In an emergency where minutes are critical, medical professionals sometimes determine that patients need to be airlifted to a hospital rather than transported by traditional ambulance. This is particularly true in rural areas, where emergency rooms can be hundreds of miles away. During these occasions, decisions need to be made quickly and the last thing EMT personnel and the patient are thinking about is how much the air transportation is going to cost and how will the cost be paid. Unfortunately, situations have arisen where patients who have utilized an air ambulance get the unwelcome surprise of receiving a huge bill (often exceeding $50,000) for the service. In these cases, the patient receives the bill because either his health insurer does not cover air-ambulance services, or the service was provided outside of his health-insurance network.

To try to protect patients from getting socked by these costs, a number of states have tried to regulate the air-ambulance industry. Unfortunately, such regulations have been overturned by courts on the basis that any state regulation of such transport is preempted by the Airline Deregulation Act (ADA) and therefore outside of the states’ regulatory authority. Presumably, the federal government could enact legislation to exempt air-ambulance regulation from being preempted by the ADA, but unfortunately so far has failed to do so.

While the ideal situation would be to have the federal government act, that does not appear to be forthcoming. In the meantime, I have been working with the air-ambulance industry and insurers through the National Conference of Insurance Legislators (NCOIL) to craft model legislation that would protect patients from being charged such substantial bills while at the same time insulate the legislation from being preempted by the ADA. I am pleased to say that NCOIL recently adopted a model bill, which I sponsored, that will accomplish just this.

Essentially, this model bill, which any state can use as a basis for its own legislation, would take the patient out of the billing process for air-ambulance services. Rather, the patient’s health insurer would be responsible for such payment even if the air-ambulance provider is out-of-network. The health insurer would be required to pay either (a) the amount billed by the air-ambulance service; (b) an amount negotiated with the air-ambulance service; or (c) what the insurer pays to an air ambulance in its network which cannot be less than the average rates published by air-ambulance services as determined by the state’s department of insurance.

If there is a disagreement between the insurer and the air-ambulance service regarding the bill, the model legislation provides for an independent dispute resolution where an independent reviewer could determine a binding amount that both parties would be forced to accept. The creativeness of the model legislation is that it gets around the ADA preemption issue by requiring any air-ambulance service that wishes to participate in the independent dispute-resolution process to waive its right to claim preemption under the ADA. It is anticipated that air-ambulance services would rather collect their costs from a health insurer rather than a patient and therefore will be motivated to agree to the independent dispute-resolution process and to waiving any claim of preemption.

Working with other state legislators from around the country, I am proud to have been able to come up with a solution to a problem that has caused tremendous financial hardship on families. In an emergency, a patient should not have to worry about whether necessary services, in this case air-ambulance services, will bankrupt his or her family. I look forward to introducing this model bill in the New York State Legislature this year and I am confident that the necessary support can be achieved to see the bill enacted into law.             

William (Will) A. Barclay is the Republican representative of the 120th New York Assembly District, which encompasses most of Oswego County, including the cities of Oswego and Fulton, as well as the town of Lysander in Onondaga County and town of Ellisburg in Jefferson County. Contact him at barclaw@assembly.state.ny.us, or (315) 598-5185.

A college education is a powerful tool to empower future leaders, giving them the life-experience, knowledge, and professional skills necessary to thrive personally and professionally. Yet, crushing student debt continues to inhibit our next generation of public servants and entrepreneurs, and sky-high college costs remain a challenge for prospective students.

 Gov. Andrew Cuomo’s “free” college tuition program is misleading, at best, and does little to address systemic problems of debt and affordability affecting the broader student population. The Commission on Independent College & Universities (www.cicu.org) recently issued a report that showed a steep decline in student enrollment this fall, as compared to 2016. This program threatens an important private-sector industry and does nothing to help financially struggling low-and-medium-income students who find themselves at a financial disadvantage. 

Getting more help to more students and recent grads

The Assembly Minority Conference is renewing its call to enact the Affordable College for All Initiative, which would help prospective college attendees at both public and private institutions, as well as address crippling debt holding back recent graduates. Our plan does the following.

• Increases the household-income threshold — The state’s existing Tuition Assistance Program (TAP) eligibility limit has not been adjusted from $80,000 in almost two decades. We propose phasing in raising the threshold to $125,000 in order to bring more students into the program. 

• Makes the TAP awards bigger — We propose raising the maximum award to $6,470, from $5,165. In addition, all TAP recipients would receive at least a $500 increase.

• Assists graduate students — Graduate students lost TAP eligibility in 2010, and bringing it back would give even more New Yorkers the much-needed break they deserve. The average graduate-school borrower takes on more than $57,000 in combined debt from graduate and undergraduate education.

• Gives student-loan payers a tax break — New York gives outlandish tax breaks to Hollywood studios and luxury yacht owners, but not college graduates swimming in debt. Single filers could receive up to $4,000, head-of-household filers could get up to $6,000, and married filers could receive up to $8,000 in taxable income reductions on the principal and interest of their loans. 

The governor’s headline-grabbing “free” tuition plan was a narrowly tailored initiative that ignores room and board, textbooks, and existing debt. It barely scratches the surface of a growing problem. We must enact programs that treat all students and institutions equitably and provide relief at each layer of higher education.             

Brian M. Kolb (R,I,C–Canandaigua), a former small-business owner, is the New York Assembly Minority Leader and represents the 131st Assembly District, which encompasses all of Ontario County and parts of Seneca County. Contact him at kolbb@nyassembly.gov