Members of the Spokane City Council were taken aback earlier this month when they were asked to sign a contract that would raise the rates the city’s ambulance service provider, American Medical Response, charges its patients by 28%.

What they didn’t know, at the time, was that AMR’s original ask was much higher.

Citing the increased cost of doing business and the comparably low rates it charges Spokane for medical transport, AMR initially asked for an increase in its base transportation rate from a base of $757 to about $1,207.

But Spokane Fire Department Chief Brian Schaeffer negotiated the company down to a rate of $975 before introducing the contract for the Spokane City Council’s approval.

The council discussed the contract proposal again on Thursday, but deferred action until next week as it mulls its options.

The argument made by Colorado-based AMR – which is backed by the administration of Spokane Mayor Nadine Woodward – is multifaceted. The company’s labor costs increased when it negotiated a new contract with the union representing its medical personnel, and the onset of COVID-19 has brought new challenges, like increased costs needed to thoroughly clean equipment.

The company charges Spokane significantly less than other communities in the Pacific Northwest for the same service. The city of Tacoma, for example, pays nearly four times the rate of Spokane for AMR’s advanced life support and basic life support services. Ambulance service in unincorporated parts of Spokane County has a base rate of $857 for both services, exactly $100 more than the city of Spokane.

Due to the way it is reimbursed by private insurance, Medicare and Medicaid, AMR has said it will only reap a small percentage of the overall rate increase.

“What we’re really asking for is $27 extra per trip in order to sustain our system and pay our troops,” Paul Priest, representing AMR, told the council on Thursday.

The city has an option to renew the contract for another five-year period, with increases limited to the rate of inflation, or about 2%. But the administration agreed with AMR that the company was due for a raise, either in the form of a one- or five-year contract.

City Administrator Wes Crago said the emergency medical services business is a volatile one, and said the administration would approve of a one- or five-year contract at the increased rate – but its preference would be for five years.

“Having a professional, stable, long-term partner for EMS is priceless,” Crago said.

While nobody wants to see rates increase, Crago said, “They’re justified, they’re worthwhile, and things are expensive right now in this industry.”

Several council members expressed dismay on Thursday that they’ve been backed into a corner, as the contract with AMR expires at the end of May.

Crago and Schaeffer took full responsibility.

“I can’t make an excuse. It’s not the way we normally do business, and it’s not the way we will do business in the future,” Schaeffer told the council.

Schaeffer said he was empathetic to concerns about the rate increase, but said he was attempting to “keep a Spokane business solvent enough to provide a life-saving service to support our mission.”

Officials have argued that the increase wouldn’t directly impact most AMR patients in Spokane, the vast majority of whom are covered by private insurance or Medicare or Medicaid.

But Councilman Michael Cathcart expressed concern Thursday for the “8 to 10 percent” of the population who fall through those gaps, who are neither privately insured or qualify for a form of government insurance and “can’t afford” such an increase.

“The folks stuck in between are people that don’t have a lot of options,” Cathcart said.