08/28/2026
You cannot call EMS an essential service while funding it like a transportation company that happens to carry oxygen.
Last October, during the federal government shutdown, Arkansas ambulance services started sounding the alarm.
Medicare payments had been disrupted, and ambulance leaders were warning that if the money stayed hung up long enough, eventually it could affect staffing and response times.
Think about how completely backwards that is.
The ambulance still had to be sitting there.
The paramedic still had to come to work.
The EMT still had to come to work.
The truck still needed diesel, tires, brakes, insurance, maintenance, cardiac monitors, medications, oxygen, stretchers, radios, medical supplies and enough assorted expensive junk to make a NASCAR pit crew jealous.
At 3:17 in the morning, when somebody's husband quits breathing, nobody expects 911 to say:
"Unfortunately, Medicare hasn't processed our claims this week. Have you considered dying during normal business hours?"
The ambulance is expected to come.
Every. Damn. Time.
And that's exactly the problem.
We keep calling EMS "essential," but we still finance much of it around transportation.
You haul somebody to the hospital, somebody gets billed.
You spend the entire day sitting ready to save somebody's life and nobody calls?
Congratulations.
You successfully provided emergency coverage all day and generated damn near nothing for doing it.
That's a mighty peculiar way to fund something we're supposedly unable to live without.
Police departments don't send Blue Cross a claim after arresting somebody.
Fire departments don't bill Medicare after putting out Grandma's kitchen.
Nobody tells the sheriff, "Sorry about payroll. We didn't have enough burglaries this month."
We understand those services have a cost simply because they must EXIST.
They have to be staffed and ready before the emergency happens.
EMS somehow got invited to the same emergency-services family reunion, then got seated at the card table by the bathroom.
Arkansas actually took an important step toward recognizing the reimbursement problem in 2025.
Act 867 changed the minimum allowable reimbursement rules for certain ground ambulance claims under commercial health plans. When there isn't a locally approved or contracted rate, the law sets the minimum at the lesser of the ambulance provider's billed charges or 325% of the Medicare Ambulance Fee Schedule's Arkansas rural rate.
Three hundred twenty-five percent.
Now stop and appreciate that number for a minute.
Arkansas lawmakers looked at what Medicare pays, looked at what ambulance services actually have to survive on, and essentially said:
"Well, we're gonna need more than THAT."
That's not criticism of Act 867.
Quite the opposite.
I think Arkansas deserves credit for recognizing there was a problem and doing something about it.
But it also accidentally illustrates just how screwy the larger system has become.
Because Medicare itself still operates under a national ambulance fee schedule, complete with temporary rural and "super rural" add-on payments that Congress has repeatedly had to extend. The current extensions run through December 31, 2027.
Temporary.
There's another comforting word to attach to the funding mechanism keeping rural ambulances alive.
Nothing makes a paramedic sleep better at night than learning part of the financial structure holding up his profession comes with an expiration date.
And rural Arkansas is where this gets serious.
An ambulance isn't Uber with a cardiac monitor.
That truck may be the only advanced medical care available for miles.
The crew may respond down a county road, stabilize somebody in their bedroom, carry them through a yard, manage their airway, treat their shock, start medications, interpret a 12-lead ECG and then drive another forty-five minutes before reaching a hospital.
The expensive part isn't merely the ride.
The expensive part is having trained people, equipment and an ambulance READY to make the ride when the call comes.
That's what we continue refusing to properly value.
Readiness.
EMS shouldn't have to pray enough people get sick this month so the service can afford to answer when somebody gets sick next month.
That's insanity dressed up as healthcare finance.
If a community believes EMS is essential, then at some point we've got to quit pretending ambulance reimbursement alone is a sensible way to guarantee emergency medical coverage.
Insurance reimbursement matters.
Medicare reimbursement matters.
Medicaid reimbursement matters.
Arkansas improving commercial reimbursement matters.
But none of those things change the fundamental question:
Who pays for readiness?
Because when your chest starts hurting at 2:00 in the morning, you aren't buying transportation.
You're buying the thirty years of experience sitting six minutes away.
You're buying the paramedic.
The EMT.
The ambulance.
The monitor.
The medications.
The training.
The equipment.
And the fact that all of it was waiting for you before you ever knew you needed it.
That's what an essential service actually means.
So if we're going to use that word, maybe it's about time we started funding EMS like we mean it.
For the EMS folks outside Arkansas, I'm curious how your community handles this. Is your service funded for readiness, or are y'all still expected to finance 24-hour emergency coverage one ambulance ride at a time?
Sources: 5NEWS, October 20, 2025; Arkansas Act 867 of 2025; Centers for Medicare & Medicaid Services Ambulance Fee Schedule, current through 2026.
-- East Arkansas Paramedic
