A 5-point post-election plan for EMS

The votes have been cast, congressional and statehouse leadership is changing, and EMS organizations across the country are beginning to work out what the 2026 midterm elections mean for them. In this special edition of EMS One-Stop, host Rob Lawrence is joined by longtime EMS leader and policy analyst Matt Zavadsky to look beyond the red-versus-blue election narrative and focus instead on what EMS leaders should be doing next. Their message is straightforward: election results do not automatically change policy, reimbursement rules or the economic realities facing ambulance services. What they do create is a new group of elected officials, committee members and political leaders who must quickly be educated about EMS, its value and, crucially, what it actually costs to maintain a 24/7 emergency medical response system. Rob and Matt examine what remains unchanged after the midterms, including existing federal law and regulatory changes already moving through CMS, before turning to some of the more significant state and local results. They discuss property-tax reform, EMS levy votes, commercial payer reimbursement, the cost of readiness, and the growing tension between public expectations for rapid ambulance response and the willingness of communities to fund that level of service. The episode concludes with a practical five-point action plan for EMS leaders: Calculate the true cost of readiness Demonstrate value beyond response time Reconsider system design Model financial exposure Immediately begin educating newly elected officials The election may have changed some of the people at the table, but EMS still has to make its case. Key quotes “We’re not here to talk about red or blue, we’re not here to talk about Democrats or Republicans. We’re here to talk about us.” — Rob Lawrence “Election results don’t automatically translate into policy changes … a change in congressional leadership and state house leadership and local leadership creates, if nothing else, a new opportunity for us to advocate for reform, but it’s not a guarantee of that reform.” — Matt Zavadsky “We have a lot of freshmen to influence now and educate and have them understand before anybody else gets to them.” — Rob Lawrence “Everybody wants lower taxes and everybody wants an ambulance in five minutes. But somebody needs to explain how those two expectations fit into the same spreadsheet.” — Matt Zavadsky “We can’t control who wins and who loses elections, but we can control the quality of the information that we provide, the relationships that we build and our willingness to rethink how we deliver care.” — Matt Zavadsky “For me to be there for that one unit hour that I am dealing with you as my patient, I need to be there for the other 23 hours to be ready for that one unit hour.” — Rob Lawrence “Instead of asking taxpayers to give you more money, we need to explain what we’re doing with the money.” — Matt Zavadsky “We don’t care who won, but we now have to talk to the winners in order to affect change or continue the good work that many associations, many organizations, and many individuals have been doing for some considerable time now.” — Rob Lawrence Additional resources 2026 Ambulance Ride-Along Toolkit - American Ambulance Association AAA & AIMHI EMS Media Log The economics of saving lives (and explaining it to your finance director) Episode timeline 01:00 – Rob introduces the midterms special: this is not a discussion about Democrats versus Republicans, but about what the election results mean for EMS. 02:51 – Matt’s first takeaway: elections create opportunities for reform, but election victories do not automatically translate into policy change. 04:19 – Rob’s immediate post-election task: identify new legislators, departing allies, freshmen members and the people EMS now needs to influence. 07:14 – Matt discusses treatment-in-place legislation, HR1 and why existing federal law remains in place unless Congress changes it. 08:39 – EMS organizations should continue financial contingency planning rather than assume the election will reverse current reimbursement pressures. 11:12 – Florida property-tax reform and the potential impact of reduced municipal and county revenue on public safety. 13:00 – Matt discusses alternative EMS financing, regional collaboration, consolidation and more efficient deployment. 13:26 – Fundamental system-design qu