The New York Times points out that the PPACA tends to work to the disadvantage of the rural poor:
As technical failures bedevil the rollout of President Obama’s health care law, evidence is emerging that one of the program’s loftiest goals — to encourage competition among insurers in an effort to keep costs low — is falling short for many rural Americans.
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.
but I don’t think that they quite appreciate what a problem the healthcare exchanges present to the rural poor. Reliable, high speed Internet connectivity, when available at all in rural areas, tends to be quite pricey. Of all of the people in the country the rural poor are the least likely to have high speed Internet and if you take all of the problems with the Healthcare.gov web site and multiply them times ten that’s probably about what accessing the site via a dial-up connection will be.
Presumably, for some this is more a feature than a bug. The rural poor aren’t their constituents.
Still, for somebody like Illinois Sen. Dick Durbin (the second highest ranking Senate Democrat), it’s going to present a problem. Illinois is already one of the states in which the PPACA is likely to produce substantial premium increases in the individual insurance market and these other issues with the legislation will aggravate the situation. I expect the upstate/downstate gap to be greater than ever in the 2014 midterms.