Election Day 2026 delivered some extraordinary political results. Democrats regained control of both chambers of Congress; several traditionally Republican states experienced historic electoral shifts; and voters seemed to send messages about affordability, government accountability and public spending.
But for America’s EMS professionals, perhaps the most consequential election results weren’t necessarily the ones dominating national headlines. They were the local decisions about whether communities are willing to pay for the emergency medical services they expect.
Because regardless of which political party wins an election, somebody still must answer the next 911 call. And ambulances don’t run on campaign promises.
| MORE: New York City’s EMS funding crisis isn’t just New York City’s problem
Washington changes hands. EMS still needs funding.
Democratic victories in the U.S. House and Senate will significantly change the federal policymaking environment. Congressional leadership, committee priorities, federal budget negotiations and oversight responsibilities will shift.
For EMS, these changes could influence several longstanding policy priorities:
- Medicare reimbursement reform, including ambulance payment adjustments and the implications of Ground Ambulance Data Collection System findings
- Medicaid funding, particularly supplemental payment programs such as Ground Emergency Medical Transportation (GEMT)
- Treatment-in-place and alternative-destination reimbursement, recognizing that appropriate patient care doesn’t always require an emergency department transport
- Healthcare coverage and affordability, which directly influence ambulance collections, uncompensated care and local taxpayer subsidies
However, a Democratic Congress working with a Republican president also creates the potential for legislative gridlock. EMS leaders should resist assuming that a change in congressional control automatically translates into reimbursement reform. After all, we’ve been explaining that EMS is more than a transportation service for decades. Apparently, that message has a longer response time than some of our rural ambulances.
| MORE: Treatment in place: The future of EMS … and yes, someone has to pay for it
What about H.R. 1 and the proposed CMS GEMT rule?
One particularly important question for EMS leaders is whether the election results could change the trajectory of H.R. 1 (the One Big Beautiful Bill Act) and CMS’s proposed rule limiting certain Medicaid supplemental payments, including GEMT programs. A change in congressional control could create opportunities to revisit provisions of H.R. 1 affecting Medicaid eligibility, funding and supplemental payment arrangements. However, H.R. 1 is already law, and changing it would require new legislation, potentially facing a presidential veto.
Similarly, the CMS proposal to cap certain targeted Medicaid fee-for-service payments at Medicare-equivalent levels, beginning in 2029, remains a regulatory matter. New congressional leadership could increase oversight, challenge the rule’s financial implications, or pursue legislation modifying CMS’s authority. However, the election itself does not withdraw or invalidate the proposal, and CMS could proceed with finalizing it.
For EMS agencies participating in GEMT programs, the message is simple: The election may create new opportunities for advocacy, but it does not eliminate the financial risks. Agencies should continue evaluating potential reimbursement losses, engaging policymakers and preparing for alternative funding strategies. In EMS terms, a change in the political crew doesn’t necessarily mean the patient has been stabilized.
Florida: Property tax relief comes with a price tag
One of the most consequential election results for local emergency services occurred in Florida, where voters approved Amendment 3 with approximately 62% support. The amendment increases the homestead property-tax exemption from $50,000 to $150,000 in 2027 and $250,000 in 2028 for affected non-school property taxes. It also reduces the annual assessment-growth cap for certain non-homestead properties.
State economic estimates suggest local governments could eventually lose nearly $12 billion annually in recurring revenue. That’s a significant financial challenge for counties, municipalities, fire districts and other local governmental entities that rely on property taxes to support essential services.
For EMS systems, the implications could include increased pressure to reduce operating expenses, delay capital purchases, reconsider staffing and deployment models, pursue regional consolidation, or identify alternative revenue sources. The challenge will be particularly significant for smaller and rural communities with limited tax bases and fewer opportunities to offset declining revenues.
The Florida result illustrates an uncomfortable reality: Voters understandably want lower taxes, but their expectations for emergency medical response generally don’t decrease when their tax bills do.
Ohio: Voters demonstrate support for dedicated EMS funding
While Florida voters approved substantial property-tax reductions, several Ohio communities considered proposals specifically supporting EMS and public-safety operations.
