With its contract set to expire Sept. 30, American Medical Response received a two-year extension Tuesday to provide ambulance service in Clark County.The extension was approved 2-1 by the Clark County commissioners, who were acting in their role as the Emergency Services Medical District 2 board.The vote had been twice delayed as commissioners encouraged AMR to whittle down the recommended increases to the average patient charge.Initially, AMR, which provides ambulance service to the county with the exception of Camas-Washougal and north county, estimated it would have to increase patient charges by 20 percent to account for revenue losses due to a growing population of uninsured and underinsured patients.AMR doesn’t get any public money for its service, instead earning its profits from billings.Under the contract approved Tuesday, patients will pay a 5 percent increase. The average patient charge will increase from $753 to $795, according to information supplied by Clark Regional Emergency Services Agency. Insured patients will pay an additional $8 co-pay and uninsured patients will pay an additional $34.AMR transports approximately 4,000 people a year in Clark County to local hospitals. In 2009, 3,050 patients were insured and 712 patients were uninsured.Terms changedThe fee increase was knocked down from 20 to 5 percent by changing a few terms of AMR’s contract. For example, response times will be rolled back to 2004 standards (an extra minute in suburban areas, two extra minutes in rural areas) and the county reduced the administrative fee that AMR pays for the contract.Commissioners Marc Boldt and Steve Stuart approved the contract extension, while Commissioner Tom Mielke voted no.Mielke said he didn’t want to support any fee increase.“It’s just a tough time right now,” Mielke said.But Boldt and Stuart acknowledged that it’s through no fault of AMR that a growing number of people are uninsured or underinsured or that the reimbursement rate from Medicaid has decreased. Between 2000 and 2009, the number of uninsured patients grew from 14 percent to 20 percent, according to CRESA. Patients on Medicare now account for 35 percent of patients, up from 17 percent of patients in 2000. “If we don’t move forward with this, the taxpayers will pay more,” Stuart said. “This small fee increase that affects one percent of the population will save money for 99 percent of the population.”Had the commissioners allowed the contract to expire, there would have been an open market for ambulance service in the county, which likely would have been more expensive.