Would you pay an extra $10 a year to aid rural ambulances?

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Living in a state with spectacular natural resources means Minnesotans are frequently on the go to enjoy them.

To the cabin. To the lakes where walleye are biting. To the prairies and bluffs for hunting.

Those destinations are where great memories are made. But they can also unfortunately be a place where injuries or life-threatening emergencies, such as a heart attack, can happen.

Two state legislators who have also served as emergency responders have an important question for adventurers enjoying all that Minnesota offers.

Would you be willing to pay around $10 more a year on your cellphone bill to ensure there’s prompt, well-equipped ambulance service to care for greater Minnesota visitors as well as those who live there permanently?

State Sen. Judy Seeberger, DFL-Afton, and Rep. John Huot, DFL-Rosemount, are hoping the answer is yes, with the resulting sum significantly easing the financial strains on rural ambulance services struggling to care for their communities.

The lawmakers’ telecom fee is likely a long shot in a closely divided Legislature, with the usual objections to anything that looks like a new tax. That said, the pair is offering up a logical alternative to tapping the state’s already stretched-thin general fund. Their proposal merits careful consideration as well as appreciation for proposing a bold solution to a big problem.

Rural ambulance services’ financial plight has been in the spotlight for several years at the State Capitol. The list of forces battering these organizations is long.

Among them: a shrinking and aging population, large service areas to cover, a labor shortage and rising equipment and fuel costs. Another: inadequate reimbursements from public health programs like Medicare and Medicaid, a big problem when billing for services is the funding mainstay for many ambulance crews.

A dumbfounding federal policy quirk adds to the problem. As a 2024 Star Tribune editorial noted, Medicare, the public program generally serving those 65 and up, has a “no transport” loophole. There’s no compensation for ambulance runs that respond to a 911 call but don’t wind up bringing a patient to a hospital, a not uncommon outcome. So far, Congress has yet to fix it.

Legislators during the 2024 session took a commendable step to aid rural emergency responders, providing around $24 million in grants. The assistance was welcome, but far short of the $120 million sought by ambulance service advocates.

The other problem: it was one-time money. Yet the factors fueling ambulance providers’ financial woes continue and potentially could get worse with the rapid-fire push for “efficiencies” at the federal level.

Medicaid, the federal/state safety-net program that provides medical coverage for low-income people and pays for many elderly people’s long-term care, is in congressional budget crosshairs. Reimbursement to ambulance providers from this program, which many rural residents rely on, is already too low and could get worse.

SF 1688/HF 33, the legislation championed by Seeberger and Huot, would place a small monthly fee on cellphone lines to offer an ongoing, dedicated funding stream to assist struggling ambulance crews.

The sum raised would be distributed in three main ways. There would be “an ambulance service cost of readiness grant program; an emergency medical services improvement, modernization, and sustainability grant program; and a rural emergency medical services uncompensated care pool payment program,” according to the Senate Counsel, Research and Fiscal Analysis summary.

That last item would help address the “non-transport” Medicare loophole, which leaves rural ambulance crews on the hook for gas, vehicle maintenance and staff time. There are many reasons that pancake breakfasts and other ambulance service fundraisers are a common small-town sight, but this is one of them.

While the exact monthly fee is still being worked out, it’s expected to be a matter of cents. Seeberger estimates it would total around $10 extra annually for a single line. Important to note: if you’re like me and still have a child on your plan, that other line would bring the total to $20.

A very early rough estimate of the amount raised would be around $60 million to $70 million a year, Huot said.

There’s precedent for turning to cellphone users for this badly needed assistance. Telecommunication fees power the 911 system. In Minnesota, a 12 cents per month telecommunications fee covers the cost of the 988 suicide prevention and crisis hotline.

Yes, care is necessary to avoid adding too much more to these existing fees. But a clear benefit to this approach is that the vast majority of people carry a cellphone. This would spread out the cost of ensuring robust ambulance service throughout the state.

Other legislators have proposed worthy measures this session to help rural ambulance services. But the Seeberger/Huot bill stands out for its “go big or go home” approach.

It identifies a funding source. It would provide a substantial and ongoing sum instead of piecemeal periodic assistance. It would also enable ambulance services to stay out of the annual battle at the State Capitol for general fund dollars. The current emergency-response challenges exist because ambulance services haven’t been a spending priority in too many previous sessions.

“If that were the solution, we would done it already,” Seeberger said. ”We’ve got to be creative."

So far, Seeberger and Huot are on a lonely crusade. The legislation has only one additional co-author in the Minnesota House and none in the Senate.

Seeberger remains hopeful, however. As for objections that the new fee would be unaffordable for consumers, she had this to say:

“The problem is that ambulance [services] can’t afford to keep operating the way things are. That’s who really can’t afford it.”