Wyoming’s Emergency Medical Services ‘in limbo’

LANDER —  In Wyoming, emergency medical care is non-essential. While people may feel that the ability to reach the hospital after a heart attack or a life-threatening car crash is vital to the health and wellbeing of themselves and their loved ones, legally speaking, the state of Wyoming does not consider it essential.

No one – at any level of Wyoming government – is required to provide ambulance service.

That leaves one glaring question: Who should provide ambulance service, and how should it be paid for?

After struggles with ambulance service last year, the Fremont County Commission appointed an ambulance task force including Commissioner Mike Jones to consider future funding options.

This task force met once, Jones said, and decided it had a variety of potential options to explore.

“We figured we had a couple of good options on the table,” he commented. “Things are kind of in limbo.”

Among the options considered are a sales tax, forming a special EMS district, and repurposing part of the existing half-percent economic development tax.

Some Fremont County commissioners are opposed to this last option, Commissioner Jenny McCarty explained, because they feel it stands on dubious legal ground: How does an ambulance constitute economic development?

Some Wyoming counties have no ambulance service at all – but McCarty said those counties are much smaller than Fremont County.

“We’re bigger than eight states,” she pointed out. “That’s a lot of dirt – and people are spread out all across it.”

A $2M price tag

Ambulance service in Fremont County has evolved over the years, at various points being entirely private-run, all-volunteer, fully county-operated and eventually winding up where it is today: a service provided through the county via a contract with a private company.

The county contracts with Frontier Ambulance to provide its emergency medical services.

But after its union workers voted to strike last fall, Frontier Ambulance and its parent company, Priority Ambulance, asked the county commissioners for an additional $386,796 to help cover the cost of the increased wages the workers were asking for.

In September, United Steelworkers Wyoming Union leader Will Wilkinson told this paper that low wages were leaving ambulance services short-staffed, leading to slower response times and EMTs working longer and longer shifts. The workers asked for an increase from a base rate of $12.58 an hour (for the lowest-paid EMTs) to $15 an hour.

The commissioners eventually voted in favor of the increase, bringing the county’s total ambulance expenditure up to about $1.8 million annually.

“It’s paid for this year out of the budget – but it’s unsustainable,” McCarty said.

She explained that the county had to dip into emergency reserve funds to cover the cost increase; with the county facing budget difficulties this year, that isn’t a long-term solution.

Unlike some of the other services provided through the county, Frontier Ambulance doesn’t necessarily bring the commission information about its budget or operations; as a private entity that the county contracts with, it is under no legal obligation to do so.

It used to provide periodic reports to the commissioners on how many people it had transported, but, said McCarty, it hasn’t done so for some time now.

And even if the county wanted to, shopping around isn’t much of an option.

There aren’t many organizations providing ground ambulance service in Wyoming, and if it intends to continue contracting for private ambulance service, the county doesn’t have a wealth of other companies from which to choose.

“They can walk away today; they can walk away tomorrow,” McCarty pointed out.

Although the county owns the ambulances and medical equipment and has worked out a memorandum of understanding that allows it to use these to provide services in emergencies, longterm “there is no back up.”

Property tax, sales tax

The 2023 bill that allows for the formation of emergency medical districts, sponsored by Sen. Cale Case, R-Lander, and co-sponsored by Rep. Lloyd Larsen, R-Lander, outlines a specific process by which such a district can be formed.

The county commission must create a board of directors, which will then be responsible for evaluating the financial needs of emergency medical service and collecting payment from private insurance, Medicare and Medicaid.

The county can then levy a tax of up to two mills if the district was formed by a group petitioning the commission, and up to four mills if established directly by the county commission via a resolution, based on the assessed funding needs of the district after it has collected payment.

Districts are a more sustainable source of funding than sales taxes, which have to be reapproved by voters every few years.

But property taxes are often unpopular, and some feel unfair; Jones and McCarty said that several members of the public have communicated to the commission that they feel that funding the ambulance with a mill levy wouldn’t be equitable, not least because some of the areas that the ambulance currently provides service to don’t pay county property taxes.

On the other hand, the EMS district – and therefore the area it services – doesn’t necessarily have to correlate with the county’s boundaries.

An EMS district does have to consist of a specific, bounded geographic area, but the group forming the district, whether it’s a group of citizens or the county commissioners, can select any area that they want to within the county.

The idea of changing the memorandum of understanding (MOU) regarding the current half-percent sales tax has been strongly supported by some and met with opposition from others.

The half-percent tax cannot pay for the full nearly $2 million cost of the county’s contract; across the various entities that receive half-percent funding in the county, a total of $854,376 would be repurposed to help cover ambulance costs under the new MOU.

Opponents of the changes have included those who feel their legality is questionable and those who wonder what would happen to ambulance service if the half-percent tax failed to pass the ballots this November.

Lander City Council’s lone “no” vote on the new MOU, Missy White, objected to the altered MOU because she said the percentages of funds being taken from municipalities versus the county were out of balance. The question isn’t whether there’s a plan B, said White. She’s sure the county has a plan B, C and D – but she wants to know what those plans are.

“Bottom line, there has to be a funding mechanism – and it should be the people who use it who pay for it,” Larsen said.

Statewide challenges

“Our system is not working. We’ve got challenges, and people are falling through the cracks,” Gov. Mark Gordon remarked during the Wyoming Press Association convention this past January.

Around the state, he said, ambulance services are struggling; when you call 911, he pointed out, people have a reasonable expectation that someone will show up. But when it comes to medical emergencies, there are parts of Wyoming where that simply isn’t the case.

Fremont County isn’t alone in its ambulance woes – and part of the problem, Gordon said, comes back to whether it is legally considered essential.

“How do we make it an essential service?” he asked.

Some people believe the state of Wyoming should play a larger role in helping counties and municipalities fund ambulance services.

“Ultimately the question is … whose responsibility is ambulance service?” Larsen remarked. “Is it the responsibility of the state, or should it be more local?”

The county commission may be under no legal obligation to provide emergency medical services – but, McCarty said, she at least feels a moral and ethical obligation to make sure the people of Fremont County have access to life-saving health care when they need it.

“My number one job is to make sure that everybody is safe and sound in this county,” she commented.

For now, the county commission’s ambulance task force has made no reportable further progress since its first meeting. If it’s hoping to add a new potential tax to the ballot, it still has a little time to put it together; the deadline for adding measures to the November ballot is August 25.

This story was published on July 3, 2024.