The Patient Protection and Affordable Care Act (PPACA) will extend public and private insurance to about thirty million people, which will cover more than half of those who currently are uninsured. This is a monumental achievement, but it still will leave more than twenty million residents uninsured—or about 8% of the nonelderly population. Therefore, the United States will continue to lag well behind peer industrialized nations in providing nearly universal access to a decent level of care. To approach universal coverage, additional efforts will be required to improve access to care for those who continue to lack insurance coverage. Insurance, after all, is not an end in itself; it is the best means of access to affordable care. But, if other means to minimally acceptable access exist, they may provide a form of non-insurance, direct-access coverage that helps to fill the remaining coverage gap for the uninsured.
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