Muscatine supervisors hold public hearing and pass first reading to declare EMS an essential service

The Muscatine County Board of Supervisors opened a public hearing May 4 to consider declaring emergency medical services (EMS) an essential service and approved the measure on first reading, 4–1.

Presenter (S5), who outlined the proposal, said the step would begin a multi-stage process: the board would adopt a proclamation on first reading, appoint an EMS advisory council to review budgets and recommend a levy, and ultimately place a public measure on the ballot. “This is kind of the first step… basically to levy up to 75¢ per thousand dollar valuation for EMS,” Presenter (S5) said, adding that the public would have the final say at the ballot box.

Why it matters: Board members and respondents said the levy aims to shore up funding as many ambulance services do not recover their full operating costs from billing and reimbursements. An EMS representative noted billing shortfalls: “If I put an ALS rig out… I can bill $1,478. Medicare and Medicaid will pay me $360,” (Committee member (S3)). Those reimbursement gaps, officials said, make sustaining volunteer-dependent services increasingly difficult.

Public input and process details: Presenter (S5) told the board the advisory council would collect annual budgets from transport agencies and first-responder districts, recommend a levy rate (the council’s recommendation would return to the board for final approval), and could set aside a portion of funds for capital expenditures. Staff estimated the $0.75 levy could generate roughly $1.4 million to $1.7 million annually; staff and members agreed the board is responsible for final levy approval. The auditor’s office deadline to submit public measures was noted as June 2, which staff said makes this measure more likely for next year’s ballot.

Residents and elected members raised questions about equity, cross-jurisdiction districts and how the city of Muscatine’s existing enterprise-funded ambulance would be handled. Several speakers emphasized the unique configuration of Muscatine County — a city with a paid ambulance surrounded by volunteer services in rural districts — and how that affects achieving the 60% voter threshold required for passage. Presenter (S5) said neighboring counties have followed similar processes; some passed the measure while a few did not on their first attempt.

Public testimony included a personal appeal from Becky Brisker of Moscow, who said mutual-aid responders helped save a life in her workplace and urged supervisors to support essential-service designation to preserve coverage in smaller communities. “Without the ambulance service… somebody from West Liberty came over and was instrumental in saving a life,” Becky Brisker (resident) said.

Board action and next steps: The board closed the public hearing by motion and, after returning to open session, voted to approve the resolution on its first of three readings by roll call, 4–1. The resolution authorizes proceeding with the process that would lead to the formation of an EMS advisory council and eventual voter referendum; the measure requires a 60% voter approval to take effect. The board indicated it will bring recommendations for advisory-council appointments and further details to future meetings and that staff can provide quarterly or pre-ballot updates on proposed levy plans.

What remains unresolved: Several supervisors asked for additional details about statutory requirements (one member noted difficulty locating the cited code section in a short review of the code) and requested more time to review funding models and impacts. Staff said they will continue work with the EMS Association and other stakeholders and return with clarifications and proposed advisory-council nominees before subsequent readings.