I think the issue is that there seems to be some sort of health coverage cliff, where if you make too much money you aren't covered by government programs, but

I think the issue is that there seems to be some sort of health coverage cliff, where if you make too much money you aren't covered by government programs, but you still might not be making enough to pay for health coverage yourself. 15 years ago, we just did without health coverage, but we were young and healthy. Not everyone is as blessed.