Proposition Ambulance will go up for a vote in the county on Aug. 6, putting the choice in voters’ hands to support or deny a property tax increase that would allow the Lincoln County Ambulance District to expand its facilities and services.

There have been concerns put forward by citizens about the proposed tax (which would be .35 cents per $100 assessed valuation), including the tax not having a sunset to it, the fact the district has $4 million currently in its operating reserves and the “Compassionate Billing” part of the proposal, under which the district will bill the insurance companies and cover the remainder of peoples’ ambulance bill.

If approved, Prop. Ambulance is estimated to bring in almost $3 million each year; a five-year plan put forward by the district breaks down how that money would be spent.

Right now, in most cases Ambulance District Chief Administrator Ray Antonacci said the district essentially responds to calls by moving inwards from the four corners of Lincoln County.

If the tax is approved, in 2020 the district would spend $2,700,000 on capital improvements, with three expenditures of around $625,000 going to towards work on three new ambulance bases to spread materials and personnel out in the county. 

One new facility would be built in Moscow Mills – where a large number of calls occur – and would provide coverage for all of Moscow Mills, as well as for Wright City, Warrenton and Foristell.

The second sum of $625,000 would be used in western Troy, near the area of Highway 47 and Highway AA, which would greatly decrease the response time to the areas of Hawk Point, Truxton and Olney. 

“That will decrease response times out to Hawk Point by 10-15 minutes,” Antonacci said. “We can from that position make Hawk Point city in five minutes or less; the rural parts we’ll be there [in] ten minutes or less, which are now 15, 20, 30-minute response times.”

The last new facility would be an eastern Troy base, near highways 147 and 47, which would decrease time on responses to Cuivre River state Park, Brussels/Snow Hill and the more rural eastern areas. 

The remaining money from that $2.7 million  in 2020 would go towards work on the district’s training facility ($50,000), pay for two new ambulances ($507,698), various types of medical equipment ($139,500) and field technology/software ($114,000), with a little leftover ($13,801) being put into a new Capital Improvement Reserve for unspecified future projects. The second year of the tax (2021) is slotted to have $2.2 million spent on capital improvement projects: $700,000 on training facilities/headquarters, $762,740.29 on ambulances, $117,800 on command vehicles, $20,000 on patient medical equipment, $30,000 on field tech/software and $12,600 on office equipment, with $556,859.71 going to the Capital Improvement Reserve fund. The following three years have their own breakdowns, detailed in the plan, with total capital expenses of $2.2 transferred from the general fund in 2022 and  $2.1 in 2023, and $1,750,000 transferred for capital improvement projects in 2024. 

Antonacci said in that first year of 2020, after the $2.7 million is pulled from the $3 million total for capital expenses, the remaining $300,000 will be put into the general fund to support six new employees based out of the new Base 6 in Moscow Mills.  

“Each year after we are adding six more employees to a total of 18 new employees by the end of the five-year plan,” Antonacci said. 

By the end of the five-year plan, those 18 employees would utelize an estimated $1 million, with the assumption that each would cost $60,000, give or take some for ranking on the pay structure. There’s no sunset provision attached to the tax – Antonacci said the district could have looked for a bond instead, which would have a built-in end date. 

TRU Republicans United is a group that has come out in opposition to the proposition. Speaking on that group’s behalf, Thom Artru said the lack of a sunset clause in the tax was one of the issues people have raised with the proposition.

“That’s a perpetual tax, with no sunset clause, that means once it’s authorized, without an election to undo that, it will just go on forever,” Artru said. “And I think that’s the biggest problem that I have and that I think most people have, with it not having any sunset clause.” 

The district is currently collecting .1015 cents per $100 of assessed valuation (which has dropped down from 28 cents), which balances with sales tax to create the district’s revenues. The current property tax and sales tax do not have sunset clauses either. 

“This is supposed to be a five-year capital plan,” Artru said. “I wouldn’t have a problem near as much…if the sunset clause took place in five years and the people had a chance to see what they actually did with their capital campaign as to what they were proposing versus what they actually do with the money.”

The issue with doing something like a bond, Antonacci said, would be that when the bond did time out, the Ambulance District would be left back at square one, and that the expenses involved in running EMS services don’t have a “sunset” of their own. 

“Had we gone with a bond, then there would have been a [sunset] at some point,” Antonacci said. “Then where would we find funds to maintain the buildings that we’ve built? Where do we find funds to replace the ambulances that we’ve now run two, three, four hundred thousand miles?” 

Under the five-year plan, the district says it will be able to take its response times down from 12 minutes to eight minutes on average. Patients in life or death situations like a cardiac arrest would benefit from this decrease, but even on much more mundane calls like respiratory issues – which Antonacci said are a very common type of call the district receives – four minutes can still make a difference.

“Take a straw, put it in your mouth, and breath through that straw,” Antonacci said. “See how long you can last. That’s what it’s like if you’re a COPD patient – someone with emphysema, someone with congestive heart failure – where you can’t get your breath.”

The district is currently sitting on a seven-month operating cost cushion in its reserves ($4 million), which Antonacci said shows they spend their money wisely. On average, the district adds about $136,000 to the reserves per year. 

That money is saved for emergencies – such as a natural disaster that ruins district infrastructure or causes employee deaths. 

“How do we keep this district rolling to help the people that have [had] their lives destroyed because of some kind of natural disaster like that? That’s what reserves are for,” Antonacci said, adding that revenues the district gets from sales tax aren’t safe in the case of a natural disaster either – hence the need for a safety cushion. 

“Let’s say Wal-Mart gets wiped out. What happens to our sales tax at that point?”

Artru said an issue his group has had with the proposition is that the tax is being billed as going towards capital improvements, but that an increasing portion will be used for salaries as the five-year plan goes on. 

“When they already have an operating budget surplus reserves of close to $4 million, that seems to me to be a little disingenuous,” Artru said. 

“I’m glad they are being somewhat fiscally responsible,” Artru added. “But I don’t see why they couldn’t use part of those reserves say for those salary increases that they were talking about, rather than just keep putting money in the bank.” 

Regarding the concerns about Compassionate Billing, Antonacci said currently $170,000 per year comes in through personal payment of ambulance bills. There are patients that are fully insured, partially insured and those with no insurance within the district.  

Antonacci said some have commented that they don’t want to pay for the people without health insurance, but he said the district struggles to collect money from those folks already. A lot of the $170,000 collected from personal payments comes in slowly from payment plans – some as low as $10 per month on bills worth hundreds of dollars – and some of that money goes to a collection company as well. 

“All I’m doing is saying to the people that have a high deductible plans, you have enough to worry about with the hospital bill,” Antonacci said. “You pay taxes to the ambulance [district], we’re not going to send you a bill for out-of-pocket – we’re going to send a bill to your insurance company – but we’re not going to ask for it out of pocket.” For a list of local polling places, visit

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A certified wiz at playing tabletop war games and binge-watching anime, I spend far too much time on the internet. Also I run a couple of newspapers.

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