First responders with the Houston Fire Department (HFD) are proposing expensive new charges for ambulance services in an effort to recoup expenses — including if a patient dies on the scene.

Should the proposal be approved by the city council, anyone who calls an ambulance in the future would pay $1,876 plus the standard $14.36/mile charge normally charged for an ambulance ride in the city. According to a recent Houston Chronicle report. that’s a 70 percent increase from the current rate charged for an ambulance.

However, some of the new additional charges HFD is charging are likely to prove even more controversial. In addition to fees for elderly patients who fall and can’t get up ($175), when a patient doesn’t need to be driven to the hospital after first responders give immediate treatment (also $175), and even when a patient dies at the scene ($365).

HFD chief Sam Peña defended the new proposed fees to the city council, saying the fire department was eating the bulk of current costs.

“In essence, the taxpayers of the city of Houston are subsidizing every medical transport call,” Peña told a city council committee on Tuesday. “We are not recouping what we incur to deliver that service.”

HFD assistant chief Justin Wells added that the fees are mainly for habitual callers, like elderly patients who call an ambulance to have them moved from their wheelchair to their bed, and from their bed to their wheelchair.

“These people that call routinely out of convenience instead of emergency, this might change their behavior,” Wells said.

However, the new proposed charges for ambulance rides will likely have a disproportionate impact on Houstonians who don’t have health insurance. According to the Chronicle, approximately one-third of Houstonians who call 911 are uninsured, and the city rarely collects anything from those trips. And because Texas is one of the states that never expanded Medicaid under the Affordable Care Act, more than two million Texans who would’ve gotten basic health insurance under Medicaid expansion remain uninsured.


International Association of Fire Chiefs emergency medical services chairman Mike McEvoy told the Chronicle that roughly one-third of major metropolitan fire departments already charge these fees, meaning ambulance service is growing ever more costly for uninsured Americans across the country. In one extreme example, a woman in Boston who mangled her leg at a train station begged bystanders to not call an ambulance because she couldn’t afford the cost due to a lack of health insurance, even though the laceration on her leg cut all the way to the bone.

The U.S. stands alone in its expensive ambulance fees. A 2016 report in The Guardian showed that ambulance costs in most developed countries are either free — like in the United Kingdom — or at a cost far lower than what American ambulances charge. The Commonwealth Fund’s 2017 rankings of national healthcare systems ranked the U.S. 11 out of 11 countries in overall healthcare system performance, as well as in individual categories like healthcare access, equity, and outcomes.


Scott Alden is a freelance contributor covering national politics, education, and environmental issues. He is a proud Toledo University graduate, and lives in the suburbs of Detroit.

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