As rural hospitals close, we must protect access to air ambulances
By PJ Amartey
September 29, 2025
In Pagosa Springs, Colorado, the nearest cardiac center is over eight hours away by automobile — all the way in Colorado Springs. Often, in the case of life-threatening emergencies, residents must travel out of town to get the care they need. This was the case in 2023, when an elderly resident suffered a heart attack and needed immediate, specialized treatment to ensure a full recovery. Given the dire circumstances, an air ambulance was dispatched and transported the patient to a Level 1 trauma hospital in Colorado Springs in under one hour.
Stories like these are a common occurrence in rural and underserved parts of our country. Seniors, veterans and rural Americans depend on emergency air medical services to get the specialized care they need. Unfortunately, these lifesaving services are at risk and air ambulance bases may be forced to close if Congress doesn’t act.
Rural America is suffering due to a lack of adequate health care. There are a decreasing number of hospitals and fewer doctors, particularly specialty doctors, which leads to health disparities and worse outcomes for patients. Rural Americans are at greater risk of dying from heart disease, cancer and stroke1, in part because rural Americans tend to be older. These factors are compounded by the fact that rural Americans do not have access to the same kind of care as urban Americans.
The relentless wave of hospital closures has left many rural communities and residents reeling. Nearly 200 hospitals 2 have closed since 2005 and another 700 face the looming threat of closure.3 For people who live hours from the nearest medical facility by car, air ambulances are often the only — and many times, last — lifeline in an emergency. If air medical resources are taken away, the odds of a full recovery and, in some cases, survival, are slim.
Emergency air medical services serve as airborne ICUs. Each flight is staffed with highly skilled crews — paramedics, nurses and pilots — who are prepared to handle severe medical crises, from heart attacks to traumatic injuries. They dispatch only when called in by an EMT or attending physicians.
Despite their vital role, the air medical industry has been reimbursed by Medicare at a profoundly low rate — a rate that hasn’t changed in 25 years. Today, it covers just 59% of an air ambulance transport. Yet, the costs of operating an air ambulance base have increased 190 percent over the last decade. Almost all these expenses (90 percent) are fixed, such as maintenance, labor, facilities, medical supplies and training. If the Medicare reimbursement rate is not adjusted, millions of Americans, particularly those in rural America, will lose access to this essential lifeline.
Why has it been 25 years? Because the Centers for Medicare & Medicaid Services (CMS) has stated it does not have the authority to review and update air medical rates. That’s why Congress must pass the Protecting Air Ambulance Services for Americans Act. Supported by a broad coalition of health care advocates, rural advocacy groups and air ambulance providers, this simple, common-sense legislation would empower the CMS to evaluate and update the Medicare reimbursement rate for air ambulances using current, industry-provided cost data — a change that 84 percent of voters support.4 This bipartisan bill would help ensure air ambulance bases can continue serving rural communities without the threat of interruption or closure due to crushing costs.
Every American deserves access to emergency health care, regardless of where they live. Allowing air bases to close denies millions — many in rural areas — the chance for life-saving care when it’s needed most. SOAR is urging Congress to promptly pass the Protecting Air Ambulance Services for Americans Act and protect access to life-saving services for seniors across our country.
PJ Amartey is spokesperson for the Save Our Air Medical Resources (SOAR) Campaign.
Sources:
1 Leading Causes of Death in Rural America
2 States With the Most Rural Hospital Closures
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