On May 15, I voted along with five of my colleagues (a 6-3 vote) in favor of , services which are now supported by Montgomery County taxpayers.
Ambulance service is commonly covered by insurers. Medicare and Medicaid cover it. So do major private insurers including the BlueCross BlueShield Service Benefit Plan, CareFirst, Kaiser Permanente, United Healthcare, Government Employees Health Association, the Maryland Health Insurance Plan and many more.
If you have any of these plans, you are paying for ambulance coverage now, in your premium. But the county isn’t billing the insurers for it. The insurers are just keeping the money that they collect by charging you for the coverage.
Most surrounding jurisdictions bill insurers, including Prince George’s County (which collects $11.5 million a year), Fairfax County ($15.5 million) and the District of Columbia ($20 million). Most Maryland jurisdictions also bill insurers.
Our county government estimates that we are leaving more than $17 million on the table by not charging a reimbursement. It is simply unfair to ask our taxpayers to pay for ambulances while we give insurance companies a free ride.
Opponents of the reimbursement argue that residents will be so frightened by the prospect of paying for service that they will not call for help in an emergency. The fire chief for Prince William County (VA), which charges a reimbursement, rebutted this allegation in testimony to our County Council. He said: “This is simply unfounded and I can tell you that Prince William County has not experienced any decline in EMS incidents. In fact, we’re having an increase in EMS call volume consistent with our population.”
The fire chief for Anne Arundel County, which also collects a reimbursement, testified, that “There has been no reduction in call volume consistent with the introduction of the Fee for Service program. In fact, our call volume continues to increase at the steady rate of approximately 5 percent per year. In the three years since the program started, no county resident has paid any money out of pocket for an ambulance transport when transported by a county ambulance.”
Nevertheless, many Montgomery County voters believed residents would be directly billed for ambulance service when they rejected a reimbursement law in 2010, when I was first elected to the council. That is why I added the following language to the new law:
Section 21-23A(f)(1) and (2)
County residents must not be required to pay any out-of-pocket expense relating to any emergency medical services transport because residents are deemed to have paid any co-payment, deductible, or uninsured portion of the cost of each emergency medical services transport through taxes paid to the County. Tax revenues the County receives must be treated as payment, on behalf of County residents, of the balance of each resident’s portion of the emergency medical services transport reimbursement charge that is not covered by the resident’s insurance.
This language guarantees that county residents will never pay out of pocket. Only insurers will pay.
With this protection in place, I believe the primary question is: Who should pay the approximately $17 million in fire and rescue services this fee would cover? Should it be residents? Local businesses? Or insurance companies?
Residents who are in tune with the tax increases and spending cuts we have had to make in recent years know that the County Executive and County Council are not crying wolf about our fiscal difficulties.
I understand that the voters rejected a reimbursement law at the ballot box two years ago. Supporting this new law is not a position I take lightly, but I believe fully that I am doing just what I was elected to do—make sound decisions to benefit the whole community and not back down in the face of adversity.
This bill may also go to referendum, where the voters can reconsider the issue. I am confident that when voters understand that this new law protects them from paying any bills or fees, they will support it.
I hope you will, too. I welcome comments on my blog or my Facebook page.
Do you think that the ambulance services are free? You are actually paying for them, in your taxes. As to the insurance question, there seems to be some confusion, here. Health insurance, while it is somewhat based on actuarial estimates of future use, it is primarily a method of spreading risk among a larger group of people. What some people need to do is process the fact that, currently, we are paying for these services used by individuals in PG, Anne Arundel, DC, etc., within our health insurance. Additionally, we pay for the services, in MoCo, within our tax bills. People should do a little exploration before jumping to conclusions.
How do you feel about referendums? Should the results of a referendum be totally disregarded? Should referendums even be allowed? Are referendums equally confusing? What is that elected servant of the people saying to his or her constituents when he or she ignores the majority of those same constituents he represents. That to me is indeed "confusing" and some other choices words I won't use here.
If you allow the concept of a referendum to take precedence over any and every decision made by an elected body, you negate the purpose of that body and make all of the work that they do a waste of time. To confirm, all you need to do is look at your email and see the things that are forwarded and reforwarded to your mailbox, most of which are easily proven to be false, yet many people believe every word.
I take it then you feel referendums should not be allowed and the results ignored. I would submit to you that ignoring a referendum by the people is "negating" the people themselves. Nobody was suggesting that a referendum be allowed for "every decision made by the elected body", but when one IS put on the ballot it should be obeyed. Pretty simple really..........
In this case, the county council needed to set aside the referendum because it was not a good barometer of public will. The opposition to the ambulance cost reimbursement conflated real concerns (which have since been addressed) with imagined problems, such that the outcome of the referendum hinged more on one's ability to sift through disinformation than on true preferences. Thus, given the exceptional nature of the referendum, the council displayed courage (see the initial comments) in setting it aside. Moreover, we (the voters) should not be subjected to a referendum vote over an accounting issue like this one.
