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The Senate version of the health care reform bill currently has what’s being called a “frontier amendment” that would boost Medicare reimbursement rates for some doctors and hospitals in Montana, Wyoming, North Dakota, South Dakota and Utah. The extra payments would amount to $2 billion over ten years. 

“I can’t describe to you how tough a fight this is,” North Dakota Democratic Sen. Kent Conrad told the Associated Press. “There’s ‘x’ amount of money on the table. You can imagine other states that don’t benefit see that as taking money from them. They are pushing back very, very hard.” The higher payments to low population density states was conceived by a hospital in North Dakota. Fargo’s MeritCare hospital (above) laid off 90 employees last year and eliminated 120 positions that were already vacant. Hospital officials say its costs are as high or higher than in the rest of the country, but that current reimbursement rates are lower.

Just because the frontier amendment is now in the bill doesn’t mean it will stay. North Dakota has two Democratic senators, but the other states due to benefit are represented by Republicans who say they will vote against the bill. That leaves the states little leverage in how the bill is shaped.

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