you and say, ‘Let’s do a mandate,’” Brasfield said. “That should tell you what kind of crisis we believe we’re in.”
Kimberly Trotter, mayor of Rehoboth, said the issue affects not only rural areas but also larger hospitals that become overwhelmed when ambulances transport patients unnecessarily because there is no reimbursement for on-scene treatment.
“Right now … there’s no provision for me to bill for that service,” Trotter said. “This fixes those issues.”
Opponents cautioned that mandated reimbursement rates could drive up premiums for small businesses and self-employed individuals. Sid Phelps, a trucking company owner, said prior mandates have contributed to rising insurance costs in his industry and urged lawmakers to consider alternatives rather than a statewide requirement, suggesting solutions may differ between urban and rural areas.
“When prices are fixed or mandated, the cost is ultimately passed down to the consumer,” Phelps said.
The committee did not vote on the bill after the hearing. Lawmakers carried over House Bill 400 and plan to place it on the agenda for a vote next week.