"In my opinion, referendums need to be respected, although they should only be invoked for major decisions." Only if you agree with the outcome :)) ? Who gets to define what a major decision is? Your intial thought was correct, referendums shoud be respected.
So, the issue (for me) is not whether or not I agree with the outcome, but whether or not the outcome was obtained in a reasonable way.
Of course, we would all like to get rid of the "fat" in county, state, and federal budgets. The problem is that virtually every situation of removing the fat either is anecdotal and does not account for a significant part of the budget and/or is your fat and someone else's necessity. Again, it is our job to elect representatives who subscribe to our general philosophy and allow them to make decisions. If you continue with the concept of putting every decision, with which you (or someone else) disagrees to a referendum, it is easy to become like California (i.e. totally ungovernable.) Or you can look at the plebiscites in the Saar in the 1930s.
Good lord. It's like a Twilight Zone episode on this site. Your provider already includes emergency transport in your insurance and those rates are regional. The price is built in to your premium already because all the other counties already collect on the fees. Your beloved VA collects these fees, as does DC, as does most of the rest of the state. Hence why it makes no sense for MoCo to continue wasting our tax dollars on a service that is covered by our insurance premiums. It's a dumb redundancy and I can't believe liberal ol' me needs to point out that it's a waste of county funds and my tax dollars to cover the cost just so insurance companies can line their pockets with the money. It's the same thing as you saying "I'm going to pay for this hospital visit out of pocket instead of having insurance cover it because that'll mean my insurance rates won't go up!" It's illogical and completely contradicts the entire point of paying the premiums in the first place. MoCo should seek reimbursement just like everyone else.
"I was at the polling place the day of the referendum, and the misinformation I heard was appalling. I did not leave with the impression that people knew what was going on." Peter, I believe that sentiment could be applied to any election/poll that we have. Unless you want to start requiring a test of some sort on the issues and candidates prior to the people casting their vote, we are going to have to trust the will of the people. For me, it's not the outcome of the referendum that matters the most, it's the process that must be respected. I think we agree on that point? "So, the issue (for me) is not whether or not I agree with the outcome, but whether or not the outcome was obtained in a reasonable way." Can you think of a more reasonable way than a vote by the citizen's? If the referendum results had gone the other way, would you still feel the same way about it being obtained in a reasonable way or not?
Where we might disagree is whether or not the people (the majority) is always right. In certain circumstances, I find it appropriate to overrule the will of the people. For example, when it comes to civil liberties, the majority tend to allow these liberties to be curtailed (which is not to imply that ambulance fees have anything to do with civil liberties). A constitution or charter provides one check against simple majority rule. A representative government provides another check. Yes, by default, the will of the people should be respected, but that is a default that can (and should) be overturned under the right circumstances. I believe this to be one such scenario.
First off, no, that's not actually true. They could absorb the cost - that happens all the time in a competitive marketplace and is a very fundamental aspect of capitalism. But anyways, even assuming you're right, then you basically are restating my joke logic of "I'm going to pay for this hospital visit out of pocket instead of having insurance cover it because that'll mean my insurance rates won't go up!" Insurance rates are regional; most all neighboring jurisdictions already legitimately require insurance to cover this cost, which is already factored into the rate you or your employer pay. You, personally, paying out of pocket in my joke or MoCo paying for transport out of pocket as they needless have been have a negligible impact on the cost of your premium. Rates most certainly will not go up $17 mil (the amount the county expects to be paid every year by insurers) worth for MoCo residents. I don't think there's any debate at all that MoCo coffers come out ahead and it's not at the expense of resident's pocketbooks (which I find to be a nice change of pace, personally).
"Where we might disagree is whether or not the people (the majority) is always right." Agreed, the majority might not always be right (who is?). In addition to that though is that the elected body might not always be right either. Rather than have the citizen's suffer at perhaps misguided laws and decisions, it can put together a referendum to correct those mistakes. It's a scary thought to think that an elected body could easily and without recourse "rule" us. We will have to agree to disagree.
I do feel the voice/will of the people should have been respected. In 2010 we said NO and that should have been it. Now the Mo Co council has superceded us. I hope this goes for referendum and when we AGAIN vote NO AMB FEE will this 2nd no vote be respected?
Jim, you don't pay for the fee and then seek reimbursement from your insurer. If you have insurance that covers ambulance transportation then the county files a claim for your insurer to meet their financial obligation. It drives me nuts to think about the 100+ million dollars the county has neglected to claim over the years and instead needlessly taxed me for the service. I assume all our neighboring counties in VA and MD as well as DC handle the collections the same way. That'd be awful if those residents have to fill out the paperwork for claims. Dealing with insurers sucks.