The votes have been cast, congressional and statehouse leadership is changing, and EMS organizations across the country are beginning to work out what the 2026 midterm elections mean for them. In this special edition of EMS One-Stop, host Rob Lawrence is joined by longtime EMS leader and policy analyst Matt Zavadsky to look beyond the red-versus-blue election narrative and focus instead on what EMS leaders should be doing next.
Their message is straightforward: election results do not automatically change policy, reimbursement rules or the economic realities facing ambulance services. What they do create is a new group of elected officials, committee members and political leaders who must quickly be educated about EMS, its value and, crucially, what it actually costs to maintain a 24/7 emergency medical response system.
Rob and Matt examine what remains unchanged after the midterms, including existing federal law and regulatory changes already moving through CMS, before turning to some of the more significant state and local results. They discuss property-tax reform, EMS levy votes, commercial payer reimbursement, the cost of readiness, and the growing tension between public expectations for rapid ambulance response and the willingness of communities to fund that level of service.
The episode concludes with a practical five-point action plan for EMS leaders:
- Calculate the true cost of readiness
- Demonstrate value beyond response time
- Reconsider system design
- Model financial exposure
- Immediately begin educating newly elected officials
The election may have changed some of the people at the table, but EMS still has to make its case.
Key quotes
- “We’re not here to talk about red or blue, we’re not here to talk about Democrats or Republicans. We’re here to talk about us.” — Rob Lawrence
- “Election results don’t automatically translate into policy changes … a change in congressional leadership and state house leadership and local leadership creates, if nothing else, a new opportunity for us to advocate for reform, but it’s not a guarantee of that reform.” — Matt Zavadsky
- “We have a lot of freshmen to influence now and educate and have them understand before anybody else gets to them.” — Rob Lawrence
- “Everybody wants lower taxes and everybody wants an ambulance in five minutes. But somebody needs to explain how those two expectations fit into the same spreadsheet.” — Matt Zavadsky
- “We can’t control who wins and who loses elections, but we can control the quality of the information that we provide, the relationships that we build and our willingness to rethink how we deliver care.” — Matt Zavadsky
- “For me to be there for that one unit hour that I am dealing with you as my patient, I need to be there for the other 23 hours to be ready for that one unit hour.” — Rob Lawrence
- “Instead of asking taxpayers to give you more money, we need to explain what we’re doing with the money.” — Matt Zavadsky
- “We don’t care who won, but we now have to talk to the winners in order to affect change or continue the good work that many associations, many organizations, and many individuals have been doing for some considerable time now.” — Rob Lawrence
Additional resources
- 2026 Ambulance Ride-Along Toolkit - American Ambulance Association
- AAA & AIMHI EMS Media Log
- The economics of saving lives (and explaining it to your finance director)
Episode timeline
- 01:00 – Rob introduces the midterms special: this is not a discussion about Democrats versus Republicans, but about what the election results mean for EMS.
- 02:51 – Matt’s first takeaway: elections create opportunities for reform, but election victories do not automatically translate into policy change.
- 04:19 – Rob’s immediate post-election task: identify new legislators, departing allies, freshmen members and the people EMS now needs to influence.
- 07:14 – Matt discusses treatment-in-place legislation, HR1 and why existing federal law remains in place unless Congress changes it.
- 08:39 – EMS organizations should continue financial contingency planning rather than assume the election will reverse current reimbursement pressures.
- 11:12 – Florida property-tax reform and the potential impact of reduced municipal and county revenue on public safety.
- 13:00 – Matt discusses alternative EMS financing, regional collaboration, consolidation and more efficient deployment.
- 13:26 – Fundamental system-design questions: Does every call require an ambulance? Does every call require a paramedic? Does every patient require an 11-minute response?
- 17:04 – Rob’s “political meteorite” theory: could financial pressure finally extinguish outdated EMS operating models?
- 18:48 – Not every tax measure failed: Matt examines communities where voters supported additional EMS funding.
- 19:21 – EMS levy campaigns: why successful funding measures require genuine campaigning and community education.
- 22:39 – Matt argues that EMS must become better stewards of resources and acknowledge that many low-acuity calls do not require rapid emergency response.
- 23:07 – Examples of high-performance systems adopting 45-, 60- and 90-minute response targets for some low-acuity calls.
- 25:25 – Matt argues that the changed political environment could create another opportunity to address commercial insurer underpayment of EMS.
- 26:22 – Revisiting the Ground Ambulance and Patient Billing Advisory Committee recommendations.
- 28:50 – Rob asks Matt for his post-midterm EMS leadership “top five.”
- 29:27 – No. 1: Calculate the true cost of readiness. Understand what it actually costs to maintain 24/7 ambulance availability.
- 29:44 – No. 2: Measure and communicate value beyond response time. Include clinical outcomes, patient experience, unit-hour costs, response costs and transport costs.
- 30:35 – No. 3: Reevaluate system design. Consider regional partnerships, consolidation, deployment changes and different service models.
- 31:02 – No. 4: Model financial exposure. Understand how Medicare, Medicaid, GEMT and local tax changes could affect the organization under different scenarios.
- 31:59 – No. 5: Educate newly elected officials now. Do not wait for the next crisis or budget cycle. Begin building relationships and teaching newly elected officials about EMS immediately.
- 33:06 – The objective: make sure EMS remains “at the table and not on the menu.”
