On Oct. 1, despite the government shutdown, the health care insurance exchanges opened, allowing Americans to buy health insurance in an online marketplace where they can compare prices and benefits of different, available plans. Everyone is required to buy insurance or must pay a fine to the government. However, this rollout of so-called “Obamacare” is affecting rural and urban America differently, which is fundamentally unfair.

There are some baseline rules and assumptions that everyone must abide by as the law is rolled out. All Americans must buy managed care plans, which usually come in one of two forms: preferred provider organizations (PPOs) or health maintenance organizations (HMOs), which allow subscribers different options as far as doctor choice and other technical and payment options are concerned. One guarantee everyone has is that 80 percent of their premium will go to medical services, with a maximum of 20 percent going to administrative costs.

It is also assumed that most all individuals under 35 will see a massive hike in their health insurance premiums which helps to subsidize the more expensive care needed for the elderly or those with pre-existing conditions.

According to the Robert Wood Johnson Foundation, rural residents are more likely to be covered by employers with less than 50 employees or purchase their own insurance on the market than their urban counterparts, likely leading to higher premiums. Rural residents are also more likely to be enrolled in PPOs than HMOs, and PPOs pay double the tax charged to HMOs, increasing the disparities.
Decisions by some states to expand the Medicaid program and recommendations by the Department of Health and Human Services to recertify access to hospitals are also causing concerns about rural access to health care. The states that refuse to expand Medicaid as part of the health care reform will see the rural poor hit the hardest.

These disparities make rural residents subsidize urban residents as the law is rolled out. This will happen everywhere from the Colorado Front Range to California and New York, and the significant rural-urban divides in those states. This is fundamentally unfair, however, as no one should have to subsidize others’ insurance premiums simply because of where they live.

Colorado is an important state in this disparity since there are already heightened tensions between the liberal urban areas on the Front Range and the rural areas on the Eastern Plains, and central and western Colorado. This subsidy of sorts to urban dwellers at the expense of the rural population will only exacerbate this problem.

Steps need to be taken to account for these unfair disadvantages experienced by rural America as a result of this rollout of Obamacare. It is only fair.