 One of the largest groups of people excluded from access to insurance coverage under the ACA is the group comprised of unauthorized immigrants (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 ACA is fully implemented, will not be truly universal. To be sure, unauthorized immigrants still have access to emergency care at all U.S. hospitals because of EMTALA.