Ambulance Service Fees Urged By Leggett - Washington Post

Montgomery Officials Say Bills Would Go To Insurance Firms

By Ann E. Marimow
Washington Post Staff Writer
Monday, July 7, 2008; B01

Montgomery County Executive Isiah Leggett (D) is engaged in his most extensive lobbying campaign to date to win support from the County Council and the public for an ambulance transport fee to increase funding for fire and emergency medical services.

Montgomery is one of the only jurisdictions in the Washington region that does not charge for ambulance service, but the legislation has encountered fierce resistance in part because of the county's influential corps of volunteer firefighters.

Opponents contend that emergency services are a basic government obligation that should be funded through general taxes, and they fear that an ambulance fee will dissuade senior citizens and new immigrants from calling 911.

"It's not worth the risk of those who would hesitate to call," said council member Phil Andrews (D-Gaithersburg-Rockville), who chairs the Public Safety Committee. "One cannot measure who doesn't call."

Leggett's aides and fire department leaders stress that the legislation is designed to charge health-insurance companies -- not residents. There is no evidence, they say, that residents in other jurisdictions have hesitated to call because of the charge. This month, Prince George's County expanded a longstanding paramedic fee and began charging for all ambulance transportation.

Proponents say the fee is necessary to keep pace with demands for service from a population nearing 1 million and to cope with budget constraints. The proposed fee, which ranges from $300 to $800, depending on service, plus $7.50 per mile traveled, would raise an estimated $14.8 million in its first full year.

Patients who live in the county would not be billed whether they have health insurance or not. The county would accept whatever an insurer provides and would not seek payment from uninsured residents.

"We're not charging anyone. We are recovering revenues that you have already paid for in your insurance premiums," said Assistant Fire Chief Scott Graham. "Nobody will be badgered."

For years, Montgomery's elected officials have debated charging for ambulance service. Legislation backed by former county executive Douglas M. Duncan (D) was twice scuttled by the council. Leggett was unenthusiastic about the idea during his tenure on the council, he said. But he has come around because of the experiences of Montgomery's neighbors, a simplified billing system and the needs of the growing county, such as new fire stations and equipment, including electronic patient tracking.

"I'm convinced this is a more equitable way to pay for it," Leggett said. "If we don't do this, we will have a huge hole in the budget as we go forward."

Leggett initially suggested the fee to help balance the books for fiscal 2009, but the council's president, Michael Knapp (D-Upcounty), refused to introduce the legislation as part of the budget. Leggett's team is now working to sway public opinion through town hall meetings with seniors, brochures in English and Spanish and a Web site. The county has also hired lawyers with national experience setting up such systems.

Under the legislation, county residents with health insurance would not be responsible for a co-pay or deductible. An insured patient who does not live in the county would be billed a co-pay or deductible but could seek a waiver from the fire chief.

County officials expect to collect some payment for about 60 percent of the estimated 58,000 trips each year. Medicaid pays $100 per trip, according to the county's research, and Medicare pays an average of $267 for basic life support. Leggett's aides predict that 13 percent of revenue would be used to manage the program. Five percent of that would go to pay a private billing company.

Montgomery residents pay a portion of their local property tax to fund fire and rescue services.

Opponents contend that the proposed policy would narrow the definition of basic government services and lead to other user fees.

"Public schools do not charge fees to parents for educating their children. The police department does not charge fees to burglary victims," wrote Darian Unger, a volunteer firefighter and chairman of the Silver Spring Citizens Advisory Board. "Fire and EMS services are no different."

The measure is opposed by groups including the League of Women Voters and the Montgomery County Civic Federation. Leaders of the volunteer firefighters' organization have labeled the fee "blood money" and consider the concept at odds with their philosophy. Volunteers also are concerned that residents will become reluctant to participate in fundraising drives some departments depend on.

"We don't want to bill for something we are providing for free," said Eric N. Bernard, executive director of the Montgomery County Volunteer Fire and Rescue Association, which is planning to hold a rally tomorrow before the County Council's public hearing on the fees.

A review of the program in Fairfax County after one year found mixed fundraising results, with some departments raising less and others raising more. Leggett's aides said they would be willing to make up the difference.

The Fairfax report also found "no apparent drop in the number of calls for service," an assertion confirmed by former Fairfax fire chief Michael Neuhard, who implemented that county's system.

"There are always little hiccups," he said. "But we don't have a lot of push back, complaints or problems once you get going."

Council members will hear public testimony on the proposal at 7:30 p.m. tomorrow at the council building, 100 Maryland Ave. in Rockville.