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their costs of providing services to Medicare patients. A similar report commissioned by the American Ambulance Association (AAA) determined that figure to be approximately 8%. Those figures do not take into consideration other factors such as uncompensated care which the AAA report estimates to be between 10.8% and 16.5% of all ambulance care. The effect of these reductions has resulted in a significant loss of ambulance funds for most urban jurisdictions around the nation, including Eugene and Springfield. Although there are a number of contributing factors, our deficit is primarily attributed to the reduced levels of reimbursement our department receives from Medicare and Medicaid for qualifying patient transports. These decreases have been phased in over time and impact our ability to cover the service delivery costs. To place this situation in perspective it is important to understand that Medicare and Medicaid transports, along with Medicare HMO covered transports, account for approximately 60% of our current business and we lose money on each and every one we perform. In fact, the federal government and HMO-capitated payments pay about half of our standard fee for service and federal law does not allow us to bill the patient beyond what is allowable under Medicare and Medicaid. Subsequently we are required to "write down" the difference that exceeds the federal reimbursement schedule since we are not allowed to collect for it. In the cities of Eugene and Springfield, these losses have resulted in changing ambulance funds from self-sustaining to losing money. These diminishing levels of reimbursement are jeopardizing the health and safety of the very citizens it seeks to protect. We cannot afford to allow our health care safety net and a critical part of our emergency and disaster response system to deteriorate further because of below cost Medicare reimbursement. S. 1310 and H.R. 2164 would provide a 5% increase in Medicare payments rates which would maintain the level of relief from the expiring provisions of the MMA. While this increase will not adequately address the enormous negative impact of below-cost reimbursement on patient access to life-saving and high quality ambulance care, it will sustain providers until a permanent solution can be addressed. The cities of Eugene and Springfield strongly urge your support of S. 1310 and H.R. 2164. It is critical that Congress act now and extend the relief to ambulance services providers from the MMA by supporting a 5% across the board adjustment in 2008 and 2009. Sincerely, Chief Randall Groves, Chief Dennis Murphy, City of Eugene City of Springfield Page 2 of 2