The American frontier—the lawless land of gold and gunplay, of gamblers, prospectors and prostitutes, and the great promise of manifest destiny—is gone. Frederick Jackson Turner told us this in a seminal essay way back in 1893. And yet, 120 years later, the Health and Human Services Department isn’t quite ready to give up on the frontier. They have even proposed a new definition that could see it expand, and it’s made at least two Montana lawmakers more than a little worried.
“That coarseness and strength combined with acuteness and inquisitiveness; that practical, inventive turn of mind, quick to find expedients; that masterful grasp of material things, lacking in the artistic but powerful to effect great ends; that restless, nervous energy; that dominant individualism, working for good and evil, and withal that buoyancy and exuberance which comes with freedom—these are the traits of the frontier.”
-–Frederick Jackson Turner
Currently, HHS defines "frontier" as being a county that has six or fewer people per square mile. But a new definition puts a greater emphasis not on the population density of a county, but on proximity to a major metropolitan area. HHS says this would deal with the places like Coconino County in Arizona, which has a population of about 6 people per square mile, but also includes the city of Flagstaff. Under the new definition, only the parts of Coconino far enough away from Flagstaff will be designated frontier. HHS says that it’s just a more accurate way for reseachers and political scientists to categorize the country. But Democratic Sens. Jon Tester and Max Baucus of Montana say they are worried about unintended consequences.
Their concern, as penned in a letter to the Office of Health and Rural Policy, is that the new definition could have “major impacts” on programs that rely on the way that rural and frontier lands have been designated. When it comes to health care, there are a number of advantages of being labeled a frontier county, including easier access to some grants and greater Medicare reimbursement opportunities. And while not all of these programs will necessarily use the new definition, there is apprehension that the new classification could take precedent.
For Montana, a state where 45 out of 56 counties are frontier, the new designation could mean more places would qualify for programs, making it more difficult for inhabitants to compete for health services.
“Frontier counties in Montana … face significant problems in recruiting physicians and other health professionals; in supporting the range of services needed to meet basic health needs of the community,” the senators wrote. “Sparse population density is compounded by distance to services, but is, in and of itself, a defining characteristic of a frontier community.”
Kristin Juliar, the director of the Montana State University Office of Rural Health, said that one of the best ways to attract health care professionals into these ultra-rural areas is through the loan-repayment funds that are easier to get in frontier areas.
“There’s rural, and there’s super-rural,” Juliar told National Journal. “We think it’s important to be real clear what makes frontier areas different from rural in general. So the frontier definition should look at the unique characteristics of the most frontier parts of the country.”
HHS says that they don’t disagree with the idea, but believe that the current system is flawed. Counties sizes vary widely, and geographic location should be taken into account, they say.
“We’ve talked about this for years,” said Tom Morris, the associate administrator for the Federal Office of Rural Health Policy. “We always felt like the six people or fewer per square mile was one way to look at it, but it had its drawbacks. It just doesn’t say what that area looks like in relation to other areas.”
He was quick to point out that this new definition wasn’t going to necessarily replace the old one entirely (HHS isn't the only government agency with a definition of frontier), just that it was a new way to look at things. He said in his office no grants are given out exclusively to people in frontier territory, but realized that not everyone was going to be satisfied.
“With any geographic standard, nothing is going to be perfect,” he admitted. “Any new standard is going to put some people in and leave some people out. People out may not be happy about it.”