Why It Matters

Rural ambulance services are closing at alarming rates, leaving millions of Americans without timely emergency care. The American Ambulance Association is pushing for three key solutions—extending temporary Medicare add-on payments, securing funding for EMS workforce development, and winning reimbursement for treating patients on-site without hospital transport—because current Medicare reimbursement covers only a fraction of actual ambulance service costs. The timing is strategic: Congress is showing unprecedented bipartisan interest in EMS reform, with multiple bills directly aligned to AAA’s priorities.

By the Numbers

The American Ambulance Association has filed 267 disclosures and spent approximately $27.8 million on federal lobbying over two decades, demonstrating sustained commitment to EMS policy.

For the fourth quarter of 2025, AAA retained Lester Health Law PLLC for $60,000—consistent with typical quarterly spending. Kathleen J. Lester, the sole listed lobbyist, has represented AAA since 2010, providing continuity on healthcare reimbursement issues.

AAA employs a multi-pronged approach. In-house staff handles 78 disclosures ($18.72 million total), while external firms handle specialized issues. Lester Health Law leads externally with 49 disclosures ($2.25 million).

The Agenda

The American Ambulance Association is lobbying on three core issues: extending Medicare ground ambulance add-on payments, securing continued funding for EMS workforce development grants, and advancing regulatory and reimbursement policies.

Specifically, AAA is pushing for passage of the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232 / S. 1643), which would extend temporary Medicare add-on payments for ground ambulance services. The association is also advocating for the Comprehensive Alternative Response for Emergencies (CARE) Act (H.R. 2538 / S. 3145), which would create a Medicare payment model reimbursing ambulance crews for treating patients on-site without transport.

Broader Context

AAA’s fourth quarter 2025 lobbying arrives amid a critical juncture for emergency medical services policy. Rural ambulance closures are accelerating, with 4.3 million Americans now living in "ambulance deserts"—locations more than 25 minutes from an ambulance station. The fundamental problem: Medicare reimburses roughly $390 for basic life support services that cost approximately $940.

The EMS sector faces an unprecedented staffing crisis, with average EMS personnel age exceeding 50 in some states and over 80 percent of ambulances relying on volunteers in rural communities. Multiple states advanced aggressive Medicaid reimbursement increases—Texas proposed raising ambulance rates up to 50 percent, while Wyoming backed 100% Medicaid rate increases.

Between The Lines

AAA’s lobbying arrives amid significant congressional activity on EMS funding. Multiple bipartisan bills directly align with AAA’s advocacy priorities, with strong bipartisan sponsorship. Senators Susan Collins (R-ME), Catherine Cortez Masto (D-NV), Bill Cassidy (R-LA), and Peter Welch (D-VT) lead the ground ambulance bill, while Representatives Terri Sewell (D-AL-7) and Claudia Tenney (R-NY-24) champion the House version.

Competitive Landscape

AAA’s legislative priorities are publicly backed by a powerful coalition including the International Association of Fire Fighters, International Association of Fire Chiefs, National Association of Emergency Medical Technicians, and the National Rural Health Association. This united front suggests AAA is operating within a broader consensus on the urgency of EMS funding and workforce challenges, rather than advancing a narrow organizational agenda.

The Bottom Line

The American Ambulance Association paid Lester Health Law PLLC $60,000 in the final quarter of 2025 to advocate for extending Medicare ground ambulance add-on payments, securing EMS workforce development grants, and advancing treatment-in-place reimbursement policies. The lobbying aligns with active bipartisan legislation backed by a coalition of fire chiefs, firefighters, and rural health groups, representing hundreds of ambulance services and 150,000-plus paramedics and EMTs.

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