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Monday, May 14, 2012

Why I Voted for the Ambulance Reimbursement

Today, I voted along with 5 of my colleagues (6-3) in favor of collecting reimbursements from insurance companies for emergency transportation, 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, UnitedHealthcare, 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).

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.


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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 of Prince William County, 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 of Anne Arundel County, which also collects a reimbursement, testified,

“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% 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.