“An estimated 32 million to 34 million individuals will gain public or private health insurance under the Patient Protection and Affordable Care Act (ACA). Insured individuals consume nearly twice as much health care as the uninsured, on the average. Thus, EMS utilization will likely increase; however, the ACA does not provide funds to pay for increased EMS use. This will force local governments to choose between raising taxes, finding alternative revenue sources or reducing emergency services.”