The goal of universal coverage has long eluded the Affordable Care Act — especially in rural areas. Because insurers have less financial incentive to offer plans in less densely populated places, residents have an especially hard time finding health coverage through the ACA exchanges.

The dire state of rural health access was driven home for me recently when I went looking for health coverage. After returning from several months out of the country, my husband and I signed up on healthcare.gov and put in his family’s address in Caroline County, a rural area outside Richmond, Virginia. While we expected to find few options, especially compared to our previous address in Northern Virginia, we were both shocked by the results. Our search turned up just two insurers and eight plans. All of them included a deductible and charged exorbitant rates for two people in their thirties.

As a point of comparison, we decided to look up the rates for a similar silver-level plan in Pittsburgh (Allegheny County), where we’re moving later this year. The premiums were almost half of those in the rural Virginia exchange, and we could easily select a zero-deductible plan, instead of the hefty $3,600 deductible we were saddled with in the other plans.