A year and a half after raising the price of an ambulance ride from $415 to $1,000, Houston City Council is scheduled to consider Wednesday whether to charge for mileage, too.
If the $13-per-mile charge passes, few people will pay it.
The city does not collect a cent from the indigent uninsured who account for about 45 percent of the 131,000 ambulance rides the fire department's Emergency Medical Services units give annually. About a third of Harris County adults have no health insurance. The remainder of the rides are covered primarily by insurance, whether private or Medicaid or Medicare.
Wednesday's proposal actually would reinstate a mileage fee. In council's reluctance to raise the base price so much in November 2010, it included an amendment that eliminated a $7.50-per-mile charge.
Two things have happened since then.
First, city officials have discovered that dropping a mileage charge that, on average, brought in slightly more than $40 per ride ended up costing the city more than it gained by boosting the base price by nearly $600.
That's explained by some Medicare math. Medicare, Medicaid and private insurance agree to reimburse the city for both the ride and the mileage on behalf of insured patients. By dropping the mileage fee, the city forfeited that part of the reimbursement - $2.7 million a year. Raising the base price, though, did not raise revenue, because insurers cap what they will pay for an ambulance ride. As a result, the city actually has been collecting less money per ride since it changed the fees.
In addition, a task force created by the council to examine ways to ward off long-term financial calamity recommended the return of the mileage fee.
Charging for ambulance mileage is the first idea to make it to a council agenda from a list of more than 100 suggestions by the Long-Range Financial Management Task Force.
The administration of Mayor Annise Parker has raised more than 100 fees in an attempt to cover the costs of providing the services.
Parker has said the idea is to charge users for the services they use instead of relying on subsidies from taxpayers.
Councilman C.O. Bradford, who voted against the price increase in 2010, said he again is concerned about tacking a mileage charge on to ambulance rides.
"I don't think you garner additional revenue through charging those who are in need of emergency services," Bradford said Monday. "This is like charging to put your house out when it's on fire."
Low-income Houston residents are exempted from the costs of an ambulance ride if they fill out a form stating that they cannot afford it and provide proof that they qualify for other forms of government assistance to the poor.