Legislative inaction on EMS could spell trouble for rural Iowa

Response times for an ambulance vary widely in Iowa, with rural areas faring worse than urban locations. (Photo courtesy of Scott County)

A bill that would have provided a long-sought stable source of funding for emergency medical services in Iowa was one of the casualties of the 2020 legislative session.

Supporters say the bill’s failure to win approval means rural residents of the state will continue to see long delays for ambulance calls, with response times of up to 45 minutes.

Currently, there are 14 Iowa counties — including 10 near the state’s southern edge — with only one ambulance service based within their borders. There is no ambulance services based in Worth County, on the state’s northern border.

Like many states, Iowa is also struggling to recruit and retain emergency medical technicians, with some fire chiefs calling for a lowering of the standards to become certified as an EMT. In recent years, some areas of Iowa have been served by high school students called out of class to act as first responders. In other areas, EMS “agencies” consist of a single individual working out of their home and car.

A bill that would have enabled Iowa’s county supervisors to impose a tax for EMS may have fallen victim to other EMS-related bills competing for lawmakers’ attention this year.

One failed bill would have increased the fines for speeding as a way to pay for EMS. Another would have tied EMS funding to tax receipts generated by internet-based fantasy sports contests. A third wouldn’t have provided any new revenue, but would have authorized EMTs to obtain professional permits to carry guns while on duty.

Mark Sachen of Mason City, president of the Iowa Emergency Medical Services Association, says something needs to be done to address the funding issue.

Mark Sachen of Mason City is president of the Iowa Emergency Medical Services Association. (Photo courtesy of the Iowa Senate)

“The goal is to make sure every Iowan, no matter where they live, has access to the same reliable medical care in the event of an emergency,” he said. “I think everyone takes it for granted that if they need an ambulance and call 911, they are going to get one in a timely manner. And, you know, given the current state of affairs, that is really not the case. In this business, every minute counts. So if you have to wait for an ambulance 30 to 45 minutes, that could have a really negative impact on a patient.”

Sachen noted that unlike police and fire protection, which cities or counties are required to provide, EMS is not considered an “essential service” under Iowa law.

At present, counties can either try to absorb the cost or, with the approval of voters, they can impose a property tax levy, an income surtax, or a combination of the two, to pay for emergency medical services.

Legislation that would have eliminated the requirement for a public vote and allowed county supervisors to simply declare EMS to be an essential service and impose the tax on their own authority has been supported by some state lawmakers in recent years, but never has made it to the governor’s desk for final approval.

This year was somewhat different, with the Iowa House approving a variation of the bill that kept the requirement for a public vote but removed the provision requiring a special election. That version of the bill won almost unanimous support in the House, but never made it to the Senate floor for a vote.

Under current law, voter-approved EMS taxes can be imposed for a maximum of five years without the voters’ consent for renewal. The initial version of the proposed new law would have removed that five-year cap, while allowing county residents to petition for a vote on terminating the tax.

It also would have modified provisions in the current law so that instead of listing the precise types of expenditures that could be made with the EMS tax revenue, the law would let counties use the money for any operational expenses related to EMS.

The bill also would have removed what supporters say is an unintended roadblock to consolidation of services and cost savings. The current law allows counties to partner only with other counties in providing EMS; the proposed new law would have enabled counties to partner with cities and townships, as well.

“The cost of equipment and training and everything has gone up for these agencies,” said Sen. Kevin Kinney, D-Oxford. “Anything that we can do to get more funding for EMS, I would look at.”

Another bill that failed to win support this year would have increased the relatively small amount of money the Iowa Department of Human Services currently distributes throughout the state for EMS support. In March, one of the measure’s primary backers, Rep. Bobby Kaufmann, R-Wilton, suggested increasing the funding from $300,000 annually to $5 million.

IEMSA has backed the county-imposed tax levy as “the best and most comprehensive plan to date that balances statewide need with local realities and accountability.”

Sachen says the association expects to bring the issue back before lawmakers this fall in advance of the 2021 session.

“We were pleasantly surprised by the overwhelming support we had in the House this year, but with the abbreviated session we just didn’t have enough time to finesse the language in the bill in a way that would have made it more palatable to the Senate,” he said. “But we’re definitely going to be hitting the issue hard this fall.”

Clark Kauffman
Deputy Editor Clark Kauffman has worked during the past 30 years as both an investigative reporter and editorial writer at two of Iowa’s largest newspapers, the Des Moines Register and the Quad-City Times. He has won numerous state and national awards for reporting and editorial writing. His 2004 series on prosecutorial misconduct in Iowa was named a finalist for the Pulitzer Prize for Investigative Reporting. From October 2018 through November 2019, Kauffman was an assistant ombudsman for the Iowa Office of Ombudsman, an agency that investigates citizens’ complaints of wrongdoing within state and local government agencies.