Samer Choucair: America Prepares to Reprice Ambulance Services A Gap Exceeding $1,500 Shakes the Sector
Investment expert Samer Choucair said the RESCUE Act of 2026, now before the U.S. House of Representatives, represents an attempt to reprice ambulance services in line with actual operating costs, more than two decades after the current Medicare fee schedule was adopted — a schedule that took effect in 2002 and was built on cost data dating back to 1998. The bill was introduced by Republican Congressman August Pfluger on July 27, 2026, with bipartisan support, and has been referred to the Energy and Commerce and Ways and Means committees, though it has not yet become law.
Choucair explained that the bill's importance lies in the size of the gap between the cost of running ambulance operations and the revenue they generate. Data from CMS's ambulance cost collection system, analyzed by RAND, showed an average cost of about $2,673 per transport against average revenue of roughly $1,147 — a gap exceeding $1,500 per transport across the providers and payers covered by the data.
Choucair noted that around 10,600 ground ambulance providers and suppliers delivered 11.3 million transports for traditional Medicare beneficiaries in 2024, with total payments of about $5.3 billion, underscoring that this is no marginal issue for the U.S. healthcare system. The ambulance inflation factor stood at 2% in 2026, following 2.4% in 2025, but the inflation adjustment alone does not resolve the problem of relying on an outdated cost base.
Samer Choucair said: "An investor isn't buying an ambulance ride — they're buying response capability. If prices don't reflect the cost of readiness, the shortfall shifts onto local budgets, service operators, and care providers. Repricing based on current data can redistribute risk and make cash flows more predictable to model."
Under the bill, a substantial payment update would begin in 2028, followed by comprehensive reviews every three years, with inflation-based updates in the intervening years, alongside expanded cost-data reporting requirements that would include air ambulance services at least once every three years.
Choucair believes that if the legislation passes, its impact will extend to private ambulance companies, municipal financing, equipment and vehicle manufacturers, and fleet management and data software providers — but he cautions against treating the legislation's impact as a foregone conclusion, saying: "The real investment opportunity begins when the bill moves from a political headline to an enforceable payment schedule. Until then, the probability of delay or reliance on temporary extensions needs to be priced in."