Healthcare issues are mounting in America’s rural areas. Not only are many small, rural hospitals closing but a growing number of mostly rural areas will have only one insurer to choose from on Affordable Care Act exchanges next year as some companies exit unprofitable markets, The Wall Street Journal reports.

It makes one wonder if  this will end in politicians giving up on the very complex ACA and going with “Medicare for All” in the next few years.

The WSJ reports that Alaska and Alabama are expected to have only one insurer on the ACA marketplaces next year, with the same in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma.

It’s unclear, of course, what the effect of this might be on healthcare access and quality.