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Affordable Care Act Options May Depend On Where You Live

MIAMI (CBS4) - Despite technical glitches with the Affordable Care Act's under-performing website, some people have managed to maneuver through the site only to find limited options.

Rural areas tend to have fewer insurance carriers and plans available, and premiums are higher than in their urban counterparts.

"I don't see how you're going to get competition if you've only got one provider," said insurance-seeker Bill Ackley.

Users in urban areas tend to have a variety of plans to choose from, but in more rural locales, it's slim pickings.

According to a New York Times review of the roughly 2,500 counties served by federal exchanges, more than half have plans offered by just one or two insurance carriers.

One such county is right here in South Florida.

"In a smaller area, a rural area, like the Keys, where there are fewer people who are going to sign up, that pool is much riskier. And that drives up the cost of care," said Dr. Steven Ullmann, a health sector management and policy professor at the University of Miami.

In Miami-Dade, someone under 50-years-old has the choice between 141 plans from nine different providers.

Premiums range from $108 to $420.

By contrast, in neighboring Monroe County, where the population is much smaller, only two carriers offer 38 plans.

The cheapest one is $242.

Ullmann said there is some oversight to make sure insurance providers don't overcharge, even in areas where they're the only game in town.

He explained carriers  must be mindful ratio of what they're charging relative to what they're paying out in terms of their benefits.

"In rural areas, it's 80 cents out of the dollar that they're receiving. So that monitors a little bit of the pricing structure," said Ullmann.

The issues with the ACA website,, took center stage on Capitol Hill Thursday, where government contractors convened to answer lawmakers' questions about the shaky launch.

"I don't know what they're offering because I haven't been able to get into the site to see it," said Ackley. "I went through the whole thing. Tried to pick a password. Then it pretty much said, 'Oh, we can't do that right now.' And that was the end of it."

Republicans argue the bungled roll out points to bigger problems with the Affordable Care Act itself.

They want the law suspended until problems are fixed.

Ullmann said we'll have to wait and see how things shake out.

"I think we're watching history being made right now," said Ullmann. "Whether it be a positive or a negative remains to be seen."

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