President George W. Bush released his proposed 2009 budget Feb. 4, which contains nothing but bad news for EMS. He proposes cutting Medicare and Medicaid reimbursement for ambulance services (and for hospitals, nursing homes, home health care and hospices), eliminating most of the federal EMS programs and making deep cuts in first responder grants.
As he did in his fiscal 2008 budget, the president proposed only $300 million for the Fire Act grants program (less than one-third of the $1 billion Congress authorized for the program). Congress defied the president and awarded $560 million for Fire Act grants in 2008 (compared with $650 million in fiscal 2005, $540 million in fiscal 2006, and $547 million in fiscal 2007). Fire-based EMS programs benefit from the grants, and 2% of the grants go to non-fire-based, not-for-profit ambulance services.
The president proposed zero-funding the SAFER grants program this year as he did in 2007, when Congress appropriated $190 million for the program, which helps fire departments hire personnel.
He also proposed only $200 million for the first-responder State Homeland Security Grant Program, which Congress gave $950 million to in fiscal 2008, although he would provide a very slight increase for the Urban Area Security Initiative (from $800 million to $825 million), which goes to high-risk urban areas.
˙The president_s budget is an abrupt and dramatic reduction of federal support for our nation_s firefighting and EMS personnel,Ó said Philip C. Stittleburg, chair of the National Volunteer Fire Council.
The president wants to completely eliminate such critical programs as EMS for Children, the Metropolitan Medical Response System, the Preventive Health Services Block Grant (which helps fund many state EMS offices) and the Traumatic Brain Injury Program. Although Congress reauthorized the Trauma Systems and Development Act in 2007, it did not appropriate fiscal 2008 funding for the program, which provides grants to help states develop their trauma systems. The president wants that program zero-funded in 2009 as well.
The president_s budget would also completely eliminate funding for Rural Health Outreach Grants, Rural Hospital Flexibility Grants, and the Rural and Community Access to Emergency Devices (AED) program.
The budget also would cut funding for the 9/11 World Trade Center Medical Monitoring and Treatment Program from $108 million in 2008 to $25 million in 2009.
˙The bottom line is that it_s nearly the same budget he proposed last year,Ó said Lisa Meyer, a lobbyist for Advocates for EMS. AEMS and other advocacy groups worked hard last year and convinced Congress to provide at least some funding for most, but not all, of the programs the president wanted to cut.
For example, Congress gave EMS for Children $19.45 million in 2008, the Prevention Block Grant got $97.3 million and the Rural AED program got $1.5 million. In addition, AEMS succeeded in getting $750,000 appropriated for the National EMS Information System in 2008.
Medicare & Medicaid
Ambulance services would likely feel the greatest impact from the president_s plan for Medicare. ˙The FY budget would eliminate the inflation update from 2009 to 2011, and then provide a full update minus 0.65% annually thereafter,Ó the American Ambulance Association reported. Because the Government Accountability Office estimates Medicare already pays ambulance services an average of 6% lower than it costs them to transport a beneficiary, this would make a losing proposition even worse.
Meanwhile, ambulance services may find their already-too-low Medicaid rates slashed as states cut their budgets. For example, California Gov. Arnold Schwarzenegger signed a bill into law Feb. 16 that will slash Medicaid reimbursement by 10% for ambulance services in that state.
Although those cuts also affect other California health-care providers, they will be ˙devastatingÓ for ambulance services, according to Helen Pierson, co-owner of Medic Ambulance of Vallejo, Calif. ˙About 25% of our patients are on [Medicaid, which] already reimburses us less than one-third of the costs,Ó she said in a letter to Schwarzenegger that was excerpted by the Vallejo Times-Herald. ˙We are required by law to respond regardless of a patient_s ability to pay, whether it_s a cardiac arrest or a stubbed toe.ÓFor more information, visit„www.advocatesforems.org,„www.the-aaa.org,„www.iafc.org,„www.iaff.org and„www.nvfc.org.