ATLANTA — If the Georgia House approves, voters in November will decide whether to impose a $10 annual car registration fee to fund the state’s cash-strapped network of trauma hospitals.

The Senate passed the bill on Monday with a 43-7 vote, and it must go back to the House because House members passed a different version of the bill.

The measure would channel $74 million into the state’s 15 trauma centers.

State Rep. Jay Neal, R-LaFayette, said if the $10 fee comes back from the Senate and it’s not tied to the House’s preferred tax cut, the bill will face trouble in the House.

The House passed the fee referendum as part of its measure to remove the annual state property tax on vehicles.

“I’m opposed to it by itself,” Rep. Neal said.

He said alone the fee measure would be “simply a tax increase,” and added, “I would encourage our leadership not to agree with the increase.”

Rep. Neal said if the $10 trauma fee is tied to the tag tax elimination, it would be a tax decrease.

“If my (vehicle registration) bill goes from $100 to $10, that’s a 90 percent tax decrease,” he said.

If it does pass, the fee would still have to be approved by voters in a referendum on the Nov. 4 general election ballot.

“We are not imposing a $10 fee,” said Senate President pro tem Eric Johnson, R-Savannah. “We are allowing the voters to impose one on themselves.”

A legislative study committee last year said the state’s trauma network was in crisis, and results in a death rate in Georgia from traumatic injury that is 20 times the national average.

The fee on auto owners was picked by lawmakers because motor vehicle accidents account for almost three-quarters of trauma injuries in Georgia.

The state’s trauma centers have complained of chronic underfunding, saying they provide at least $170 million a year in uncompensated care. The largest, Grady Memorial Hospital in Atlanta, is facing a massive deficit that has prompted an overhaul of its leadership.

Officials at Erlanger Medical Center in Chattanooga said last month that it spends nearly $5 million per year treating Georgia trauma patients. The hospital, the closest top level trauma center for much of North Georgia, treats about 6,000 trauma patients a year from Georgia.

That is about 30 percent of the total of trauma patients Erlanger treats, Erlanger CEO Jim Brexler said.

It is not clear how or whether Erlanger would collect from the Georgia money if the new trauma fee is approved.

Trauma centers differ from regular acute care hospitals in several very expensive ways.

They have teams of specialty surgeons — like orthopedists and neurosurgeons — on call 24 hours a day, seven days a week. They also have high-tech equipment on hand to treat the most severe injuries on site.

The staggering costs have led some hospitals to drop the voluntary “trauma” designation because of the expense. That’s especially problematic in rural areas.

Some lawmakers worried Monday that the money from the car fee would flow into the general fund, rather than being earmarked specifically for trauma care.

Sen. Johnson said the Department of Revenue would provide a report detailing how much money was raised by the fee so that legislators could appropriate the same amount to trauma care.

Staff writer Lori Yount and The Associated Press contributed to this report.

ON THE WEB

H.B. 1158: www.legis.ga.gov