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Opinion: EMS picking up the pieces: Why I support Amendment 2


The 10 rural hospital closings across Missouri since 2014 have gotten plenty of attention lately, and like many, I’m supporting the Amendment 2 Medicaid expansion vote on Aug. 4 to help our struggling rural providers.

When rural hospitals close, local economies are devastated, frontline health care worker jobs irretrievably lost. But for those of us who work in emergency medical services, this issue boils down to one thing — local hospital closures make it harder for us to save lives. Period. 

Justin Duncan
Justin Duncan

After nearly two decades in emergency medicine — as a critical care paramedic, EMS educator, and now director of a county ambulance district — I’ve lost track of how many patients didn’t seek medical care for a treatable or preventable illness until forced to call 911. 

And when they finally do, this rash of rural hospital closures means we must transport that patient 25 or even 50 miles further. In some cases, this could be the difference between life or death. And it is heartbreaking.

In Washington County, about one hour southwest of St. Louis, we face both a high poverty rate and above-average rates of heart disease, obesity, high blood pressure, and diabetes. Patients without insurance postpone treatment they can’t afford. They call for help only when the pain is unbearable or their conditions deteriorate, a crisis that could have been avoided with proper access to care. 

In the emergency care world, we don’t turn people away, regardless of their ability to pay. So who absorbs those costs? You guessed it — us as taxpayers. 

The Amendment 2 ballot initiative is an investment in our state’s future. It enjoys broad support from hundreds of organizations across the state, including local and county ambulance districts such as my own, as well as our industry’s three statewide groups: the Ambulance District Association of Missouri, the Missouri Ambulance Association, and the Missouri Emergency Medical Services Association.

We paramedics and emergency medical technicians know all too well how the epidemic of rural hospital closures in Missouri and nationwide is making us sicker. 

Missouri’s rural hospital closure rate is among the highest rates in the country. Nationwide, at least 130 rural hospitals (where the rate of uninsured patients is higher) have closed in the past decade (most in the 14 states that haven’t expanded Medicaid), with hundreds more remaining in financial peril.

The shutdown of hospitals in places like Boonville, Farmington, Poplar Bluff, Mount Vernon, and Sweet Springs don’t just mean longer, riskier drives. It often means the loss of a town’s biggest employer, an economic, social, and cultural death knell from which many towns never recover. 

A recent independent study on behalf of the Missouri Foundation for Health found that Medicaid expansion will create more than 16,000 new jobs annually over its first five years, with nearly 80 percent of those from outside the health care industry. 

Ninety percent of those new jobs would pay more than $15 an hour, with most of the new positions located outside of St Louis and Kansas City. 

And similar to a rash of other studies, the research found that the reduction of state government spending (through higher federal reimbursement rates) “would effectively expand Missouri’s operating budget to reallocate funding for other priorities.”

Put another way, Medicaid expansion would allow us to bring more than $1 billion in tax dollars home from Washington each year – money that instead goes to the three dozen states to already expand Medicaid, places like Arkansas, Ohio, California, and New York

If the countless patients that we see in crisis had insurance, would they see a primary physician on the regular? Would they do their follow-up care with specialists? Would they participate in routine screening exams and diagnostics?

How much money could we save the system if our patients just had the ability to manage their conditions — and how many lives could be saved if they had regular access to the health care system, not only in a crisis situation?