To the editor:

Poverty rates are generally higher in rural areas than in urban centers. Also, rural Iowans are more likely than their urban neighbors to be self-employed or working for a small business without employer-sponsored health insurance. They are, therefore, more likely to be uninsured or underinsured.

As written, the Affordable Care Act would expand Medicaid eligibility to all adults below 138 percent of the federal poverty level. The U.S. Supreme Court, however, ruled that states could not be compelled to participate in the Medicaid expansion.