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Frontier Amendment: A matter of fairness

Frontier Amendment: A matter of fairness

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Many people found a lot to dislike in the 2010 federal health care reform bill. However, North Dakotans almost uniformly cheered including the Frontier Amendment in that reform. It corrected inherent unfairness to North Dakota and four other rural states when it came to reimbursement by Medicare.

But as the Joint Select Committee on Deficit Reduction meets, the Frontier Amendment is in trouble. It's being considered as part of the $1.5 trillion in cuts that must be proposed by the committee before Thanksgiving.

Medicare made reimbursements for years to hospitals based on a wage index that took into consideration cost of living but not the cost of doing business. The cost of living might be lower in rural areas such as North Dakota, South Dakota, Montana, Wyoming and Nevada - the states affected by the Frontier Amendment - but not the cost of doing business.

In a Tribune story earlier this year, Jerry Jurena, president of the North Dakota Healthcare Foundation, offered the following example: When a CT scanner was purchased for Rugby, the cost was more than if it was purchased for an urban area because he had to pay travel expenses for the technicians from Minnesota to install it. That kind of cost of doing business was not a part of the Medicare equation - and, as a result, North Dakota hospitals were being shorted.

The difference in what North Dakota receives under the Frontier Amendment amounts to more than $50 million.

Even given up to a 7 percent disadvantage in reimbursement, the state ranked in the top 10 in terms of quality of health care.

Sen. Kent Conrad, Sen. John Hoeven and Rep. Rick Berg all support the amendment. The Obama administration, however, has it on a deficit-reduction hit list.

The Frontier Amendment did not expand federal health care. It provided no new service. What it did was make the payment system fair for hospitals in rural states. It did add to the overall cost of Medicare, and that has become a problem for the administration. Rather than suck it up and deal with adjusting benefits or paying more, the administration and some urban members of Congress on both sides of the aisle want to kill the amendment, turn their backs on rural America and re-establish an unfair system.

The Frontier Amendment made North Dakota and its peers part of a fair system. It gave the Frontier states an honest share of Medicare reimbursement. It would be inherently dishonest of Congress and the administration to return to an unfair system.

North Dakotans understand all Americans will have to sacrifice in order to reduce the federal deficit and national debt, but that sacrifice ought to be fairly shared.


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