Sen. Tom Carper said yesterday on a conference call that the insurance exchanges would be available over the Internet, with the ability to compare pricing and benefits and make an informed decision about choices. In addition, plans would get rated by its consumers on a government website, a kind of Amazon.com reader reviews for health insurance.

That all sounds like a great idea. However, what use is that to low-income Americans who don’t readily have Internet access? Or in other words, the majority of Americans who would be eligible for the exchange, due to the lack of receiving insurance from an employer?

Many low-income Americans don’t have a computer or device to access the Internet, and those who do may not have a reliable Internet connection. They could possibly access the Internet at their local library, but they may not have a lot of facility with navigating the Web to purchase health insurance. This just brings up a host of questions.

1) Would exchange plans only be sold on the Internet, or would they be available at government offices? Storefronts?

2) If they are only sold online, would participants need a credit card account to secure an exchange plan? Could they purchase with a check or money order?

3) Could this alternatively be done by phone? Apparently Massachusetts gives this option. Is there any funding for operations of this type?

4) Would there be funding for facilitators, tech support specialists to walk people unused to using the Internet through the process?

5) Could we get to an automatic enrollment situation, where you are signed up for insurance without having to jump through such hoops?

I know these are largely implementation questions that fall outside of federal legislation, in a general sense. But the digital divide is just one area where the health care bill intersects with the other inequities in American life. Maybe it will spur calls for universal broadband access, to reduce the barriers to entry to the health care system. Or maybe this health care bill was designed by lawmakers and staffers who didn’t conceive of the real-world problems with creating an online entity to sell insurance. Hopefully it can be overcome.

There’s another area where the inequities of America are highlighted by this legislation – under the Senate bill, undocumented workers are barred from the exchange, even to pay for insurance with their own money.

The solutions to these questions could cut two ways. One is salutary – future policy proposals would have the health care bill to keep in mind as a reason for moving forward. We must allow universal access to broadband Internet because we have to get access to the exchanges and real-time information about insurance company practices for everyone. We must offer a path to legalization for the undocumented so we can offer universal health care to everyone in America, broadening the risk pool and potentially lowering costs.

The other solution could be very negative, ignoring these ancillary issues or even using health care as a reason to stop movement on them. For example, on immigration reform, I can easily see an argument that we cannot legalize the undocumented because they would then become eligible for coverage subsidies, busting the federal budget (I don’t know if it would actually do that, I’m making an approximation of the argument).

The point is that there’s a principle involved here – how do you ensure access when you create new programs? Hopefully somebody is thinking about this.