There is no doubt this upcoming presidential election is one of the most important events in a generation. COVID-19…civil unrest…the stakes are high. But how does it affect us, the first responders on the ground? How will this election impact EMS?
To gain a better understanding, let’s dig into the details of both major candidates’ healthcare plans. As a disclaimer, the analysis of Joe Biden’s plan is based off the Affordable Care Act of 2010, when Biden served as vice president. The former VP has vowed to expand the Affordable Care Act and keep in place many of its key objectives.
Joe Biden’s Healthcare Agenda
The Affordable Care Act (ACA), better known as Obamacare, is one of the most comprehensive and bold proposals of healthcare reform in our nation’s history. Its multifaceted legislation aimed to address uninsured individuals while promoting preventative health. Although many consider it an extraordinary accomplishment by the Obama Administration, most agree further modifications and reforms are still needed.
Regarding paramedicine, a Biden presidency would affect emergency medical transport and care in four major ways.
First, through the expansion of both Medicare and Medicaid, Biden intends to expand healthcare coverage to all Americans.1 The main consequence to us as providers would be a higher volume of patients requiring transport to the hospital.2 Even though one of the objectives of expanding coverage is for individuals both healthy and sick to seek care with their primary care physician before going to the emergency department, the evidence tells us this is not always the case—more individuals are using their local ED as their go-to doctor.3 Some credit this to the Affordable Care Act’s failure to expand the healthcare infrastructure while simultaneously expanding healthcare coverage.4
Secondly, a Biden presidency would prioritize underdeveloped rural health systems, particularly through grants issued by the Center for Medicare and Medicaid Innovation (CMMI).3 Although it is unclear how much discretion individual healthcare networks—including hospitals, local rescue squads, and private EMS systems—would have when using the grant, some hospitals would likely invest this money to better establish their own community’s paramedicine infrastructure.3 This, perhaps, will shift jobs from private/local EMS to hospital-based EMS systems.
In addition to the subsidies many rural healthcare systems would receive, the Biden healthcare plan would encourage hospitals to use accountable care organizations (ACOs). ACOs aim to decrease costs and improve patient outcomes by leveraging strong collaborations among healthcare professionals, minimizing administrative errors, and implementing preventative care.5 With hospitals held more accountable for the outcomes of their patients, EMS providers will also be held to a higher standard by their receiving hospitals; if EMS agencies fail to comply with these new, high standards, hospitals have the right to establish their own EMS units—both BLS and ALS.6
Doubling down on hospital accountability, the Biden plan also proposes that hospitals with patients preventably readmitted within 30 days of discharge will not receive the full reimbursement for services they provide.7 This will lead to hospitals dispatching case management teams directly to patients, eliminating the cost of housing them in EDs. This practice also ensures hospitals receive the entire reimbursement from the government. For EMS professionals, this may reduce our load of frequent flyers.
Through Medicaid and Medicare expansion, new preventive care measures, and greater emphasis on hospital accountability, the Biden healthcare plan will without a doubt alter the way we do our jobs.
Donald Trump’s Healthcare Agenda
Professionals across the political spectrum agree the Republican incumbent has no clear agenda concerning healthcare—that helped Democrats retake the House of Representatives in the 2018 midterm elections. While the president does see healthcare as a kitchen table issue in this election, he believes reforms to lower drug prices while providing greater consumer transparency constitute the best approach to fixing American healthcare.
One of the president’s most significant legislative actions has been removing the mandate for individuals to obtain healthcare coverage—citizens no longer get penalized for not having healthcare insurance. As a result, the country at large should expect to see greater instances of preventable, chronic diseases in patients: Without health insurance, more people are reluctant to see their primary care physician and thus less likely catch health conditions early.8
The Trump Administration has also made efforts to fight the opioid drug crisis. This includes nearly $900 million in new funding to states and local governments, emphasizing prevention education and first aid training opportunities.9 The benefits for EMS professionals here are twofold: The general public will be better informed on how they can assist in case of an opioid overdose, and people will be better informed on the dangers of opioid usage, which will hopefully reduce the number of opioid emergencies we respond to.
