By Renee Fox
syracuse.com
LAFAYETTE, N.Y. – Residents keep stopping Town Supervisor Bill McConnell at the post office, the convenience store and around town with questions about this November’s election.
They don’t want to talk about politics. They want to talk about ambulances.
Town leaders are considering creating a new tax to staff its ambulance corps 24 hours a day.
It would raise town taxes by nearly 16%.
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Now, town taxpayers cover a $430,000 bill to staff one ambulance crew about two-thirds of the time. When they’re on duty, the LaFayette EMTs answer calls in a little over six minutes, on average. When they’re off, it can take as long as 14 minutes, on average, for neighboring ambulances to respond.
But paying for a full-time corps in a town of 4,900 people comes with a heftier price tag. It would tack an additional $1 million on property owners’ tax bills. That works out to an extra $332 for a property assessed at $200,000.
There’s a catch: The change would make coverage more consistent, but it would not guarantee that a LaFayette ambulance would be available for every town call. That’s because LaFayette’s crew would still be part of the larger web of ambulances that fill in for each other when they’re on another call or stuck at one of Syracuse’s crowded emergency rooms.
It’s a big ask from a town where tax bills have steadily increased since the pandemic. LaFayette is facing the same rising prices for insurance, road salt, fuel and other resources straining town budgets across Upstate New York. That doesn’t count school taxes.
The proposed ambulance tax would come on top of those increases.
Town officials have the power to approve the extra fee for full-time EMS.
But LaFayette is doing something different. McConnell and the town board want their neighbors to weigh in on the new tax on Election Day. The proposed ambulance tax is the only contest on LaFayette’s ballot.
While the straw poll is a new twist, the struggle to provide ambulance services in rural areas is becoming more common. Volunteer EMTs are aging out and younger ones are scarce. Insurance reimbursements fail to cover the payroll in a rural department like LaFayette, which answers about 20 to 25 calls each month across 40 square miles.
The alternative is stark. AMR, a paid service, left Cayuga County in 2023 because there wasn’t enough emergency business to cover costs. North Shore Ambulance Service in Oswego County closed two summers ago after a 75-year run. Across the state, nearly 100 ambulance services folded between 2013 and 2023.
No calls have been missed in LaFayette, McConnell said. But in June, a patient with a severe bleed had to wait 19 minutes for an out-of-town ambulance to respond. LaFayette firefighters responded from the station, just a mile away from the patient. But the town’s EMS crew were off duty at the time so there was no available ambulance nearby.
That’s why McConnell and the ambulance corps are asking for buy-in from the people who would pay the extra costs and need the coverage.
“It’s only fair to both the ambulance service, who identified a need, and the constituents who would pay for it,” McConnell said. “We thought that type of increase should be decided by the voters.”
Ambulance math
Ambulance services make money in two basic ways: from insurance reimbursements and from taxpayers who pay to keep rigs staffed.
The larger the call volume, the more a service can rely on patients and their insurance to pay the ambulance bills.
Three years ago, LaFayette began using federal COVID relief money to add paid staff to its shrinking volunteer ambulance corps. The town hired four people, two paramedics and two EMTs. Together, they cover about 96 hours each week. Part-time workers help fill shifts.
The service also has four emergency volunteers, down from 16 a decade ago.
Those efforts cover 100 hours a week. That leaves another 68 hours throughout the week when LaFayette relies on its neighboring crews and volunteers to respond.
To fully staff the service, LaFayette estimates it needs about $1.1 million each year. That would double the full-time staff and keep its part-timers to cover vacations and other openings.
About $100,000 of that new budget would come from private-pay patients and insurance policies, including Medicaid and Medicare.
Ambulance Vice President David Hoxie says that insurance income should be more.
It can cost about $1,000 on average for each ambulance response, he said. But the government insurance programs that cover older, disabled and poor people only send back a small portion of those costs, Hoxie and others said. Medicaid, for example, sends back about $250 to $300 for each ride, depending on the severity of the case.
That means taxpayers would pick up the larger tab — $1 million – under LaFayette’s proposal.
The good news, Hoxie says, is that for now the service doesn’t need big investments in equipment. Almost all of the new tax would go toward payroll and benefits.
“We just need the people,” he said.
