With the rise of the Tea Partiers and change of majority in the House of Representatives, the 112th Congress is quite a bit different than the 111th. But supporters of Advocates for EMS' field EMS bill hope it will still resound with legislators in this age of financial austerity. Key provisions are structured with that appeal in mind.
Section 13 of the bill as it was first introduced last year--H.R. 6528, the Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act, sponsored in the House by Reps. Tim Walz (D-MN) and Sue Myrick (R-NC)--creates an emergency medical services trust fund that lets taxpayers voluntarily contribute to a pool of money to pay for EMS programs.
"We wanted to find a means to promote federal support for field EMS in a way that didn't increase the budget deficit and wasn't a tax or user fee," says Lisa Tofil, JD, who represents Advocates for the law and lobbying firm Holland & Knight. "The trust fund is something that can provide sustained funding into the future and not be subject to the ebbs and flows of the budget."
If enacted, the idea would work similarly to the presidential election campaign fund checkoff that appears on U.S. tax return forms: Taxpayers wishing to contribute simply mark how much they want to go to the fund. Amounts start at $1 but, unlike the campaign fund donation, can go higher. However, while campaign fund donations are paid by the government from collected tax revenue, EMS trust fund donations would come out of taxpayer refunds.
From those fund monies, the Walz-Myrick bill authorized:
- $11 million a year to support a lead federal agency in NHTSA, the National EMS Advisory Council, improved medical oversight, emergency care coordination and evaluation of alternative care delivery models;
- $200 million a year for grants to bolster quality, access, innovation and preparedness;
- $50 million a year for grants to enhance system performance, integration and accountability;
- $15 million a year for education grants; and
- $45 million a year for field EMS research.
Obviously, things can change from one Congress to the next and on a bill's journey from introduction to disposition. If and when the field EMS bill is reintroduced for this Congress (by EMS On the Hill Day in May, Advocates hopes, if not sooner), it may advance in whole or just in part. Components may be changed, added or removed. Parts may be stripped and appended to other bills. Introduction is just the beginning of the journey.
But even since last year's first run, Advocates has worked to solicit additional feedback and refine its legislative language for strength and broader support. Most recently it hosted a summit of stakeholder groups in March to hear their thoughts about sharpening the product.
The idea of a lead federal agency for field EMS remains a point of debate. While most folks seem to support one, opinions still differ on where it's best located. The Walz-Myrick bill created one in NHTSA's Office of EMS. Since then, a white paper from the International Association of EMS Chiefs and National EMS Labor Alliance surfaced arguing that authority for such an entity need not be created, but already exists within the Department of Homeland Security through the Homeland Security Act of 2002.
There's even greater momentum, though, behind the notion of putting a new office in the Department of Health and Human Services. After hearing from supporters, Advocates revised its bill in March to consolidate a range of field EMS functions under a new Field EMS Administration (FEMSA) within HHS. The consolidation would move the mission, programs and personnel of NHTSA's office to this new body, and transfer other existing programs, like EMS for Children, to it as well.
Advocates remains open to discussion. But Tofil notes the best home for a new agency should hinge on what the EMS community expects that agency to do.
"One of the things we've spent a lot of time discussing is the purpose of a lead federal agency," she says. "What is it there for? What does the community think is going to occur? How is having it going to help the EMS community in its service of patients? We think it makes sense to look at this functionality: What do we want it to do for EMS?"
That's a big, sexy question, but it's not all there is to talk about, and community feedback has been vital to refining the bill in other areas too. Since the last Congress ended, it's led to honing language in areas like medical direction and grant-program accountability, among others.
It's a turbulent time in Congress, but field EMS legislation has bipartisan support in the House and, with the trust fund, doesn't cost any new money. That, its backers hope, will make it a palatable sell to budget hawks. Ongoing consensus-building efforts also ought to make the bill's next version a stronger, more focused product for House reintroduction, and eventual introduction in the Senate.
Once that's achieved, the onus turns back to you, front-line EMS folks. Legislators need to hear your support for the bill, and your desire they vote for it.
"We're going to need the active participation of the EMS community across the board," says Tofil. "The squeaky wheel gets the most attention in Congress, and if we want to get the bill enacted, as a whole or even in pieces, members need to hear from folks back home that it's important. It will be vital for the EMS community to engage and communicate with their members of Congress, whether that's by participating in EMS On the Hill Day, communicating by letter or e-mail, meeting with lawmakers back in their districts or inviting them to visit EMS agencies and see what they're doing. There are many different ways of advocating, all of which are good, and none of which are mutually exclusive."