Trauma funding vote must overcome distaste for new taxes

By Craig Schneider

The Atlanta Journal-Constitution

Put a new tax on the ballot in November, and watch what happens.

Here in Georgia, the general anti-tax atmosphere, tight economy and countless promises by elected officials to hold the line, can kill a proposal before it's even spoken.

But what if you call it a “fee” rather than a “tax?” And what if you have powerful business interests backing it? And a million-dollar marketing campaign?

“They can dress it up all they want to, it’s still a tax,” says Debbie Dooley, state coordinator of the Georgia Tea Party Patriots.

A coalition of medical and business leaders are pushing a proposed new fee -- or tax, if you will -- that they believe Georgians can embrace. That is an annual $10 tag fee to boost trauma care in the state. Georgians will vote on the measure on Election Day in November. Five months before the vote, advocates are intensifying their efforts to rally support.

The coalition has met a handful of times in recent weeks to create a million-dollar campaign to convince voters to support the fee. The group has gathered about a dozen proposals from public relations firms, and expects to launch its campaign around Labor Day.

"We plan to make a full-blown campaign," said George Israel, president of the Georgia Chamber of Commerce. He envisioned billboards, radio and newspaper ads, polls and lots of speeches to community and business groups. "We're not going to let it get lost."

Still, Georgians as a rule hate anything that smacks of a new tax, said Kerwin Swint, a professor of political science at Kennesaw State University. He believes the tax taint will be the biggest obstacle for the trauma tag vote.

"This kind of state is usually anti-tax, and in this current climate, nobody wants a new tax," Swint said.

Swint said the coalition's effort could make a difference. Some proposals for taxes/fees have a pretty good record of success in Georgia, particularly those penny-sales taxes called SPLOSTS. But those taxes are generally local proposals in which people can directly see the difference in a road project or new park, he said.

To make a difference, the coalition must make people see the trauma issue in a personal light, and they need to be assured the government will steer the money as intended, said Rusty Paul, former chairman of the state Republican Party.

His pitch: "Is your life worth $10 a year?"

Advocates say the $10 annual fee is needed to raise Georgia out of a crisis in trauma care. They say there's not enough hospitals in the state prepared for the worst injuries that come with car crashes, gun and knife attacks, and those traumatic household mishaps that land people in emergency rooms. The problem is costing lives, they say, and hampering efforts to draw business to the state, since employers want to know workers hurt on the job will receive adequate care.

The tag fee, which would raise $80 million a year, would essentially serve two tasks: It would help the 16 trauma hospitals in the state -- which have advanced equipment and expertise -- offset the high cost of providing this care. Many lose money on trauma care, since it requires high-paid specialists be either on hand or on call.

Beyond that, the money would be used to entice other hospitals to enhance their facilities to become trauma centers. Georgia has wide swaths below Macon and in the rural corners of the state where people are dangerously far from a designated trauma unit, Israel said.

The early signs of action -- the coalition plans to select a public relations firm in a few weeks, followed by a campaign fund-raising effort  -- reflects the urgency of these advocates, which include The Georgia Hospital Association, the Georgia Chamber of Commerce, the Medical Association of Georgia and and the Georgia Alliance of Community Hospitals.

They know they face significant hurdles in gaining public support.

"I don't trust government. Look at what they're doing to our country right now," said David Jones, 52, who lives in Paulding County.

The Georgia Tea Party Patriots plan to oppose the measure in its upcoming voters guide, Dooley said. But she said the group does not plan to make defeating it a priority.

Others view the tag fee as more government assistance to Grady Memorial Hospital, the highest profile trauma center. Lt. Gov. Casey Cagle expressed concerns two years ago that a trauma tag fee could become an "entitlement program" that only pays the hospital bills of the poor and uninsured, instead of expanding the network of trauma hospitals around the state.

Coalition members see the campaign as educational, noting some people don't know hospitals have different levels of trauma expertise. The key is framing the Election Day vote as a life-and-death matter of access to health care, said Kevin Bloye, a spokesman for the Georgia Hospital Association.

