While competition is intense in many populous regions, rural areas and small towns have far fewer carriers offering plans in the law’s online exchanges. Those places, many of them poor, are being asked to choose from some of the highest-priced plans in the 34 states where the federal government is running the health insurance marketplaces, a review by The New York Times has found.Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
Even liberal media outlets that strongly backed Obamacare are coming out with new stories every day about the glitches and unintended side effects of this poorly drafted law. In light of that, it seems increasingly likely that the building wave of failures will ultimately force the administration back to Congress to try to tidy up this mess. What’s not yet clear is whether the changes will be big or small, reform-based or repeal-based. The next few months will be play a large role in determining the direction of that conversation.Whatever direction the tidying up takes, however, reformers should bear in mind that this story also points to the sinking fortunes of working class rural America. With stagnating wages and tumbling life expectancies, rural Americans are falling even farther behind their urban counterparts. This story confirms that the trend holds in health care as well. We are moving, as our colleague Adam Garfinkle has noted, to an even more class-stratified health care system.