We asked EMS1 readers, “Is an EMS subscription, in which residents pay an annual fee for services, a good idea, and would you support one in their own community?”
Responses ranged from agencies that have quietly run subscription programs for decades to skeptics who see the whole concept as taxes with extra steps.
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Successful subscriptions in progress
Several commenters didn’t have to speculate about whether a subscription model could work; their own agencies have successfully implemented them; in some cases, for decades.
- “We have done it for many years where I work. For the fee, it covers a household and allows them to not be billed for anything insurance doesn’t cover.”
- “It’s called ESDs in Texas, and it’s added onto the water bill. Not optional.”
- “Yes, for almost 60 years.”
- “Many companies in Pennsylvania do this. It is a great way to raise some capital for the company and can be very beneficial to the patients.”
- “We already do, for a long time.”
Taxes by another name
A bigger group pushed back on the whole premise, arguing that a subscription fee is functionally identical to a tax that residents are often already paying.
- “It’s called taxes.”
- “It’s almost like you’re describing taxes and what they’re supposed to be used for.”
- “Already paying local taxes that go to the system.”
- “It’s an attractive, inequitable, short-term solution that hides the basic problem of EMS being ignored as an essential service.”
Support with conditions
A smaller group landed in the middle: open to a subscription fee, but only if it covers true out-of-pocket gaps, rather than replacing the EMS funding that taxes are already supposed to provide. And a couple of readers skipped the subscription idea entirely in favor of single-payer healthcare.
- “You already pay taxes for EMS, but I would absolutely support a modest ‘subscription’ service that covers out-of-pocket costs for billing after you’re transported. However, it should come with the caveat that the transport was medically necessary — you call for some BS, the bill is yours.”
- “Not everyone pays taxes for EMS. Many rural jurisdictions have no EMS tax. So, small rural ambulance companies struggle to survive as the inevitable yet necessary transition from volunteer to professional services continues. These subscription programs help, but certainly do not close the funding gap.”
- “Full single-payer healthcare. Full stop.”
Not a full fix
Even some readers who liked the idea in principle doubted it would close the funding gap on its own, and a couple pointed out that subscription models are outright barred in some states.
- “We did it for years. Then a person who pays $100 but is transported 10 times in a year creates a loss leader. Multiply that by 30 to 40 people, and you are losing tons of money.”
- “Sure, not a bad idea. However, unless they charge a very high subscription fee, it’ll never entirely offset the cost of doing business, and they’ll still need to rely on billing, grants and tax levies to fill in the gap.”
- “It’s an administrative burden with less than 20% response rate. How about taxes just fund an essential service like they fund DPW?”
- “Depends. My area has little-to-no tax revenue going to EMS. My service runs an annual subscription drive that is voluntary. It is our biggest revenue raiser aside from billing for calls. We have about a 22% return on that subscription that comes out to about $125k a year, but it continually drops each year. If we were to do a per residence mandatory subscription at a lower cost we would see a much higher revenue with a better return of service than we do currently.”
🩺 The EMS Pulse takeaway
Readers whose agencies already run subscription programs described them as real, if modest, revenue sources — but even their numbers show returns that are uneven, prone to shrinking over time and limited to those who opt-in.
In 2023, Matt Zavadsky wrote about MedStar’s MedStarSaver+PLUS, a program that offered on-demand community paramedicine response to members for non-transport care. Though successful, the program was discontinued after EMS services in the area were integrated into the Fort Worth Fire Department.
That leaves an open question: Is an EMS subscription a reasonable stopgap for underfunded agencies or does the idea let local governments off the hook in treating EMS as the essential service most readers agree it should be?
