Health Exchanges Pretty Lousy for Rural Customers Competition is low, and prices are high By Kevin Spak, Newser Staff Posted Oct 24, 2013 8:59 AM CDT 98 comments Comments A would-be customer fills out a health insurance application in this file photo. (AP Photo/Mel Evans, File) (Newser) – ObamaCare's technical difficulties are well-documented—the House is dragging four contractors in to talk about them today—but it has one problem no web developer can solve: It's pretty lousy in rural areas. The theory behind the Affordable Care Act's health insurance marketplace is that forcing insurers to compete will keep prices low. But in many rural areas, that competition simply isn't materializing, the New York Times reports. In 21% of the 2,500 counties serviced by the federal exchanges, consumers have only one carrier to choose from. Among the reasons why new insurers aren't stepping in: "dominant" insurers hold tightly to their territory, and "powerful" hospital systems fiercely oppose any moves that would trim their rates. Most under-served areas are poor, and many are in the South; there's only one option in almost all of Mississippi and Alabama. That lack of competition can have a huge effect on prices. A 50-year-old in rural Georgia, for instance, would pay twice as much for a silver-level plan as one in Atlanta. The cheapest silver plan in Wyoming, which has two insurers, costs as much as the most expensive in Montana, which has three (including one new co-op). "The Affordable Care Act was designed for … big cities," Wyoming's insurance commissioner says. "You've got to have some bargaining chips, and we don't have that much."