An Alabama House committee heard arguments for and against a bill aimed at keeping struggling Emergency Medical Service providers afloat on Tuesday.
Senate Bill 269, sponsored by Senate Minority Leader Bobby Singleton, D-Greensboro, would raise the minimum reimbursement rate that insurance companies must pay ambulance services.
During a House Insurance Committee public hearing on Wednesday morning, two Alabama first responders spoke in support of the bill, arguing it would provide much-needed financial support for struggling EMS providers. Meanwhile, representatives of state insurers spoke against the legislation, arguing it will increase premiums while failing to adequately address the issues it’s attempting to tackle.
Following the public hearing, committee members voted unanimously to give the bill a favorable review.
Alabama’s current reimbursement rate for commercial insurance providers is among the lowest in the nation, at roughly 140 percent of the Centers for Medicare and Medicaid Services Medicare Ambulance Fee Schedule rate.
If SB269 is passed, beginning on October 1, 2026, the minimum reimbursement from health insurers to emergency medical service providers within the provider’s network shall be 200 percent of the rate published by CMS. The minimum reimbursement rate for covered out-of-network services would be increased to 180 percent.
The legislation would also prohibit ground ambulance providers from billing insurance enrollees more than the rate of their in-network cost-sharing amount for emergency services, even if the provider is not covered by the patient’s insurance. Currently, insurance enrollees who utilize ambulance services may be charged by the ambulance provider if the company isn’t covered by the enrollee’s insurance plan.
SB269 would also allow ambulance services to be reimbursed for treat-in-place care, which bill proponents say will reduce unnecessary hospital trips, lowering stress upon struggling ambulance providers.
The legislation would additionally require ambulance providers and insurers to submit annual reports on their operations, including financial information, to the Alabama Department of Public Health.
If enacted into law, SB269 will remain in effect for three years, with a sunset date of June 1, 2029.
Singleton told the committee one of the key reasons he is carrying the bill is because a constituent contacted him with a request to help raise money to keep her area’s ambulance service in rural Greene County from going out of business.
“She said, ‘I’ve used this ambulance service because of my heart eight times in the last three and a half years. And without that ambulance service, I can’t get from Greene County up to DCH, in Tuscaloosa, where I can get better cardiac care,’” he said.
Singleton said that, while he is helping to raise local funds for the ambulance service, the situation made him think of further solutions for Alabama’s EMS shortage.
“We want to make sure that we have a good 911 service that, when you call it, that you can get an ambulance that’s gonna be able to come, and the ambulance service is gonna be treated right, in terms of the reimbursements that they get,” the bill’s sponsor said.
Vicki McCrory, who has served for 36 years with Pickens County Ambulance, spoke in favor of the legislation.
“When I first got into EMS, we had a thriving hospital, complete with ICU, obstetrics, pretty much whatever one would need,” McCrory said. “And I watched it go from that, closing their doors to COVID, which took away about half of our employees.”
McCrory argued that the bill would help relieve strain on rural EMS services, which have faced issues retaining adequate staff due to low reimbursement rates.
She went on to highlight an incident that occurred on Christmas, where she and her coworkers were unable to transport a man to the hospital because they were already in the process of transporting another patient.
“This man basically drowned in his own fluids for over an hour waiting for us to get there. When we walked in, he took his last breath,” she said. “At that point, he was too far gone. We did everything we could possibly do for him.”
Stephen Wilson of Haynes Ambulance Services of Alabama also voiced support for the bill.
“This bill is gonna help with the rural healthcare crisis that we have in EMS,” he said.
“This bill will also address the shortage of EMS personnel, the competitive wages that we need to pay in order to keep these personnel working for us. EMS personnel have been grossly underpaid for years due to a lack of reimbursement,” Wilson added.
Speakers from the Alabama Farmers Federation and Alabama Association of Health Plans argued the bill would shift EMS providers’ current financial burdens to insured individuals through premium increases.
“I think that the folks behind this bill genuinely want to do right by rural Alabama, and let me say this sincerely, so do we,” said Preston Roberts of Alfa Insurance. “Rural EMS is in a crisis. We don’t dispute that, but this bill, by its own design, does not solve that problem. And it puts this mandate on a single group of insureds, and this is the same group that are struggling now to afford premiums.”
While opponents and supporters of the bill both acknowledge the legislation will lead to premium cost upticks, the two groups have debated just how much more Alabamians would have to pay should the bill be enacted.
Alfa has projected that only 10 percent of the revenue generated by the bill will go toward Alabama’s 28 most rural counties while raising premiums “for the 10 percent of Alabamians already struggling most to afford health coverage.”
Bill proponents, meanwhile, have argued against Alfa’s numbers. Representative Ed Oliver, R-Dadeville, sponsor of SB269’s House companion bill, HB400, estimated the legislation will increase monthly premiums for Alabamians by 60 cents to $5 depending on their insurance plan and location.
Roberts argued greater analysis of the state’s EMS crisis would allow greater clarity on the bill’s financial impacts, and allow stakeholders to develop more effective solutions.
When asked by Representative Artis “A.J.” McCampbell, D-Livingston, how he would suggest improving rural EMS access, Roberts called for “further study” of the issue, further utilization of direct grants and the utilization of Rural Healthcare Transformation Program funds procured for Fiscal Year 26.
“We’ve studied everything forever. I know that this bill has a three-year sunset,” McCampbell told Roberts. “So, I think that’s a fair period for us to study the effects of this bill. It may be the thing that actually works.”
“And this legislature is not immune to not giving it a full three years if we find that it doesn’t work,” he added.
While Alfa has criticized the bill as disproportionately benefiting urban areas and failing to address Alabama’s rural healthcare crisis, Wilson advised against viewing Alabama’s EMS crisis as a solely rural issue.
“Haynes Ambulance currently serves 11 counties in the state of Alabama. Some of those counties are urban, and some of those counties are rural,” Wilson said. “Two of those counties don’t even have a hospital in them. So, therefore, we become the primary healthcare for those communities.”
“If the urban areas don’t work, the rural areas don’t work,” Wilson added. “So, if Montgomery, here, is our urban area, if it doesn’t work, then there won’t be service in Bullock, Crenshaw, Covington, Macon and Lowndes Counties, because we need the urban area of Montgomery to work.”
Michael O’Malley, CEO of the Alabama Association of Health Plans, also voiced opposition to HB269.
“It’s always been our position as the Health Plan Association that we oppose any bills that get between one party and another party and a contractual arrangement, and this bill does that,” he said.
“No question that there’s an issue in rural Alabama, not just with ambulances, but our rural system is in turmoil,” O’Malley said. However, he argued that SB269 put increased financial burden on “small, fully insured employers” who have already voiced frustration to his agency regarding the cost of insurance premiums.
Singleton’s bill will now also advance to a vote on the House floor.