In Wadsworth, voters approved a five-year EMS levy renewal and increase, raising the rate from 3 mills to 4 mills. The measure received approximately 57.5% support. The additional funding is expected to increase annual EMS revenue from approximately $1.61 million to $2.52 million.
City officials cited increasing emergency call volumes, rising operating expenses and staffing requirements. EMS demand had grown from just over 2,000 annual calls in 2016 to more than 3,200 in 2025. Interestingly, Wadsworth voters simultaneously approved a reduction in a separate fire levy, partially offsetting the increased EMS tax burden. That’s a particularly noteworthy example of aligning public funding with changing service demands, rather than simply asking taxpayers for more money.
In North Royalton, early unofficial returns also showed approximately 59% support for renewing and increasing an EMS levy from 1.7 mills to 2 mills. The proposal would generate an estimated $2.27 million annually, although final results required confirmation.
Elsewhere, Washington County, Ohio, voters approved a levy supporting 911 dispatch operations, reinforcing the importance of funding the infrastructure that makes emergency response possible.
These results are not a comprehensive national assessment of EMS ballot measures, but they offer an encouraging lesson: When communities understand the need, the costs and the intended benefits, voters may support additional investments in emergency services. Apparently, explaining the actual cost of EMS readiness can be more effective than simply telling people we’re essential. Who knew?
The bigger lesson: Readiness isn’t free
The contrast between Florida and Ohio highlights one of the EMS profession’s most persistent challenges. Our communities expect ambulances to be available 24 hours a day, seven days a week, regardless of whether anyone actually needs one. That readiness requires personnel, vehicles, facilities, equipment, medical oversight, communications infrastructure and administrative support. Yet our reimbursement model continues to rely heavily on transporting patients.
Imagine funding a fire department primarily by the number of fires extinguished or paying police departments only when someone gets arrested. It sounds ridiculous. And yet, here we are.
The election results should reinforce the importance of developing sustainable financing models that recognize EMS readiness as a public benefit, while appropriately compensating agencies for the clinical services they provide.
Five things EMS leaders should do next
Rather than waiting for newly elected officials to discover EMS on their own, the profession should take several proactive steps.
- Quantify the actual cost of readiness. Understand staffing requirements, unit-hour costs, service demand, clinical acuity, payer mix, and the difference between reimbursement and the full cost of service delivery.
- Demonstrate value beyond response times. Policymakers need evidence of patient outcomes, appropriate resource utilization, patient experience and the benefits of alternative care pathways.
- Evaluate opportunities for system redesign. Regional collaboration, consolidation, clinically appropriate ALS/BLS deployment and integration with healthcare partners may improve sustainability without compromising patient care.
- Engage policymakers early. New congressional representatives, state legislators, governors, county commissioners and municipal officials need credible information about the challenges facing EMS systems and practical recommendations for addressing them.
- Prepare for changes in federal and state reimbursement policy. Evaluate your agency’s exposure to potential changes in Medicare, Medicaid, GEMT supplemental payments and other reimbursement programs. Model the financial implications of proposed policy changes, identify alternative funding strategies, and engage policymakers before decisions become final. Hoping Congress or CMS will ride to the rescue is not a particularly sound financial strategy.
- Tell your story and make the financial case to your community. The EMS levy results demonstrate that voters may support additional funding when they understand what they’re paying for and why it matters. Communicate service demand, readiness costs, clinical outcomes, and the consequences of underfunding in terms that elected officials and taxpayers can understand. Don’t wait until a funding crisis or ballot initiative to begin educating your community. The best time to explain the value of EMS is before someone asks why an ambulance costs so much.
The bottom line
The 2026 elections delivered significant political changes and some fascinating contradictions in public attitudes toward taxation and essential services. But the fundamental EMS challenge remains unchanged. Communities want reliable, high-quality emergency medical care. EMS agencies need sustainable funding to provide it. And policymakers must reconcile those expectations with increasingly constrained public resources.
Election night determines who gets elected. What happens next determines whether our EMS systems can continue delivering the care their communities expect.
The ballots have been counted. The challenges remain. And the next 911 call isn’t waiting for the new Congress to be sworn in.
WATCH | FDNY Chief of Department John Esposito: One department, one mission
