Why is it that despite public and private health insurance programs, some U. S. citizens are without any coverage?

Health insurance is offered voluntarily by employers as a fringe benefit. Some employers, especially small businesses, cannot afford to provide health insurance to their employees. The unemployed generally cannot participate in an employer-sponsored program. Under current laws, those who have recently separated from their employment can generally obtain coverage at group rates for up to twelve months from their previous employer. They must, however, pay the entire premium, which many cannot afford. Even when premiums are subsidized by the employer, many low-wage workers cannot afford them. Participation in public programs, such as Medicare and Medicaid, requires meeting certain eligibility criteria. For instance, Medicare is only for the elderly and certain disabled individuals. Medicaid eligibility is determined  on the basis of assets and income, and generally only the very poor qualify.

ACA is supposed to increase the number of people insured since it requires that all individuals must be covered by either public or private insurance and that insurance companies cover all applicants regardless of pre-existing conditions or sex.

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