Rural Alabama Deserves Real Answers

Guest Opinion by Brian Hardin, External Affairs Department Director, Alabama Farmers Federation

Rural Alabama has been waiting decades for access to affordable health services — and despite the empty promises of a bill funneling millions of dollars to large ambulance companies, we’re still waiting.

The stories of loss and heartbreak are real. We’ve seen them. We’ve lived them. The families who depend on rural ambulance services are not just our members. They are our families and neighbors.

Alabama Farmers Federation has been fighting for rural Alabama for over 100 years. We aren’t opposing SB 269 and HB 400 because we don't care about rural EMS. We oppose this legislation because we do care!

The math doesn’t lie. Alabama’s most rural counties would receive less than 10% of the money collected from this legislation. Although supporters claim it helps the ambulance crisis in rural Alabama, the bill directs more funding to big city ambulance companies than the 28 most rural Alabama counties COMBINED. Those 28 counties are the exact areas that need the most help. Protecting those counties — and the people who live there — is precisely why we oppose SB 269 and HB 400.

Of the estimated $21 million in new operator revenue generated by this bill, only $2 million reaches Alabama’s most rural counties. Supporters dispute this calculation, claiming the bill generates closer to $34 million. Even accepting their number, Alabama's 28 most rural counties would receive approximately $3.4 million, still less than 10% of the total. The distribution problem doesn't change. The numbers just get bigger.

Rural Alabama is being used as leverage to pass this legislation, but the reality is rural families will pay more and receive far less than big-city companies. In fact, the entire reimbursement formula of the bill is based on a single “super-rural” ZIP code in Greene County, Alabama. Yet, Greene County only stands to gain $25,000 from this legislation, while Huntsville Hospital collects nearly $4 million annually, and a New York private equity firm gets more than $2 million. 

Sending pennies to rural counties will not solve the ambulance crisis real Alabamians are facing. Worse yet, it subsidizes a few large companies by taking money from farmers, small businesses, teachers and state employees.

Alabama families deserve to know what this bill actually does before it becomes law.

SB 269 and HB 400 would raise insurance premiums for the 10% of Alabamians already struggling most to afford health coverage. Medicaid and Medicare patients are specifically exempt from the bill, and state legislation cannot mandate rates for self-funded employer plans governed by the federal ERISA law. That means self-employed individuals like farmers; small businesses with commercial plans; and teachers and state employees will pay the full cost of the bill. Because 90% of ambulance rides are exempt, this legislation closes only 6% of the funding gap the ambulance industry itself says exists.

SB 269 and HB 400 are a hidden tax. This legislation would send 90% of the money from YOUR higher insurance premiums to a few large companies operating in metro areas. Only 10% of the money would reach EMS providers in the most rural counties.

Let’s find a REAL solution. Alabama farmers and rural families deserve answers that address the availability and affordability of health care services. SB 269 and HB 400 do not accomplish that. We are eager to explore options that will address the EMS crisis without shifting costs to a small fraction of patients while benefiting a few large companies.

Alabama is set to receive more than $200 million through the Rural Health Transformation Program. The Legislature has laid a foundation for improvement with Alabama’s Rural Roadmap. It’s time to address the health care crisis in rural Alabama. Sending millions in higher insurance premiums to a few companies is not the answer.

Rural Alabama is waiting.

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