Monday, December 21, 2009

Health reform bill boosts Medicare payments in frontier states

An article by Robert Pear in Sunday's New York Times explored items "buried" in the new health care bill. One of those hidden items may bring significant money to Wyoming and adjacent states:

Another item in the package would increase Medicare payments to hospitals and doctors in any state where at least 50 percent of the counties are “frontier counties,” defined as those having a population density less than six people per square mile.

And which are the lucky states? The bill gives no clue. But the Congressional Budget Office has determined that Montana, North Dakota, South Dakota, Utah and Wyoming meet the criteria.

In the 2000 census, Alaska boasted 1.1 person per square mile while Wyoming was the second-most frontier of frontier states, with 5.1 people per square mile. During the Bush-era energy boom, more people moved into the state than out, making Wyoming the 49th state in population density, with 5.4 per square mile. Alaska now has 1.2.

Since more than 50 percent of our counties have less than 6 ppsm, we qualify. While Utah has a whopping 32.2 ppsm (2007 census estimates), most of its southern and eastern counties are very rural, bringing down the big numbers for Salt Lake City. Same goes for the rest of those big Northern Rockies and High Plains states. The big numbers in Missoula and Billings and Bozeman are leavened by counties in Eastern Montana, where antelope and tumbleweeds are more prevalent that people.

In Wyoming, my county of Laramie has 30 people per square mile, which dwarfs the 1 ppsm in Niobrara County and 2 ppsm in Hot Springs and Weston counties. Because humans are packed like sardines in Laramie County, we rub up against other humans in new and interesting ways, causing us to either bolster our humaneness or flee to less-populated counties. Because of this, Laramie County is registering more Democrats (and winning more legislative seats) while northern and western counties continue their one-party status.

Speaking of Republicans... our good senators and lone rep should be happy with this frontier state designation in the health care bill they all oppose.

Barrasso/Enzi/Lummis all have taken the Repub party line (NO!) on health care legislation. They have advocated for higher Medicare payments. Lummis, in fact, spoke to a gathering of health care professionals at the hospital in Casper during last summer's "yell and scream at town meetings" craze. Most of the docs were upset about low Medicare reimbursement rates. Lummis also was upset. Now she will be happy and congenial, right? And what about Dr. Barrasso? Will he too be happy and congenial and vote for the final bill? Not bloody likely.

Hummingbirdminds also wonders about Sen. Enzi. He was one of the vaunted Gang of Six who steered the Senate Finance Committee's health care bill. He was joined by Committee Chair Max Baucus of Montana and Sen. Kent Conrad of North Dakota. While the Dems are voting for the bill, Enzi is not. Does that mean he does not want doctors and hospitals in his frontier state to receive larger medicare reimbursements? You can ask him via e-mail at

Frontier State Gang of Six members are getting what they wanted. So is Sen. Nelson of Nebraska. From the NYT article:

Nebraska, with help from Mr. Nelson, won a particularly generous arrangement under which the federal government would indefinitely pay the full cost of covering certain low-income people added to the Medicaid rolls under the bill.

Republicans derided this provision as the “Cornhusker kickback.” And they said it was typical of the favors Democrats had given to Mr. Nelson and a handful of other senators.

“You’ve got to compliment Ben Nelson for playing ‘The Price is Right,’ ” said Senator Richard M. Burr, Republican of North Carolina. “He negotiated a Medicaid agreement for Nebraska that puts the federal government on the hook forever. Not for six years, not for 10 years. This isn’t the Louisiana Purchase; this is the Nebraska windfall.”

I love how Repubs object to these sorts of specific earmarks buried in legislation. Defense bills are larded with funding for military bases and specific projects backed by Repubs. They even vote for the occasional Bridge to Nowhere.

Meanwhile, we can only marvel at the "Cornhusker Kickback." Sen. Nelson is a player. As a Democrat, he was in the game. While Sen. Enzi may have worked some frontier state items into the bill, our Repub senators are mainly left on the sidelines to stew and fume.

Perhaps some of that Nebraska Windfall will blow over the borders into Wyoming. But I forget that the prevailing winds blow from the West. From all those rural Republican Wyoming counties in the West.

1 comment:

Anonymous said...

Since Barasso from Wyoming complained about the Cornhuskher kickback so much I decided to call his office and ask him about the Frontier Folly but his office phone lines will not accept calls from outside of Wyoming. If you dial his 202 prefix they won't answer the phone and if you dial his 866 prefix they said they can't handle calls in my region. Well, I guess it is easier than trying to explain himself.