Piggy banks with calculator and stethoscope  More than half of the country's 498rating regions had only one or two insurers participating in theACA marketplace. Those regions are disproportionately in sparselypopulated areas. (Photo: Shutterstock)

The Affordable Care Act marketplace is struggling to deliver affordable premiums torural areas, largely due to a lack of insurance competition.

A new analysis by the Urban Institute, aliberal-leaning think tank, finds that more than half (271) of thecountry's 498 rating regions had only one or two insurersparticipating in the ACA marketplace. Those regions aredisproportionately in sparsely populated areas.

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