Like Biden, Trump also sees the crisis America is facing in rural healthcare delivery systems. EMS response times are increasingly long, rural hospitals are over capacity, and there is a serious shortage of healthcare professionals.10 To address it, the Trump Administration passed the Rural Action Plan, which focuses on implementing new healthcare technology and increasing healthcare capacity. The legislation enables the Substance Abuse and Mental Health Services Administration (SAMHSA) to invest $5 million to recruit and train EMS personnel in rural areas over a one-year period; reforms the wage index to increase payments to hospitals and allow for new investment to improve quality and foster competition; and expands telehealth capacity to reach patients more quickly and efficiently.10 This effort should enhance the quality of health networks in rural areas and improve the recruiting process for new emergency medical professionals. Moreover, the advance in telehealth could assist in quickly delivering care to patients in remote locations and help limit long transports to the hospital.11
Although Trump’s vision for healthcare is still unclear, EMS providers can look forward to subsidized educational programs, a more informed public, and fewer nonemergent transports if the president is reelected.
This article is not an endorsement; the objective is to inform you of some of the differences between the two candidates’ positions on healthcare topics. Both leaders embrace the urgency of the American healthcare crisis, though Biden has a more clear-cut plan to address it. Unfortunately, issues like surprise billing—where patients are billed out-of-network rates for their emergency care without full consent—and the decoupling of quality of care with maximizing economic efficiency are issues both political parties fail to address.12
Regardless, as EMS professionals, we must continue to adapt to new policies, stay informed, and let the data guide our decision making.
Lastly, no matter whom you support, it is imperative that you to voice your opinion and vote either by mail or in person on November 3.
Acknowledgements: A special thank you to Prof. Laura Olson for her thoughtful insight and her contributions to political science. I would also like to thank Prof. Holona Ochs and Liz Giambattista for their contributions.
1. Sotomayor M. What’s in, and out, of Biden’s health care plan. NBC News, Meet the Press Blog, 2020 Sept 4; www.nbcnews.com/politics/meet-the-press/blog/meet-press-blog-latest-news-analysis-data-driving-political-discussion-n988541/ncrd1030086#blogHeader.
2. Ginde AA, Lowe RA, Wiler JL. Health insurance status change and emergency department use among US adults. Arch Intern Med, 2012 Apr 23; 172(8): 642–7.
3. Ostermayer DG, Brown CA, Fernandez WG, Couvillon E. Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature. West J Emerg Med, 2017 Apr; 18(3): 446–53.
4. Landro L. The Doctor Won’t See You Now. Wall Street Journal, 2020 Sep 9; www.wsj.com/articles/the-new-doctors-appointment-11599662314.
5. Woods L, Slotkin JR, Coleman MR. How Employers Are Fixing Health Care. Harvard Business Review, 2019; https://hbr.org/cover-story/2019/03/how-employers-are-fixing-health-care.
6. Ludwig G. How the Affordable Care Act Will Change EMS. J Emerg Med Serv, 2013 Apr; www.jems.com/2013/04/04/how-affordable-care-act-will-change-ems/.
7. Patel A. The Effects of Obamacare on Your EMS Service. Carolina Fire Rescue EMS Journal, 2014 Jan 23; www.carolinafirejournal.com/Articles/Article-Detail/ArticleId/3649/The-effects-of-ObamaCare-on-your-EMS-service.
8. McWilliams JM. Health Consequences of Uninsurance Among Adults in the United States: Recent Evidence and Implications. Milbank Q, 2009 Jun; 87(2): 443–94.
9. Morse S. Trump Administration Announces $1.8 Billion in Funding to States to Combat Opioid Crisis. Healthcare Finance News, 2019 Sep 4; www.healthcarefinancenews.com/news/trump-administration-announces-18-billion-funding-states-combat-opioid-crisis.
10. Department of Health and Human Services. HHS Releases Rural Action Plan, 2020 Sep 3; www.hhs.gov/about/news/2020/09/03/hhs-releases-rural-action-plan.html.
11. Munjal KG, Margolis GS, Kellermann AL. Realignment of EMS Reimbursement Policy: New Hope for Patient-Centered Out-of-Hospital Care. JAMA, 2019 Jun 21 [epub ahead of print].
12. LaPointe J. Studies Examine Surprise Billing for Ambulance Rides, ASC Visits. Revcycle Intelligence, 2020 Apr 24; https://revcycleintelligence.com/news/studies-examine-surprise-billing-for-ambulance-rides-asc-visits.
Ross Bell, EMT-B, serves with the Millburn-Short Hills Volunteer First Aid Squad in Millburn, N.J.