Racing for solutions in rural EMS crisis

A financial crisis threatens rural emergency medical services across the country, especially right here in our own back yard. Increased attention to the issue in recent months has yet to improve the situation. But, at last, more leaders at every level of government are beginning to act. Their efforts will determine whether regions like ours keep vital emergency services.

Last fall, I wrote about the challenges facing Nashwauk’s ambulance service. Like others small towns providing regional ambulance coverage, Nashwauk found itself supporting a large service area with no hope of recouping costs. Attempts to sell the service to a private provider fizzled out because no profit could be realized.

On Feb. 15, a local task force comprised of representatives from the Nashwauk Ambulance service area, gave a recommendation. The group wants to create a joint powers board to oversee the ambulance service. This would maintain faster response times for a massive stretch of land that would otherwise fall to MEDS-1 in Grand Rapids and the Hibbing EMS department. Both services are located much farther away.

The proposal must now thread a delicate needle. The tax district would include the cities of Keewatin, Nashwauk, Calumet, Taconite and Marble, the townships of Nashwauk, Balsam, Lawrence, Bearville, Goodland, Greenway and Lone Pine, and some unorganized sections of Itasca County. Local leaders will present the proposal to their constituents over the next month. 

Based on feedback, local governments could opt into the joint powers authority. Households could expect to pay between $20 to $40 per year for the service if everyone joins; however, the price would go up if some local governments opt out or if costs run higher than last year.

Nevertheless, local governments cannot fully solve this problem by themselves.

On Feb. 16, shortly after the legislative session kicked off, a bipartisan panel of state lawmakers met to share their recommendations for solving rural ambulance woes. The Emergency Medical Services Task Force toured Greater Minnesota last year to hear testimony from people affected by the problem, including stops in Winona, Mankato, Elbow Lake and Mountain Iron. 

Co-chairs Sen. Judy Seeberger (DFL-Afton) and Rep. John Huot (DFL-Bloomington), both of whom serve as EMS providers, recommended a scattershot of potential state solutions. One bill gathering support would provide one-time financial relief to rural ambulance services, helping them get back on their feet after significant losses during the COVID-19 pandemic. Other legislators will introduce bills aiding retention and recruitment of volunteers and EMS staff. 

One remarkable feature of the state EMS task force was the productive nature of the discussion among Republicans and Democrats. Rep. David Lislegard (DFL-Aurora) and Sen. Grant Hauschild (DFL-Hermantown) expressed the unique challenges facing their vast rural districts. Reps. Natalie Zeleznikar (R-Duluth), a health care administrator, and Jeff Backer (R-Browns Valley), a volunteer EMS, provided useful first hand experiences to the debate.

But even the state’s intervention can only address some of the issues.

On Jan. 26, U.S. Sen. Tina Smith held a meeting in Hibbing to hear concerns about federal EMS policy. Smith is advocating for higher reimbursement rates, but argued that complex insurance billing procedures don’t help either.

One immediate problem is that the challenges facing rural EMS providers aren’t new or unique to the health care system as a whole. “Profit” remains a callous way to assess the quality of emergency services, or any kind of medical care. Responsibility falls across federal, state and local governments. And yet, failures disproportionately harm rural communities.

The federal government must address the financial shortfalls of federal Medicare and Medicaid reimbursement rates. State government can play a role in recruiting new EMTs and paramedics, while providing one-time money to help struggling departments find solutions. Locally, counties, towns and townships should work together to avoid redundancy and stretch taxpayer resources.

This issue requires the kind of fast, unified response that is so hard to accomplish in our politically divided times. And yet, there are signs that leaders of both parties and many places are willing to work together on this issue. Let’s cheer them on while holding them accountable. Insufficient progress will imperil the lives of people we know and love.

Aaron J. Brown

Aaron J. Brown is an author and college instructor from northern Minnesota’s Iron Range. He writes the blog and co-hosts the podcast “Power in the Wilderness” on Northern Community Radio. This piece first appeared in the Saturday, Feb. 24, 2024 edition of the Mesabi Tribune.

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