National EMS Week is underway, and South Dakota ambulance providers serving smaller towns and cities say they're barely getting by, with aging crews and whatever funding they can cobble together.

A legislative committee will soon study these issues. This summer, the interim panel will look at staffing woes for emergency medical services across the state.

It'll also dive into access barriers to trauma response in remote areas.

Brian Hambek, executive director of the Spearfish Emergency Ambulance Service and president of the South Dakota Ambulance Association, said these problems have been examined before, but the challenges aren't going away.

For example, he said his crew in Spearfish has two 82-year-olds helping out.

"We can't seem to get a lot of the younger kids to do this," said Hambek. "And a lot of that is because of the finances -- we're having a hard time paying people what they deserve and what they need."

Hambek said reimbursement rates from private insurers, as well as Medicaid and Medicare, aren't high enough for ambulance providers to keep up with operational costs.

States can set their own rates, but there's a bipartisan bill in Congress to help rural areas. However, it's unclear if it'll gain momentum.

In the meantime, Hambek said he hopes the South Dakota committee identifies lasting solutions.

Hambek credited the state for enhancing EMS support in recent sessions. But a bill this year that would have classified these services as essential failed in the legislature.

Unlike police and fire, Hambek said an ambulance provider no longer able to stay in business could shut down with little warning.

"We do almost 3,000 calls a year here on Spearfish," said Hambek, "and I could talk to my board tomorrow and say, 'We're closing the doors as of the first of June,' and there's nothing the city or county could do."

There was disagreement over the proposed funding mechanism to ensure all South Dakota communities had access to EMS.

Ambulance providers from larger cities say they sometimes have to assist with calls from surrounding towns where there are coverage gaps, leading to longer response times.




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While cuts to food support programs and Medicaid gained attention as the debate over the budget bill went on, there is also a long-term likelihood it will result in automatic spending cuts to Medicare.

According to the Congressional Budget Office, the reconciliation bill is projected to add more than $3 trillion to the deficit over 10 years. If the estimate is accurate, the Statutory Pay-As-You-Go Act would require the executive branch to enact automatic spending cuts, including 4% annual cuts to Medicare starting in January, translating to around $500 billion in cuts over 10 years.

John Geer, professor of political science at Vanderbilt University and co-director of the Vanderbilt Poll, said a spring survey found Tennesseans were broadly opposed to cuts.

"We ask about Tennesseans' willingness to support cuts to Medicaid, Medicare, Social Security, veterans, etc.," Geer outlined. "And the truth of the matter is that Tennesseans are opposed to cuts in any of these programs. And it doesn't matter your partisan stripe, whether you're a liberal Democrat or a conservative MAGA-ite, you don't want to see these programs cut."

More than 1.5 million Tennesseans depend on Medicare. Congressional action would be needed to avoid automatic cuts, likely requiring a 60-vote majority in the Senate.

While funding to research under the National Institutes of Health would not be subjected to automatic cuts, the Department of Government Efficiency has already fired 2,500 researchers at the NIH and canceled more than 800 research grants. Geer's polling found more than 70% of Tennesseans oppose cutting funding for basic research.

"We asked a battery of questions about cutting research at universities, at hospitals, for drug discovery, etc., and again, there's partisan differences," Geer reported. "The MAGA folks, so to speak, are happy to do the cutting but the rest of the state has concerns."

The poll found 73% of Tennesseans support research at teaching hospitals and 66% supported research at universities.


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As the U.S. Senate has approved President Donald Trump's tax cut and spending bill, health care advocates are hoping to get California's Republican members of Congress on board to reject huge potential cuts to Medicaid, known as Medi-Cal in the Golden State.

The House approved the massive budget bill once before but now must reconsider the changes made in the Senate.

Matthew Herdman, California state director for the nonprofit Protect Our Care, hopes three California House members in particular will "flip" their votes.

"We believe that it's possible to stop this," Herdman explained. "When it initially came through the House, it only passed by one single vote, which means any one -- of David Valadao, Young Kim or Ken Calvert -- could vote against this in order to stop it."

The Congressional Budget Office estimated the Senate version of the bill would slash about $1 trillion from Medicaid and other health programs and it is forecast to cause almost 12 million people to lose health coverage by increasing work requirements and requiring people to verify their eligibility more often. Backers said the savings are necessary to partially cover the cost of extending Trump's 2017 tax cuts.

Rep. David Min, D-Calif., who represents parts of Orange County, said the bill would still increase the national debt by trillions of dollars.

"It's all because of this completely evil and immoral agenda to give more money to people in the world who don't need it," Min asserted. "This is so wrong, and we need to fight back."

Naida Tushnet, a member of the Long Beach Gray Panthers, said she is worried about low-income older people who rely on both Medicaid and Medicare, particularly for long-term care.

"If they have to keep filing, even if they're capable of doing it all, they're going to fall into the cracks, because the system -- that's all online -- has been stripped of humans, because they fired all those other people who could take it on the phone and talk them through it," Tushnet outlined.

President Trump has set a deadline of July 4 for final passage of the bill, so the Republican leadership in the House is furiously negotiating and will try to hold a vote in the next few days.


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An Illinois professor cautions against premature celebrations of victory or defeat after the U.S. Senate passed President Donald Trump's budget reconciliation bill Tuesday.

The Senate narrowly passed an amended version of the bill after Vice President JD Vance's vote broke the 50-50 deadlock. The bill now goes back to the House because of the changes made to it in the Senate.

Brian Gaines, professor of political science at the University of Illinois, said the narrow margin in both chambers still makes the bill's future uncertain.

"We've seen the House being pretty unruly lately and it's a very small margin for the Republican majority, so I think there's a lot of suspense about what the House is going to do next," Gaines explained. "This is not yet the time for a victory lap for Donald Trump or the '(One) Big Beautiful Bill (Act).'"

Gaines noted Rep. Mike Johnson, R-La., the Speaker of the House, has already faced difficulties in uniting the Republican Party on key issues like Medicaid, Social Security and local and state taxes. He added the changes made in the Senate to address the issues could further complicate its fate in the House.

The House will now work to pass the bill by Friday. Gaines views the President's July 4 deadline as potentially flexible, yet strategically important, since most folks in Congress would like to go home for the holiday weekend.

"The danger, of course, of people going back home is that they're more likely to hear opposition than support," Gaines observed. "You might end up with a caucus that's even harder to get on board after they've had the chance to hang around barbecues and have people complain to them."

Gaines emphasized the difficulty of passing legislation with small majorities and praised Johnson's skill in navigating the challenges. He noted the unpredictable nature of large legislative outcomes and the uncertainty about exactly what's in the massive bill make it hard to hone in on any implications.

"Surprisingly often, when there's a very big bill like this, 'We have to pass it to know what's in it,' turns out to be true in some respects," Gaines added. "Some of the consequences you see months later are not the ones that we were talking about in advance."