By NextBestFitGetting to care: transportation and ambulances
Missed appointments from lack of transportation are common; ground-ambulance bills are not covered by surprise-billing protections; rural EMS services are closing.
Evidence
- About 281,000 EMTs & paramedics, mean wage about $52,750.Sources: Bureau of Labor Statistics (2026)
Who's affected
Who is hurt
- Older adults: Lack of transportation causes missed appointments.
- People with ongoing or specialist care needs: Lack of transportation causes missed appointments.
- Rural residents: Closing rural emergency transport services reduce access to care.
Who gains while it lasts
- Private ambulance operators: Out-of-network ground ambulance bills lack surprise-billing protections.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
- EMS funded by local budgets and fee-for-service
- No coverage for non-emergency transport in most plans
Related costs
Open questions
- Should transport to care be a covered benefit?
- Should EMS be funded as public infrastructure?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Convert to emergency and outpatient centersRural hospital closuresChosen
Removing rural inpatient beds makes travel longer for inpatient care and births.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Cover ambulances (ending surprise bills for ground ambulances) and rides to care for everyone, not only Medicaid.
- +Getting to care: transportation and ambulances
- +Surprise billing and a runaway arbitration system
- −Fraud and improper payments
- −Raises spending or loosens control over it
- −Medical errors and poor care coordination
Fund ambulances by budget like fire departments, not per trip.
- +Getting to care: transportation and ambulances
- −Raises spending or loosens control over it
- −Reduces income or business for affected groups
Also addressed by paths for other problems
Standby payments to keep labor units openMaternity care desertsChosen
Standby payments keep births local, reducing the need for long drives during labor.