“Insured individuals consume nearly twice as much health care as the uninsured, on the average. Thus, EMS utilization will likely increase; however, the ACA does not provide funds to pay for increased EMS use,” the brief says. “This will force local governments to choose between taxes, finding alternative revenue sources or reducing emergency services.”
Noting that half of the 32—34 million newly insured will be enrolled in Medicaid, the NCPA estimates an increase of approximately 850,000 to 900,000 emergency room visits per year. According to the report, “Researchers estimate that the rate of inappropriate ambulance use by the public insured ranges from 59% to 85%, compared to only 13% to 22% of privately insured individuals.”
The brief also discusses below-cost Medicare reimbursements: “EMS agencies are not reimbursed for the full cost of Medicare transport, and local taxpayers are stuck with the difference. Furthermore, ambulance providers are generally not compensated for care unless an individual is actually transported. Thus, even if the ambulance is only called as a precaution, or an individual’s medical needs can be met at their location, there is a financial incentive to take an individual to a hospital in order to receive reimbursement.”
On its course under the ACA, the report predicts dire consequences for EMS, national preparedness and municipal budgets. Several solutions are offered, including levying dedicated taxes, providing incentives for patients to control their use of health services, and reimbursing ambulance services for medical treatment without transport.