There’s Nothing Fair About The Frontier Amendment

One aspect of Obamacare, the so-called Frontier Amendment, has been causing quite a bit of controversy in North Dakota. Senator Kent Conrad has said he was “infuriated” when he learned the amendment, which increases Medicare reimbursements for rural states like North Dakota, was on the chopping block.

The Grand Forks Herald has weighed in calling for the amendment to be preserved for the sake of “fairness.” Now the Bismarck Tribune has echoed that sentiment in an editorial of its own:

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 problem with these demands for “fairness” in government price fixing is that as long as the government is setting the prices, there is no fairness.

Is it fair that health care providers can’t negotiate their prices? Is it fair that health care consumers in the Medicare program can’t shop around for cheaper services? Is it fair that federal taxpayers in other states are getting stuck for the tab for higher reimbursements in North Dakota?

It’s not just the Frontier Amendment that’s unfair. Medicare is unfair. Americans don’t get a choice. We’re forced to pay into the program, and we’re forced to enroll in it when we’re elderly. And in the program, the government simply dictates what prices it will pay for care in a vain attempt to control costs.

They have to try and control costs because Medicare is going broke. And as the program gets even more broke, the efforts by the government to control prices and ration access to care will only get worse.

Griping about the Frontier Amendment is like re-arranging deck chairs on the Titanic.

Rob Port is the editor of In 2011 he was a finalist for the Watch Dog of the Year from the Sam Adams Alliance and winner of the Americans For Prosperity Award for Online Excellence. In 2013 the Washington Post named SAB one of the nation's top state-based political blogs, and named Rob one of the state's best political reporters. He writes a weekly column for several North Dakota newspapers, and also serves as a policy fellow for the North Dakota Policy Council.

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  • Jamermorrow

    As health care costs continue to go up Medicare/Medicaid beneficiaries will be priced out of the market. Long lines and waiting lists are going to be a common theme. Price fixing by setting the price too low creates shortages. This is already happening in some areas and for dentistry, mental health, and specialized health care. 

  • Lianne

    Medicare sets the wholesale/retail prices of orthotics, etc.  Well, at least that used to be the case.  I don’t have any documentaion in front of me currently, but I do remember in the late 80’s there was a typo in the price/cost of breast prostheses by Medicare and it put the additional cost on the patient.   The next year they corrected their mistake.   I have never heard that Medicare has stepped aside from price controls.  That does NOTHING to reduce cost.  Here is how it worked.  Medicare looked at the wholesale/consumer cost  of an item 18 months previous to the new prices being set for an item or procedure.  Retailers and wholesalers soon caught onto the process and set about charging a much higher price and then ‘settling’ for whatever Medicare allowed at the time.  Each year the cost of an item or procedure was higher than previous because of this.