Monday, December 21, 2009

A State's Guide to Qualifying for Higher Medicare Payments

From a NY Times article:

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.

This is an interesting wrinkle in the health bill, and since it falls at an intersection of two of my interests (the health care reform bill and trivial U.S. geography), I felt the urge to comment.

What is interesting to me is that the extra money for Medicare payments does not go to the least populous states (bottom five: Wyoming, Vermont, Alaska, North Dakota, South Dakota), nor does it go to the states with the least population density (bottom five: Alaska, Wyoming, Montana, North Dakota, South Dakota). It goes to the states with the highest number of counties that fall under a certain threshhold of population density. Why so arcane? I'm guessing by having it tied to counties, the provision was designed to screw Alaska, the least population-dense state by far, but a state without counties. (Take that, Sarah Palin!) But in it's stead, the provision rewards Utah, the 10th least population dense state in the country, and just as rosy red. It's two senators are no more likely to vote for the provision than they are to vote for a pro-gay marriage law. States that have less population density than Utah include swing states New Mexico and Nevada, as well as the swing-senator-Ben-Nelson-containing state of Nebraska. Utah has 29 counties, and it just so happens that the lines have been drawn so that 15 of them have a population density of less than six people per square mile.

But have no fear, sparse states! You can qualify for this additional Medicare payment just by doing a little redrawing of your maps. All you have to do is some combination of merging populous counties together while splitting less populous counties in two or three parts. For instance, New Mexico currently contains 14 counties out of a possible 33 that have a population density of under six people per square mile. Therefore, all that New Mexico would need to do was to merge six counties together that have population densities over 6 per square mile. For instance, by merging Lea, Eddy, Roosevelt, Otero, Curry and Chaves counties together into one mega-rancher-haven county, New Mexico could qualify for extra Medicare payments. (14 out of 28 counties).

There's nothing that says every state in the union can't do this. I suggest Oklahoma get in on this deal too. Keep the panhandle counties. Merge every other county together. 2 out of 4 counties would get Oklahoma some Medicare money. The state could even designate the existing counties in the main part of Oklahoma as some kind of special jurisdictions (parishes? boroughs?) so that county-level services like courthouses and rural roads don't need to be compromised geographically. But under this plan, Oklahoma would only officially have four "counties".

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