A bandage, not a cure
Steven Kroll , a leader with the New York State Volunteer Ambulance and Rescue Association, said LaFayette’s staffing shortage follows a pattern across New York.
More ambulance groups are combining volunteers with paid career staff.
“We’re finding more and more not-for-profit ambulance squads are struggling to maintain the level of volunteers they need to provide the service,” Kroll said.
Others have moved toward paid coverage around the clock. But the overall pool of EMS workers, whether paid or volunteer, is shrinking.
New York lost more than 7,000 active certified EMS workers between 2019 and 2022, a decline of 17.5%, according to a study Kroll did for the state’s EMS Council.
Volunteers are leaving faster than their paid counterparts. It’s a demanding donation of time for households that often have two adults working outside the home. Becoming an EMT takes roughly 200 to 250 hours before additional training with an ambulance service, Kroll said.
Hybrid services, like LaFayette, use both paid workers and volunteers. Across New York, about one in six hybrid services lost more than a quarter of their volunteers, Kroll’s study found. And nearly three in 10 volunteer and hybrid agencies reported frequent delays or missed calls.
For now, towns across New York are using a patchwork of approaches to try to keep responding, said Chris Koetzle, executive director of the New York Association of Towns.
Some contract with private ambulance companies or nonprofit providers through town budgets. Others create ambulance districts or reach agreements with neighboring communities.
The better solution, Koetzle said, is to establish larger districts that answer more calls and rely on a bigger group of taxpayers to make ends meet.
New York required counties in 2025 to work with towns, cities and villages on countywide EMS plans for state review, Koetzle said. That work is still underway.
Until then, towns like LaFayette struggle to provide EMS and pay the bills.
“There is a real tension between who is going to pay for this,” Kroll said.
Asking voters to decide
LaFayette’s vote on Nov. 3 is non-binding.
If voters say no, McConnell says, the town won’t create the new tax.
But if voters say yes, it’s still up to the town board to create a new tax and line item on tax bills to pay for ambulance services.
The town would take the $430,000 currently budgeted for EMS and use it for other town expenses, McConnell said.
The town estimates the new tax at $1.66 per $1,000 of assessed value.
The language on the ballot explains that cost: $332 extra for a property assessed at $200,000.
Assessments, too, are rising in LaFayette, even though the town has not done a full reassessment in 20 years. Market values are rising even faster, meaning assessed values can differ significantly from recent sale prices.
The tax would apply to more than homes. Farms, businesses, vacant land and other taxable properties would pay based on taxable assessed value.
That distinction matters in a town known for farms and orchards. Qualifying farmland can receive an agricultural assessment based on its value for farming rather than its possible development value.
A property with many acres would not automatically receive one of the largest ambulance bills. The 2025 roll includes vacant farmland parcels of roughly 18 to 30 acres with taxable assessments between about $31,600 and $43,800. At the estimated ambulance rate, those properties would pay an extra$52 to $73 a year.
High-value homes and commercial properties could pay much more. A property with a taxable assessment of $500,000 would pay about $830. A $1 million taxable assessment would produce an ambulance bill of about $1,660.
Not a fix for busy ERs
McConnell and Hoxie are up front about this: The new tax is not a promise that a LaFayette ambulance will answer every local call or arrive faster every time. The crew may already be treating another patient, traveling to a hospital or helping a nearby community through the larger mutual-aid system.
That is likely to happen, especially as ambulances throughout Onondaga County get stuck at Syracuse’s crowded ERs waiting for patients to clear out so hospitals can accept more.
Arriving at a hospital in an ambulance is no guarantee you’ll be rushed to the front of the line. Health workers triage patients based on their conditions, even if they’re lying on a stretcher.
Those hospital backups can last hours, Battelle said. The ambulance crew cannot simply leave a patient and return to town. Travel, waiting, cleanup and required medical records can turn one call into several hours out of service.
In the end, voters are being asked to pay more for the possibility that a local ambulance is near when called.
Rich Roberts, the director of operations for Lafayette’s ambulance service, said having a local crew available still cannot guarantee a good outcome in every emergency.
“But it gives them a better chance,” he said. “It gives them a fighting chance.”
The referendum will appear on the Nov. 3 ballot. Early voting runs from Oct. 24 through Nov. 1.
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