By Abigail Ham
The Keene Sentinel
SWANZEY, N.H. — During a visit to the Cheshire EMS headquarters, U.S. Senate candidate Scott Brown told local EMS providers that fixing Medicare and Medicaid reimbursements will be a top priority if he’s elected.
The county-run ambulance service was founded during the COVID-19 pandemic to fill a gap left by a closing private ambulance service in the area. It’s now the primary provider for seven local towns and has limited contracts with 19.
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Cheshire EMS isn’t funded by taxes. Instead, it launched with the help of American Rescue Plan Act funds and relies on contracts with towns and insurance reimbursements for services to cover costs.
But there are issues with that model.
EMS providers are reimbursed only for transport services, not for care given in the field.
That’s different than fire or police departments, which municipalities pay to be ready in case of an emergency as well as during an actual emergency.
Even when EMS providers are reimbursed, it’s not for the whole cost.
The average reimbursement rate from Medicare last year, for example, was about 32 percent, Cheshire EMS Chief Mark Kreamer said.
Part of the problem, he said, is that EMS services are under the purview of the U.S. Department of Transportation and not, like the fire service, under the Department of Health and Human Services.
That’s because EMS was created in the ’60s primarily as a response to traffic crashes.
The level of care provided in the field now goes far beyond just taking someone to the hospital.
But unlike fire and police, EMS isn’t considered an essential service by the federal government. That means there’s no obligation for municipalities to provide it.
With reimbursement rates as they are, there’s no financial incentive for anyone to provide it, either.
Kreamer said things will get worse if the federal government cuts into Medicaid.
The program is set to lose about $1 trillion in funding over the coming decade due to changes made in the One Big Beautiful Bill.
“If the Medicaid cuts happen, more and more people are going to lose primary insurance,” Kreamer said.
That would mean fewer people who have any way to pay for EMS.
Scott Symonds, who owns the adaptive transportation service Smart Ride, said his company’s operating margin is about 2 percent. He doesn’t collect a salary, he said.
Medicare doesn’t cover wheelchair transports, and Medicaid reimburses those rides only at a rate of about $28, Symonds said. It costs more than $80 an hour to run the service.
Fuel costs have about doubled this year, he added.
All told, Smart Ride loses about $11,000 a month on Medicaid, he said.
Brown said he “quite frankly wasn’t aware” of what he called “the ridiculous reimbursement rates,” and said he plans on addressing this if the region’s voters send him to Washington.
His comments to the EMS providers ranged widely, from unfunded mandates in special education to driver’s licenses for noncitizens.
But he said, “law enforcement and public safety is one of my top priorities.”
“If the president can find $1.8 million for an anti-weaponization fund, we should be able to find the money,” he said of the reimbursement issue.
The controversial fund for people who felt they were hurt by Justice Department investigations, which federal officials say is no longer planned, was part of a settlement agreement between President Trump and the Internal Revenue Service.
Brown is a former U.S. senator representing Massachusetts and served as U.S. ambassador to New Zealand and Samoa from 2017 to 2020.
He’ll face former U.S. Sen. John Sununu in the Republican primary next week.
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