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Illustration: Rebecca Zisser/Axios

Air ambulances have become a lucrative business over the last few decades, at patients' expense, fueled by private equity and aided by the industry's relationships with providers, John Hopkins' Marty Makary writes in a new book out today.

Why it matters: The rise of the air ambulance industry has resulted in massive surprise medical bills and a spike in unnecessary use.

  • Congress has included air ambulances in its effort to crack down on surprise medical bills, and the industry is fighting to avoid this regulation.

Background: Air ambulances used to be owned and operated by hospitals, which sometimes took financial losses on their helicopter programs.

  • But that changed when investors saw a profit opportunity and began buying the ambulance services from hospitals. They then billed patients directly for rides.

By the numbers: Between 2007 and 2016, the average price charged by one air ambulance company for a transport rose from $13,000 to $50,000.

  • With this kind of money on the table, the number of air ambulance companies rose by 1,000% between the 1980s and 2017.

People in rural areas are hit the hardest. While some of these transports are necessary and life-saving, many others could be avoided, Makary writes.

  • Of the more than half a million ambulance flights a year, 80% aren't emergencies, but rather more like routine transfers.
  • To grow their business, companies began paying paramedics, nurses and doctors to become advisers with "informal agreements" to promote the company to emergency personnel and other providers.

The other side: Air ambulances say that they have to charge higher rates to commercially insured patients to make up for lower government rates.

The bottom line: "The air ambulance industry has become big business in America," Makary writes.

Go deeper: Air ambulances are expensive and most likely out of network

Go deeper

Schumer: Trump impeachment trial to start week of Feb. 8

Senate Majority Leader Chuck Schumer. Photo: The Washington Post via Getty

The Senate will begin former President Trump's impeachment trial the week of Feb. 8, Majority Leader Chuck Schumer announced Friday on the Senate floor.

Why it matters: Trump is the only president in U.S. history to be impeached twice. The House voted to impeach the former president on Jan. 13 on a single charge: incitement of insurrection for the Jan. 6 breach of the U.S. Capitol, which resulted in five deaths.

1 hour ago - Health

CDC extends interval between COVID vaccine doses for exceptional cases

Photo: Joseph Prezioso/AFP via Getty

Patients can space out the two doses of the coronavirus vaccine by up to six weeks if it’s "not feasible" to follow the shorter recommended window, according to updated guidance from the Centers for Disease and Control and Prevention.

Driving the news: With the prospect of vaccine shortages and a low likelihood that supply will expand before April, the latest changes could provide a path to vaccinate more Americans — a top priority for President Biden.

Texas AG sues Biden administration over deportation freeze

Texas Attorney General Ken Paxton speaks to members of the media in 2016. Photo: Alex Wong/Getty Images

Texas Attorney General Ken Paxton is suing the Biden administration in federal district court over its 100-day freeze on deporting unauthorized immigrants, and he's asking for a temporary restraining order.

Between the lines: The freeze went into effect Friday, temporarily halting most immigration enforcement in the U.S. In the lawsuit, Paxton claims the move "violates the U.S. Constitution, federal immigration and administrative law, and a contractual agreement between Texas" and the Department of Homeland Security.