Wednesday, July 9, 2008

Debate over ambulance fee continues

Opponents worry that charge will cause deadly hesitation

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If Julia Bail had hesitated to call for an ambulance a year ago, she would have died.

On June 11, 2007, she woke up with an irregular heartbeat. ‘‘It was frightening,” Bail said. ‘‘I woke up and said to my husband, ‘Get an ambulance now!’”

The rescue squad arrived within minutes. ‘‘They drove me to a hospital where I was DOA,” Bail said.

Doctors revived her. The incident led her to speak out against Montgomery County’s plan to bill insurance companies for people who call for an ambulance.

‘‘We’re not poor,” said Bail, 62, who works at the National Institutes of Health in Bethesda. ‘‘We live in Chevy Chase, but if I had hesitated and said, ‘I don’t know, do I need an ambulance?’ I would have died. I don’t want people to be afraid to call an ambulance.”

As Montgomery County officials debate whether to implement an ambulance transport fee, other counties in the region — with and without the transport fee — have increased other user fees to pay for services.

In Montgomery’s case, the transport fee will generate about $14 million annually for fire and rescue service improvements as the department struggles to provide services to an expanding county, county officials say. The county would bill insurance companies for the service, which ranges from $350 to $700, and accept whatever amount the insurers pay. Residents would never see a bill, Fire Chief Thomas W. Carr Jr. said in an interview with The Gazette. Nonresidents would be charged.

The county’s fire tax does not meet the demands of adding new fire stations as the population approaches 1 million, implement four-person staffing on trucks and maintain competitive salaries and benefits, County Executive Isiah Leggett said in March.

‘‘The county has grown so fast we haven’t been able to keep up, especially in the upcounty areas where we’re building four new stations,” Carr said.

The county expects to collect almost $194 million in fire taxes during the fiscal year that began July 1.

Leggett (D) told County Council members Tuesday morning that the alternative to the fee could be higher taxes, which some council members have been reluctant to approve. The council has the final say on the fee, and some members question if it is necessary.

Volunteer fire and rescue leaders worry the ambulance fee will hurt them and residents who need help.

‘‘We feel it’ll harm our fundraising and our donations and that’s what pays our mortgage,” Damascus Volunteer Fire Chief Darron Long said.

People might think twice about whether to call an ambulance if they are billed for an ambulance or see insurance rates go up, despite the county’s assurances that neither would happen, he said.

‘‘If they can [charge fees] with ambulance service, what’s to stop them in the future from doing it on any kind of service from kids getting on school buses to school to charging for police services to respond to calls?” Long said. ‘‘This could multiply to any kind of service really.”

Leggett administration officials said that’s unlikely to happen, but the growing county needs to find revenue to provide services. Billing insurance companies is one way of doing that.

If the ambulance fee is approved in Montgomery County, Howard County will be one of the only jurisdictions in the region without a fee.

Howard has not needed the ambulance fee because fire tax revenues have been adequate to pay for fire and rescue services. The tax generates about $73 million a year.

‘‘[An ambulance fee] is something we continue to look at. It comes up every so often, and we’ve looked at the same issues that others have including liability issues, the collection process, would people not call for an ambulance for fear that they would have to pay,” said Raymond Wacks, Howard County’s budget administrator.

Howard County has increased its trash fee to pay for a change in its recycling program and increased other minor fees.

‘‘Fees are supposed to cover costs. You can’t make a profit on fees,” Wacks said. ‘‘My sense is some people seem to understand fees because they know what they’re paying for, whether, for example, it be an ambulance fee or a trash fee.”

A draft proposal in Anne Arundel would increase the fines for false residential alarms that have extended police requests.

Frederick County also levies an ambulance transport fee and has had to increase other user fees.

‘‘We have added a system benefit for our solid waste operation,” said John R. Kroll, budget and finance director for the county.

That increase allowed the county to maintain market rates for tipping rates at the county dump. Kroll’s department is also monitoring the economy for downturns which could prompt other tax and fee increases, he said.

Fairfax County, Va., has used a mix of tax increases and fees to balance its budget and has an ambulance fee.

Beginning July 1, the county increased its property tax rate from 89 cents to 92 cents per $100 of assessed value. ‘‘But the refuse collection fee, disposal rate, sewer availability charge and sewer service rate were also increased,” county spokeswoman Merni Fitzgerald said. ‘‘User fees are charged to people who use the service as opposed to a tax, which goes to everybody. I can’t say that the fees were increased instead of raising taxes, but I can say that some services are paid for through fees.”

For Julia Bail, who occasionally drops off dinner for the B-CC rescue squad, people should never hesitate to call an ambulance when they need one.

‘‘We’d be willing to pay more taxes to keep our ambulances free,” she said. ‘‘... I don’t see any reason why we can’t.”