America s heath costs have been so high despite traditionally leaving many people without coverage  because there are so many hands ii the system taking their cut such as  insurance companies and for profit hospitals and clinics.
 Even before Obamacare the very poor and those on welfare got some coverage as well as those with good jobs that provided health coverage. 
It was the vast cohort of the working poor and those who had jobs that didn't pay health insurance and those who had preexisting conditions who were locked out-by the millions.