Seven states have enacted legislation that negatively
affects EMS jobs and wages. Colorado, Idaho, Kansas, Tennessee, Texas,
Utah, Virginia and Wyoming have all approved the Recognition of EMS Personnel Licensure
Interstate CompAct (REPLICA) over the past year, which poses a serious threat to IAFF
affiliates everywhere, compromises quality care and service to the communities
they serve. States such as Michigan, Minnesota, Mississippi, Missouri,
New Mexico, Oregon have seen initiatives underway.
several states have successfully prevented REPLICA from passing, including Louisiana,
Nevada and Wisconsin.
believes EMS services should be locally driven and that REPLICA reduces control
over patient care. The legislation poses a threat to IAFF affiliates everywhere,
compromising quality care and services to the communities. It would also
negatively affect the wages of EMS workers and put their jobs in jeopardy.
also a threat because...
if a state’s fire department does not provide or support fire-based EMS, passage
in another state may affect other states that do offer fire-based EMS ambulance
the Trump administration decides that Medicaid should be under state control –
it could mean that states get less assistance over the next several years.
legislation allows ambulances to cross state lines to not only pick up
patients, but also transport them to other states or back to the state of
Association of State EMS Officials (NASAMSO) authored the legislation in
response to the federal government’s request to improve response to federal law
enforcement activities and to emergency incidents, such as wildland fires. The
federal government aims to ease restrictions to make it easier for EMS
personnel to provide services across state lines that involve high-level
security response from the FBI, Department of Homeland Security and other law
enforcement to emergencies. The IAFF understands the need to make access
more convenient, but REPLICA in its current form makes government bigger and
more bureaucratic. In addition, current legislation exceeds the scope and
extends the legislation to include day-to-day EMS response, which could include
non-emergency inter-facility work.
this could allow private entities and rival organizations to position resources
near state borders to access multiple communities and take work away from IAFF
affiliates in their jurisdictions and inadvertently create a parity gap in
wages for states that enter such agreements.
the IAFF was a stakeholder organization during the creation of this model
legislation, it is evident that our position was not inserted. We have
stated our opposition to the rest of the stakeholders and authors of the model
are some of our chief concerns:
- We believe that REPLICA is a threat to jobs and wages.
Allowing EMS providers to cross state borders from states or regions that
receive less pay negatively effects the market.
- By allowing EMS providers from other states to
transport patients, there is the
possibility that Medicaid money will be leaving your state to benefit
- Although conceptually designed to benefit the
individual and seeks to increase access
to EMS care, it has nothing in place to
enhance the safety of providers, such
as mandating radio interoperability.
- REPLICA holds itself out as not having a fiscal impact.
This is partially true because states do not experience a fiscal impact
upfront. However, once 10 states sign on,
the agreement goes into effect and
state money must be contributed to support the commission.
- There is nothing in place that truly ensures quality.
- Business will make decisions based on the flexibility
of the workforce. By using this legislation,
a private for-profit business could build a base in a less costly state,
license its ambulances in multiple states and use the lower-cost workforce to cross borders. This puts
private industry in a good position to underbid existing services.
- REPLICA does not isolate
movement of EMS personnel to the area around the state’s border. These
resources can travel the entire state.
- REPLICA is different than
the nurses agreement. Nurses travel from their home state to the state in
which they work. They do not transport patients back and forth across
state lines. REPLICA is interstate commerce.
We have offered compromises to the
authors of the legislation, but they have not been accepted. Additionally, we
are aware of a law that allows federal resources to enter the state to work
without applying for reciprocity. In lieu of joining a compact that directly affects local EMS
services, we encourage a model that allows local communities to keep their
autonomy and the federal government to do what it needs to do without applying
A potential solution is to look at
states such as Indiana, which has adopted language to address the issue:
An agency or instrumentality of the United States and any
paramedic, emergency medical technician, emergency medical technician-basic
advanced, or ambulance of the agency or instrumentality of the United States
does not include a person operating under a contract with the government of the
United States. (Indiana Emergency)
In Louisiana and Washington, IAFF affiliates have adopted
resolutions stating they will oppose REPLICA legislation until IAFF
modifications are met.