Montgomery County officials have revived the county's only law ever to be rejected by referendum, and opponents are contemplating another challenge.
The County Council voted 5-4 in May to approve a new ambulance fee that would allow the county to bill insurance companies an estimated $300 to $800 each time a policy holder uses a county ambulance, and directly bill many uninsured out-of-county residents.
The council passed similar legislation in 2010, but it was petitioned to referendum and defeated by voters.
Supporters say the fee won't come out of county residents' pockets and will generate much-needed revenue, but opponents argue that voters have already spoken on the issue.
"It shows disrespect for voters and it undermines trust and it will undermine belief that voting makes a difference," said council member Phil Andrews, a Democrat. "Governments need trust more than they need revenue."
Voters struck down the ambulance fee by an 8-point margin in 2010, but County Executive Isiah "Ike" Leggett renewed calls for the fee this spring after the General Assembly passed laws requiring the county to increase its education spending and pay a portion of teacher pension costs.
Mr. Leggett, a Democrat, has argued the changes will force his county to divert funds from other programs and find new revenue streams if it hopes to balance future budgets. County officials said last month they anticipate a $71 million revenue shortfall at the start of next year's budget process.
The ambulance fee, which is slated to go into effect Jan. 1, is expected to generate more than $17 million a year.
"Anything that relieves that load or shifts the burden a little bit should be viewed as a relief," said council member Nancy Floreen, a Democrat who voted for both fee proposals. "It is an angst-producing issue, but I do believe that people [in 2010] never understood fully what the issue was all about."
The ambulance fee would in most cases be paid by insurance companies. No county residents would have to pay out of pocket, but uninsured noncounty residents would have to pay unless they qualify for economic hardship.
The issue has divided council members for years and passed both times by a 5-4 margin.
Proponents say the fee won't hurt the public because most insurance policies already cover medical transports and companies have money set aside, but many local governments never bother to ask for reimbursement.
Ambulance fees are fairly common in the region, existing in Maryland counties such as Prince George's, Frederick and Anne Arundel, across the Potomac in Arlington and Fairfax, as well as in the District and Baltimore.
"Communities that get reimbursed by insurers have seen no impact on the quality of service and no impact on insurance rates," Mr. Leggett said in May. "It is fundamentally wrong to allow county taxpayers to foot the bill for millions of dollars that insurers pay nearly everywhere else in the nation."
Opponents worry that a fee will make some people reluctant to call 911 in a medical emergency. They also insist that insurers will find a way to pass the cost onto consumers by raising premiums.
"Insurance companies aren't charities and they are going to protect their profit margins," said Mr. Andrews, who is chairman of the council's Public Safety Committee and said the issue was first debated in 2003. "It's wrong to charge anyone for an emergency service. It should be paid for by taxes and it is paid for by taxes."
The Montgomery County Volunteer Fire-Rescue Association led the 2010 petition effort defeating the fee and is seriously considering another petition this year.
The group has already cleared petition language with the county Board of Elections.
According to county law, petitioners would have until Aug. 26 to submit 31,046 signatures from Montgomery voters - a number equal to 5 percent of registered county voters when Mr. Leggett signed the bill into law May 28.
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