 In 2010, however, The Patient Protection and Affordable Care Act (ACA) passed into law through a reconciliation act. It contains an individual mandate requiring all individuals to purchase health care insurance on penalty of a having to pay a special tax, expands Medicaid (which is a means-tested health insurance program for the poor jointly funded by states and the Federal government) coverage to an intended 16 million people, establishes insurance exchanges to sell insurance, much of it subsidized, to another intended 16 million people, prohibits insurers from denying coverage because of prior medical conditions, and allows children to be on their parents’ insurance until age 26. A U.S. Supreme Court decision (National Federation of Independent Business vs Sebelius, Secretary of Health and Human Services, 2012) upheld the individual mandate, but ruled that states had the prerogative to expand Medicaid and that such expansion could not be a requirement of the ACA. The failure to expand Medicaid in some states and their ongoing opposition to the ACA meant that the expansion of coverage did not reach the 32 million estimated. The increased coverage of the ACA never included the estimated 12 million unauthorized immigrants (Daniels and Ladin 2014), who are also excluded from universal coverage plans in most countries). Given that many of the estimated 12 million long-term unauthorized immigrants in the U.S. count as members of the society, even if they are not citizens, coverage in the U.S., even if the PPACA is fully implemented, will not be truly universal. Nevertheless, unauthorized immigrants still have access to emergency care at all U.S. hospitals because of EMTALA.