The United States is a complicated nation. Certain rights are preserved for the union. The rest are delegated to the states that make up that union.
To a large extent, health insurance is delegated to the states. (Exceptions include Medicare, Medicaid, Veterans, and military health insurance, etc)
The individual states could, but don’t, offer health insurance to all residents. They do regulate health insurance within their states.
In order to pass the national health care act, ACA, individual states were allowed to opt-out. When the Affordable Care Act passed, some states immediately went about undermining its benefits.
Health insurance has been tackled on a national basis many times. States and their elected national representatives cannot agree with other states and their elected national representatives.
The USA is a great clash of cultures, values, laws, desires, beliefs, and people. Health care and many of the issues facing the citizens of the United States is complicated because the USA is a complicated nation of vastly different states.
This complexity is both the USA’s greatest strength and its greatest weakness.
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