April 17, 2012

IN EVERY JURISDICTION in the Washington area but one, and in most others nationwide, local governments charge fees to cover the cost of ambulance service. The exception in this region is Montgomery County, where voters rejected ambulance fees in a 2010 referendum. That vote did a great service to insurance companies, whose rates already reflect regional ambulance fee reimbursements, while leaving Montgomery in the lurch.

The effect has been to deprive the county of about $14 million annually that would otherwise defray the expense of emergency services. It might be nice to keep ambulance service free, but strapped local governments can no longer afford that luxury.

That’s particularly true in light of recent actions by the Maryland General Assembly, which will transfer major costs from the state to local governments — none more than Montgomery.

Among other moves, Annapolis is in the process of shifting part of the cost of teacher pensions to counties, a measure that will cost Montgomery County more than $30 million annually once it’s fully implemented starting in 2015. Montgomery may also have to pump $25 million more into its reserve fund to protect its credit rating in light of another maneuver by lawmakers, allowing the state to seize local tax revenues in the event that county governments fail to maintain school spending.

Isiah Leggett, the Montgomery County executive, lost the ambulance fee fight in the 2010 referendum. Proposing it again scarcely 18 months later looks like a political loser.

But Mr. Leggett, who has no plans to run for office again, is concerned less with the politics than with the finances. If Montgomery is to avoid or minimize tax increases in the wake of the state’s cost-shifting, it needs all the revenue it can get.

The key is that there will be no change for county residents who call for an ambulance. Insurance companies would cover most of the cost for those with coverage, and the county would pick up any co-pays or deductibles, including charges for uninsured residents. Neither insured nor uninsured residents would receive bills for ambulance service.

People who call an ambulance when they’re in the county but don’t live there might face co-pays or deductibles if they are uninsured. And their bill would include an application allowing people with modest incomes — up to three times the federal poverty level — to have the fee waived.

Across the country, a large majority of localities charge for ambulance service, with no evidence that emergency medical treatment has suffered as a result or that people are significantly less likely to call 911 for help. When Fairfax County started charging ambulance fees in 2005, calls to 911 fell very slightly.

In Montgomery, the main opposition to fees came from volunteer firefighters, who feared the fees would upset their sweetheart deals with area hospitals. But why should that special interest trump a potential gain for the whole county?