As Seth Tupper points out, it looks like the Senate bill eases some of that pressure:
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 [Robert Pear, "Deep in Health Bill, Very Specific Beneficiaries," New York Times, 2009.12.20].
The health care bill is some serious legislative sausage. SHS, will you bite, or will you just keep up the Blue Dog bark? America—and South Dakota's Democrats—eagerly await your answer.