State lawmakers in search of money for Maryland’s network of trauma hospitals may connect cause and effect — taxing firearms dealers on the guns, firearm accessories and bullets they sell.

Maryland is one of a handful of states with pending legislation that would draw funds from gun industry revenue, mirroring an 11% excise tax on firearms and ammunition California passed last year.

The number of gun violence victims seen at specialty trauma centers is rising, bill sponsor Sen. Sarah Elfreth told her colleagues as she presented the need for more money. And “Marylanders are footing the bill for the high cost of gun violence across our communities,” the Anne Arundel County Democrat said.

“What we’re doing is making sure that we’re keeping the community safe and making sure we have all the resources for our hospitals to treat our Marylanders,” Del. Bernice Mireku-North, a bill sponsor and Montgomery County Democrat, said in an interview.

Whether a gun is used legally or not, the injuries caused by them are complicated to treat and involve long healing times, she said. “Wouldn’t you want to go to the best care that we have in Maryland?” Mireku-North said.

Studies have estimated the costs of community gun violence across the country lands in the hundreds of billions of dollars per year. The center sees anywhere from 500-600 gun violence victims each year, Maryland Shock Trauma Center surgeon Dr. Thomas Scalea said. However, falls and car accidents still make up the bulk of reasons patients visit trauma centers around the state.

Expected revenues from Maryland’s new tax could reach $22.4 million in budget year 2026 and partially cover an estimated need of at least $30 million reported by shock trauma as revenues have stalled and drug and salary costs have increased.

The proceeds would cover medical expenses for patients without insurance, supplement the cost of having specialty physicians on standby and fund violence prevention and victims’ support funds. The tax would apply to firearms, ammunition and accessories such as stocks, grips, magazines, scopes and body armor. Maryland already levies excise taxes on other products such as alcohol and cigarettes, in part because of their social costs.

“It’s only right that they’re kind of paying their fair share to help mitigate all these deaths and injuries that are being caused by their products,” said Mike McLively, policy director for the Giffords Center for Violence Intervention.

McLively worked with a coalition last year to pass California’s gun and ammunition excise tax, the first in the country. The law goes into effect on July 1 and will fund gun violence prevention programs.

The goal of the legislation was to redirect a portion of gun sales “towards solutions to the epidemic of gun violence,” and similar to what has been done with taxes on tobacco products, he said. Everytown for Gun Safety estimates that the U.S. gun industry makes approximately $9 billion a year. Maryland State Police reported performing 44,186 handgun license background checks in 2023.

Bill hearings in California drew broad support, he said. The opposition was from the gun industry who said they supported the prevention programs, just not at their expense.

McLively called his state’s tax modest and rejected the idea that it would be enough to keep people from buying guns. His coalition chose 11% to copy a federal excise tax that supports wildlife conservation, McLively said. He said the gun industry was challenged to argue against something they’d supported in the past.

“If we can support this federal tax that’s protected wildlife, we should be able to support a similar tax to protect human life,” he said.

However, the gun industry, trade associations and gun shop owners stand in opposition, arguing gun violence is perpetrated by people wielding illegal guns, not law-abiding gun purchasers.

Donna Worthy owns Worth-A-Shot gun dealership in Millersville, and she’s also a former Baltimore Police officer. Shock trauma treated her after she was injured in the line of duty and suffered a gunshot wound.

As a small business owner working on thin margins, she said she’ll have no choice but to pass the added tax onto her customers, who are typically hunters, collectors and gun enthusiasts.

“They’re not the ones that are going out there and committing these crimes,” said Worthy, who also serves as president of the Maryland Licensed Firearms Dealers Association Inc.

Trade association leaders warned the state may lose out on more than this new revenue and regular sales tax revenues if customers drive over state lines to avoid the hike.

Some businesses may close up shop, said Jake McGuigan, managing director of state affairs for the National Shooting Sports Foundation Inc, “because you’re gonna see a shift in behavior from consumers.” he said.

McGuigan lobbies on behalf of firearms manufacturers, retailers and practice ranges across the country and in Maryland.

Elfreth said she isn’t concerned that opposition will derail the Comprehensive Community Safety Funding Act of 2024. She likened the tax to how a portion of vehicle registration fees also go to the trauma system — a fee that everyone pays, not just bad drivers. The Maryland Trauma Physician Services Fund has been filled since 2003 by a $5 surcharge from every car registration because at the time the trauma centers mostly treated car accident victims.

”I don’t plan on getting in a car accident any time soon or causing a car accident any time soon, but I’m very happy that part of my vehicle registration fee goes to pay for our trauma system — just in case I am in an accident or cause an accident,” Elfreth said.

Elfreth said the bill will need a little bit of work before it moves forward, ironing out some implementation issues raised by the state comptroller. She also hopes to address concerns raised by the Fraternal Order of Police, which said that officers often have to pay for their own bullets for training and would be affected by increased costs.

Despite the number of gun violence injuries, there is good news: 95% of people brought to shock trauma survive their injuries.

Sen. J.B. Jennings’ father was one of them.

His father fell off a ladder while trimming a tree several years ago and suffered a head injury and massive internal bleeding, including a torn femoral artery, Jennings recalled. His father stayed in shock trauma for three months and became so close with one of the nurses, she invited his parents to her wedding.

But this isn’t Jennings’ only connection to the shock trauma system. The Baltimore County Republican witnessed the medical staff’s urgent attention to patients as a volunteer EMT with the Jacksonville Volunteer Fire Company for 10 years.

With contagious enthusiasm, he advocates and champions the center as a board of visitors member, explaining what makes shock trauma unique and also costly is the number of specialists on standby and ready to save lives around the clock.

But an 11% tax is too high, he said. He’d be more comfortable adding a 4% excise tax to the state sales tax, rounding the total tax rate on guns, ammo and accessories at 10%.

Jennings said he’d argue that the majority of gunshot injuries seen at shock trauma centers aren’t caused by owners of legally purchased guns and ammunition, he said. He suggested instead adding a post-conviction penalty on those committing acts of gun violence.

The bill singles out lawful gun owners he said, and “voters don’t like taxes.”