Will the Bipartisan Right to Live Act be Vetoed?

 

Franz P. Sauerteig

Years after the No Surprises Act was signed into law by President Trump in 2020, the Right to Live Act has passed the Senate and House and is heading to the President to be signed or vetoed. Achieving bipartisan support from both Republicans and Democrats, the bill proposes greatly expanding the U.S Fire administration’s role in collecting statistics, offering public education, and support state and local fire departments for emergency medical services (EMS), as well as requiring insurance companies to pay for out-of-network ambulance services at in-network rates and offering grants to encourage the elevation of EMS to be an essential service by expanding fire department medical services to include transportation.

The No Surprises Act offered protections from unexpected out-of-network medical bills after fully taking effect on January 1st, 2022. Often accrued from emergencies where patients are unable to or have higher priorities than choosing where they will receive medical care, but also including ancillary providers like anesthesiologists, the law mandates health plans cover surprise billing at in-network rates. However, although the law covers bills from air ambulance services, it only established an advisory committee to recommend options for ground ambulance bills, which concluded that it would “recommend mandatory coverage of, and prohibition of balance billing for, ground ambulance emergency medical services… [and] supported establishing a minimum required out-of-network payment amount determined by a hierarchy starting with the amount specified in State balance billing law…” before becoming inactive on August 28th, 2024.

The Right to Live Act attempts to cover the ground ambulance blind spot, but despite bipartisan support, lawmakers appear to be unconfident on whether the bill will be vetoed though the White House has yet to announce whether they plan to. Currently, only 13 states consider ambulances to be an essential service, and historically governors have often vetoed the coverage of ambulance services despite strong support in state legislators. In the past, Colorado Governor Jared Polis vetoed a bill setting regulations for ground ambulance services stating concerns over “premium impacts” estimated to rise to over $2 per member per month despite unanimously passing the House and Senate. Similarly, New York Governor Kathy Hochul vetoed two measures of a bipartisan legislature package that would have allowed local government to fund EMS circumventing the the state’s property tax cap established in 2011 and permit ambulances and fire vehicles to travel toll-free while responding to emergencies, but did approve the third bill for counties to assess current service levels, coverage gaps, costs, and how EMS services should be organized and funded.

Supporters of the program argue that the bill will not only encourage calling 911 without hesitation of surprise billing but also improve coverage equity with rural Americans by providing increased funding and accessibility to EMS. Over 100 million Americans have medical debt totaling over $220 billion, as the leading cause of personal bankruptcy despite protections of the No Surprises Act. In one recent case, after a family was T-boned while driving to a relative’s house, three separate ambulance companies responded, with one that was out-of-network, resulting in thousands of dollars of debt. In rural areas, EMS is not included with the fire department, with many relying on volunteer models that force EMTs to choose between supporting their family or saving lives.

The Right to Live Act hopes to strike a compromise between patients and insurance companies through discussions to set a minimum rate, and instead of forming a separate federal organization for EMS, formalize the fire departments across the country that already offer EMS services, albeit often without transportation services, thus requiring private ambulance companies. In 2020, there were 26,969,000 incident runs, of which 64% were for EMS and Rescue, with only 4% for fires. Many local fire departments offer Ambulance Membership Programs to help cover costs related to ambulance transport for an annual fee, though this coverage is dependent on the consumer’s medical insurance company.