NEW YORK — NEW YORK -- El Nuevo San Juan Health Center sits in a bathtub of vehicle exhaust, its South Bronx neighborhood boxed in by expressways and choked with traffic.
Despite all the tailpipes, asthma hospitalization rates among children here have fallen by two-thirds over the past decade. Dr. Samuel De Leon, the clinic's medical director, says one reason is the drop in ozone air pollution since New York adopted California's tough vehicle emission standards.
"The South Bronx is ground zero for asthma, with all of our trucks and traffic," said De Leon, a pulmonologist. "I am an advocate of the stronger air pollution laws because they eliminate one important trigger for people with asthma."
New York from 1993 to 1996 was among the first states to phase in California's mandate that all new cars include an extra $150 worth of smog-control equipment not standard on vehicles sold in other states. Today, the "clean cars" law is on the books in 11 states, covering about a third of the nation's drivers. Maryland is among five more states talking about adopting the legislation this year.
The Maryland General Assembly rejected the proposal two years ago after auto dealers claimed the extra cost would hurt business without improving the air. Auto industry lobbyists made similar arguments against the bill last week in Annapolis.
But even New York car dealers who opposed the law in the early 1990s now say it did not drive customers to neighboring states. Also, statistics from the U.S. Environmental Protection Agency show that ozone air pollution has decreased more rapidly in the New York region and in California than in other parts of the country that didn't adopt the tougher standards.
"We didn't see any drop-off in sales," said Steve Miller, past chairman of the New York State Automobile Dealers Association and owner of a Honda dealership in Vestal, N.Y. "I've never heard anyone say, 'I'm not buying your vehicle because I don't want to pay for a vehicle with the California emission standards,'" Miller said.
Ground-level ozone - the main ingredient in smog - is created when car exhaust and other pollutants are cooked by sunlight on hot summer days. It inflames lungs and triggers burning sensations, coughing and asthma attacks, causing permanent lung damage.
In 1991, before New York state put the California tailpipe law into effect, ground-level ozone in the New York region exceeded health standards 194 times, according to the EPA. That fell to 16 violations in 2005 - an improvement, although not enough to remove the New York City metropolitan area from the agency's list of places failing federal ozone standards. These standards measure spikes in ozone pollution.
Another measurement of ozone pollution, which looks at averages over eight-hour periods, fell by 16 percent in California from 1990 to 2003 and by 11 percent in New York, according to the EPA. The reduction was smaller in places lacking the California standards, including a 7 percent drop in Maryland's region and in Texas.
Tighter federal rules on power plants and other sources of air pollution contributed to the national decline. But Ray Werner, an EPA regional air program administrator, said the California vehicle regulations are "one of the tools" that drove down New York's ozone levels "pretty dramatically."
"It's a major success story," Werner said. "We think it means less doctors' visits for asthma attacks, people needing to buy less medicine, lower costs for the medical establishment and fewer people missing work because of respiratory problems."
Since Maryland considered adopting the clean cars law two years ago, the debate has changed. California updated its standards to include a hotly debated requirement that greenhouse gas emissions from new vehicles be cut 30 percent by 2016. The additional step is meant to curb global warming - and could add an average of $1,000 to the cost of a vehicle by requiring more efficient engines or hybrid technology on some.
The new rules would, in effect, discourage manufacturers from building larger sport utility vehicles and pickup trucks, which spew lots of carbon dioxide, and encourage the construction of smaller vehicles and cleaner engines. Specifically, a manufacturer would have to demonstrate that the vehicles it sells in Maryland as a group produce about a third less greenhouse gases. If necessary, the company would have to offer price incentives for certain models to make sure the goal is met. If it isn't met, the automaker could be fined.
The auto industry vehemently opposes the new provision, saying the regulations would inevitably hurt their business and prevent customers from getting the big SUVs they want.
But amid growing concern over climate change, the clean cars proposal is catching on politically. Pennsylvania's adoption of the rules in December has increased pressure on neighboring Maryland to join New Jersey, Connecticut, Massachusetts, Vermont, Rhode Island, Maine and the three West Coast states in passing such legislation.
Gov. Martin O'Malley, Senate President Thomas V. Mike Miller and House Speaker Michael E. Busch have endorsed the clean cars bill and predict it will become law.
"Rising oil prices and global warming have come together at the same time, and people have seen the advantages on both fronts in California's emissions standards," said Rob Sargent, energy program director for the Washington-based advocacy organization U.S. Public Interest Research Group. "The message we're hearing from the states is we need to act on global warming because the federal government isn't acting."
As part of a 1977 amendment to the Clean Air Act, Congress forbade states from regulating auto emissions - with the exception of California. It was given authority because it has the worst air pollution in the nation. Since then, states have had the choice of following either federal vehicle standards or California's more strict limits.
Here's how the system works in New York and the other states that have joined the California coalition. Maryland would have to follow this process, too, if it adopts the California rules.
An 11-member committee appointed by California's governor, called the California Air Resources Board, sets numeric limits for a variety of pollutants from cars and trucks.
In states using those standards, car manufacturers can sell only vehicles that are certified to meet the California rules, which are 4 percent to 15 percent stronger than federal limits for smog-forming pollutants, depending on which chemical is considered, according to a study by an association of Northeastern states.
The automakers must report to each state how many vehicles of what types they ship for sale to dealers in these states, and what the average fleetwide air pollution emissions of those vehicles are, said Steve Flint, director of the vehicle program at the New York State Department of Environmental Conservation.
"There are certainly elements of the [California] program that are stronger than the federal program," said Flint. "It has a declining fleet average, so each year's fleet of new cars is cleaner than the previous years. Each year, it gets a little bit better - and that's a big deal, because the federal standards don't do that."
If the average emissions of the vehicles sold in a year don't meet the California limits, the automakers face potential fines.
The new greenhouse limits are by far the most disputed aspect of the regulations. They would take effect in 2009 in most of the participating states and 2011 in Maryland, if it joins.
William Kress, an attorney representing the Alliance of Auto Manufacturers, argued to a Maryland Senate committee last week that requiring a 30 percent cut in greenhouse gases would prevent customers from buying the SUVs and pickup trucks they want.
"What does the fleet look like in 2009? Will the vehicles be smaller, lighter, with less utility? Likely so," Kress said. "If you are a Marylander, and you are looking for a larger vehicle, and it's not available in 2009, what do you do?"
State Sen. Brian E. Frosh, chairman of the Judicial Proceedings Committee, replied that the industry earns more profit selling larger vehicles, so it has a financial motive to fight rules that encourage smaller cars and better public health.
In the Bronx, De Leon said his enthusiasm for the regulations have more to do with asthma than global warming.
After New York fully implemented the tougher limits in 1996, the rate of children hospitalized for asthma in the Bronx fell from 22 per 1,000 in 1997 to 7 per 1,000 in 2004, the physician said. Also, fewer kids are missing school because of asthma attacks.
Meanwhile, the total number of children diagnosed with the disease has risen, perhaps because of better detection or for unknown reasons, he said. But the children with asthma are having fewer attacks triggered by air pollution, De Leon said, and they are receiving better medical care.
"I think it would be more cost effective to have the emission standards, even though they cost more per vehicle, because then you have less people hospitalized with disease, and that costs a lot, too," he said. "Plus, there's the overall quality-of-life issue. I'd rather be breathing than driving."