Surprise “Air Ambulance” Bills Are the Latest Nightmare in Private Health Insurance

On top of skyrocketing medical costs, many Americans face staggering surprise bills for “air ambulances.” What’s no surprise is that the private equity industry is deeply implicated in this nightmare — and spending heavily to make sure no one puts a stop to it.

Medical helicopter rides with private-equity-owned carriers cost, on average, $48,250. (Photo: Global Medical Response)

In rural America, many people are so poorly served by our health care system that, with the nearest hospital so far away, they have to buy “helicopter insurance” in case, in an emergency, they need to get medical attention quickly. Of course, many can’t afford helicopter insurance — and they may end up getting stuck with the bills, which are often not covered by standard health insurance plans. A New York Times investigation last week illuminated this monstrous capitalist mess: it’s not unusual for patients to receive horrifically high surprise bills for “air ambulances.”

The Times interviewed a coronavirus patient, a middle-aged woman still coping with the “brain fog” many suffer in the aftermath of the disease — and facing a helicopter bill of $52,112. There was legislation in Congress this year, sponsored by many progressive Democrats and even supported by the White House, to curb the practice of “surprise billing,” but the proposed bill stalled indefinitely after dark money blanketed the airwaves with ads in opposition. A report published last week by the Brookings Institution (a DC policy think tank) shows that private equity firms dominate the air ambulance industry. They’re also heavily invested in other medical services that profit from springing unexpected bills upon the hapless health care consumer.

In other words, working-class sick people are suffering, and the private equity industry, profiting obscenely from our society’s dysfunction, hopes to keep it that way so that men like this can keep adding billions to their net worth.

Despite all the terrific work the Times did on this issue, they buried the names of the private equity companies in question deep in their lengthy story, and they did not mention which congressmembers the equity firms were buying. We won’t be repeating those mistakes here.

According to Brookings, two private equity firms, KKR and American Securities, control almost two-thirds of the air ambulances’ Medicare market. Helicopter rides with the private-equity-owned carriers cost, on average, $48,250 — that’s 7.2 times what Medicare would cover, and much more than what carriers not owned by a PE company would charge (which is $28,800, on average). When a private equity company buys an air ambulance provider, it rapidly increases the price of the service, Brookings found.

Though the Times doesn’t say so, the legislation may have stalled for reasons apart from the advertising blitz: these players spend a lot of money on politicians. Global Medical Response, one of the air ambulance companies owned by KKR, has a PAC that gave to both parties in the 2020 election cycle (47 percent to Democrats, 53 percent to Republicans). In the House, they favored Democrats, with $7,000 going to Alabama’s Terri Sewell and smaller amounts going to many others. In the Senate, they preferred Republicans like Roy Blunt of Missouri — though they didn’t neglect Democrats, including New York’s Chuck Schumer. Michael Fisch, the CEO of American Securities, has for decades given enormous sums to right-wing PACs like Club for Growth, and mostly to Republicans, though New Jersey Democrat Tom Malinowski has also been a favorite. KKR CEO Henry Kravis mostly gives to the Republican Party, right-wing PACs, and standard Republicans like Mitch McConnell — but Maine senator Susan Collins, former Democratic VP candidate Joe Lieberman, and even New York Democrat Gregory Meeks have also enjoyed his largesse.

This problem represents a massive failure of government and a horrendous exploitation of human suffering by parasitical profiteers. Unlike most rich countries, the United States leaves the provision of life-saving essentials up to private companies. If there aren’t enough people where you live to make sure a hospital is profitable: too bad. No hospital for you. But we will be sending you a helicopter bill, and a gang of billionaires will get richer from your plight as they funnel enormous amounts of money into the political system to keep it that way.

As Eileen Appelbaum and Rosemary Batt showed in a study published in March, private equity firms have become major players in health care — not only in transport but in hospitals, outpatient care, emergency care, staffing, and many other areas, all to grotesque effect. We need a different system, and single-payer health care, public hospitals, and a ban on all for-profit health care services would be a good start.