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Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for Emergency Medical Services (EMS) transports. Factors including the rise in prescription drug prices, the rising costs of hospitalization, an aging population, and litigation have resulted in escalating healthcare costs. Despite the steep increase in healthcare costs, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented similar EMS Cost Recovery programs, and they have reported no evidence that EMS billing increases health insurance premiums.