Misconceptions
Several misconceptions about EMS billing, funding, agency expenses, and operations are commonly believed to be true. You'll see a few of the most common beliefs and the facts that debunk them.
The Problem...
These common misconceptions have steered EMS along the path it's been on. Due to these misbeliefs, voters have chosen to not make EMS essential believing they sustain themselves. Additionally, potential donors believe EMS agencies make profits and will limit their charitable gift.
Four Common Funding Misconceptions
"It's paid-by-taxes."
While the exact number of tax-supported agencies is unknown, state law does not designate EMS as an essential service that is entitled to receiving tax funds.
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Currently, only 21 of Iowa's 99 counties have designated EMS as an essential service..
"If I paid my bill, every agency gets paid."
Of all Iowa EMS agencies, 75% serve rural areas with approx. 90% of them never billing for their services.
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Transporting agencies that bill do not share revenue with the non-transport first responders, it would be illegal to bill for services not rendered by themselves.
"Ambulance transport is already overpriced."
Ambulances are expected to be equipped and ready at all times for any emergency. When transported, you are also paying for them to be "call ready".
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The average annual cost to keep an ALS ambulance staffed, stocked, and equipped 24/7/365 is $850,000/yr.
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If a rural ambulance runs 2.5 calls/day The expense per call is $930.00
A loss of $164,340/yr. due to Medicare
"EMS is the fire department"
Many EMS services are not affiliated to any fire department, even if they share a station.
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The funding a fire department receives from taxes are used for operational costs of the FD. In general EMS is not included and become an expense to the FD as they are expected to generate their own revenue but are unable to generate enough to cover their own needs.
What percentage of EMS agencies in the state of Iowa cover rural areas?
75%
As of 01/01/2026, how many active EMS agencies does Iowa have?
733
What percentage of all EMS agencies serving Iowa are 100% staffed by volunteers?
61.7%
Iowa saw more active EMS clinicians in 2025, increasing by what percentage?