He noted that only 16 of the state's 152 acute-care hospitals are designated trauma centers. Georgia's trauma death rate is 20 percent higher than the national average. And an estimated 700 Georgians die every year because they do not receive trauma care within the critical 60-minute window -- the "golden hour" -- immediately following injury, he said, citing a 2006 report by the Joint Comprehensive State Trauma Services Study Committee.

Many states across the country struggle to provide adequate trauma care, but Georgia is among those most in need of more funding and more trauma centers, said Connie Potter, president of the Trauma Center Association of America. More than a dozen states have created designated funding streams for trauma care, ranging from extra fees on cigarettes to fees on driver's license points, said Potter, whose nonprofit trade association represents about half of the trauma hospitals in the country.

Some people agree there's a need to enhance these services, according to random interviews of metro Atlantans this week by The Atlanta Journal-Constitution. In addition, a survey by the University of Georgia two years ago found that two out of every three Georgians would be willing to support an annual fee of $25 or more to increase trauma services.

"Personally, if I was injured and I needed trauma care, I would want the best service I could get," said Dave McCoy, 45, of Kennesaw.

Access to trauma care also plays a role in the Georgia economy, Paul said. The lack of trauma care hospitals has hurt efforts to draw businesses -- particularly manufacturers -- to the southern part of the state, he said.

The ballot vote is needed to change the state Constitution, and therefore create a dedicated funding stream for trauma care. The state Legislature would have the power to decide exactly where the money is directed, and it has delegated that task in recent years to the Georgia trauma care commission, composed of hospital, medical and emergency service representatives.

Even if voters approve the trauma tag fee, the state Legislature would have to craft enabling legislation to enact it. Lt. Gov. Cagle said he wants that legislation to ensure that the priorities in spending are equipment, specialists and communication systems, as opposed to the unpaid medical costs of people without insurance.

The trauma tag fee could be an even tougher sell in metro Atlanta, since the area already has a handful of designated trauma hospitals. But hospital officials say the extra money is needed to shore up these centers, and keep them from dropping out of the network.

The issue of trauma care has bounced around the state Legislature for years, slowly gaining ground. After years of false starts, failed final-hour pushes and much lobbying, the issue stayed largely under the radar this year before gaining last-minute momentum. Lawmakers may have been more supportive because the measure must still pass muster with voters, so lawmakers themselves would not be passing a so-call new tax.

In January, the state "superspeeder" law took effect to help raise trauma money. Motorists who speed at 85 miles per hour or more on a highway, and 75 miles or more on a two-lane road, would have to pay $200 to the state, above and beyond any local speeding ticket. The new law is expected to raise $23 million a year for trauma care.

For now, trauma care advocates feel their own "golden hour" has arrived.

"We've been fighting this battle for the past four years" in the Legislature, said hospital association spokesman Bloye. "This could be our last chance."

Voters choice

Georgians will vote in November on a referendum to fund trauma care. The referendum reads: "Shall the Constitution of Georgia be amended so as to impose an annual $10.00 trauma charge on certain motor vehicles in this state for the purpose of funding trauma care?"

The term "certain motor vehicles" means those designed to carry 10 or fewer passengers, including cars, pickup trucks, motorcycles, sport utility vehicles and passenger vans.

Advocates for the measure assert:

1. Only 16 of the state's 152 acute-care hospitals are designated trauma centers. Georgia should have about 30, according to state health officials.
2. Georgia's trauma death rate is 20 percent higher than the national average.
3. If Georgia's death rate improved to the national average, it would save as many as 700 more lives annually.
4. Trauma care in Georgia is in a crisis, especially in rural areas.

Source: Report of the Joint Comprehensive State Trauma Services Study Committee, 2006.

The issue faces several hurdles:

1. The perception that this is a new tax.
2. The perception that this will lead to bigger government.
3. The perception that this could be more government assistance to Grady hospital
4. The perception that this money would be an "entitlement" that pays the hospital bills of the uninsured.