Seems like that would violate the equal protection clause if care levels are different in different regions.
Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
http://pjmedia.com/tatler/2013/10/24/nyt-obamacare-disproportionately-hurts-poor-rural-americans/