In my opinion, and I really don't want to dig deep or speculate with out more information; but I foresee it being bad for smaller services. Small, one town companies, "mom and pop" services, possibly voluntary services that do bill. I don't support EMS that doesn't bill the patient for costs. We're a "rural" service, so we get more reimbursed. Medicare is definitely in the red, as far as what they owe us. I see more bills going to collections. I don't like to see a monopoly of ambulance companies. But I do think that Obamacare, with bundled costs, will have less of that money going to the EMS end of health care. Thus, the loss of services that are fighting to hang on, tooth and nail as it is.