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Opinion | Michigan ambulance services are stretched thin. RESCUE Act offers lifeline
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When someone calls 911 for a medical emergency, they expect help to arrive — and lifesaving care to begin immediately. But since Sturgis Hospital closed, an ambulance trip that once covered approximately two miles can now run closer to 25, taking crews and equipment out of service for much longer.
Sturgis is not an isolated case. It is a window into a broader crisis unfolding across Michigan, stretching emergency medical services increasingly thin. And though few have heard of it, help is taking shape in Congress.
Most people never think about what it takes to ensure emergency medical care is available. Ground ambulances and air medical aircraft must be staffed by highly trained professionals, equipped, maintained and ready before the next call.
Together, our organizations provide ground and air medical services in Michigan, and we see these pressures firsthand. Our crews travel the longer distances created by hospital closures, deliver advanced care on the way to the hospital. In many of these communities, ground crews alone cannot always close that distance fast enough, and air medical transport becomes the only way to reach a patient within the critical window for treatment.
Recent reporting by Bridge Michigan illustrates the scale of the challenge. Nearly 70% of Michigan counties contain areas where residents live more than 25 minutes from an ambulance station. At the same time, workforce shortages, hospital closures and mounting financial pressures are straining EMS systems statewide.
Behind those visible strains lies a cause largely invisible to the public — a federal payment system that has not kept pace with the cost of modern emergency medical care. The Centers for Medicare and Medicaid Services still calculate ambulance payments using claims data from 1998 — long before today’s clinical protocols, equipment standards, and labor costs transformed the field.
In the nearly three decades since, the job has changed significantly. Crews now carry sophisticated medical equipment, administer lifesaving treatments, and begin care long before a patient reaches the hospital. Providers must also absorb the substantial cost of keeping ground units, aircraft, and crews ready regardless of call volume.
Yet Medicare’s underlying payment methodology remains anchored in the past, creating a growing gap between what it costs to maintain reliable emergency response and what Medicare pays. National research finds ambulance charges have risen more than four times faster than Medicare reimbursement.
That gap is especially consequential in smaller and more remote communities. When providers cannot sustain the necessary workforce, equipment and readiness, communities can face reduced capacity, longer coverage gaps, and the loss of ambulance service altogether. Air ambulance providers face this same reimbursement gap, often under even greater cost pressure given the readiness required to keep aircraft, pilots, and medical crews staffed around the clock. They maintain that readiness across their service areas so patients needing immediate care still have a path to definitive treatment when it is too far to reach by ground.
With nearly 1 in 4 Michiganders relying on Medicare, these payment shortfalls make it harder for ambulance providers to keep crews staffed and ready to respond — threatening access to emergency care for everyone, regardless of their insurance.
Congress has an opportunity to address this foundational problem through the bipartisan RESCUE Act. The legislation would modernize Medicare’s ambulance payment system using current cost data, so payments better reflect what it takes to provide ground and air medical care today.
Michigan is particularly well-positioned to help advance that solution. Representatives Debbie Dingell, D-Ann Arbor, and John James, R-Shelby Township, both serve on the House Energy and Commerce Committee’s Health Subcommittee, where the legislation awaits action. While neither is a cosponsor, both can help move it forward.
Michigan residents who want to protect reliable emergency medical access can call the US Capitol switchboard at (202) 224-3121 and ask their representative to cosponsor H.R. 9970, the RESCUE Act.
Modernizing Medicare payments will not reverse every hospital closure or immediately resolve every workforce shortage. But it would address a financial pressure that is making it harder to sustain emergency-response capacity across Michigan.
When someone calls 911 on the worst day of their life, the question should never be whether help is available. It should only be how quickly it can arrive.
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