Ken: The momentum for open access seems to be in research funder mandates. For instance, the U.S. government spends billions of dollars each year funding academic research, resulting in thousands of journal articles published. There is a movement for such research funders to attach, as a condition of funding, the requirement that published articles must also be made available gratis online. A number of public and private funders have adopted such policies (details vary slightly), and more have been proposed; see this list 1 and look for funder mandates. Note that usually, these mandates do not require open access per the Bethesda or Budapest definitions, but only toll-free online access. Still, there's a lot of momentum there.
If the U.S. National Institutes of Health 2 mandate could finally get passed, that'd be a very notable accomplishment. NIH is funds a whopping amount of research. It would be the first mandate for a public agency in the U.S., which makes it easier to argue for the policy to apply to other agencies, as well.
The impact of improving access will be greatest where access is currently poorest. For individuals affiliated with large, wealthy, first-world research institutions, there are still limitations on access to the literature, but much less so than with students at a community college, say, or with no academic affiliation. Open access will level the playing field here somewhat - the rising tide lifts all ships. (Except for those without a boat, which in this metaphor are people without Internet access or literacy, but those are much larger questions. People without Internet access can still reap some benefit of open access literature, since the lower permission barriers make reprints much more attractive.)
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