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The answer to this question is not because 47 million Americans cannot get health insurance. The answer is far more complex. There are millions of Americans who cannot get health insurance due to their health status. Americans with serious health conditions are often unable to get policies due to health insurers not issuing a policy to them for fear of losing money. But those not able to obtain health insurance represent around 25% of the 47 million uninsured Americans.

Clearly we have a problem with access to health insurance. Thirty one states have high risk pools that allow individuals with moderate or serious health conditions to enter in to a high risk pool and obtain coverage. Check with your state department of insurance to see if a high risk health pool is available.

Small employers are rapidly dropping their health insurance offerings as prices continue to rise at a pace more than four times the consumer price index. More than 40% of employers with fewer than 50 employees do not offer health insurance. Even those employers who offer health insurance have many employees opting out of the coverage because their portion is cost prohibitive.

Americans between the ages of 18 and 24 average one in three who go without health insurance. Those in this age range go without health insurance because they cannot afford the coverage or feel they do not need the coverage.

Children are among the most prevalently represented groups without health insurance. Children generally cannot obtain coverage on their own. Due to problems with access for their parent or parents, many children go without coverage. The State Children’s Health Insurance Program was developed to provide access to children who do not have coverage currently and do not qualify for Medicaid.

Many argue that 47 million is too high of a number. There are Americans counted in this number who are between jobs and do not continue coverage while in the transition between jobs. A new report by the Congressional Budget Office (CBO), "How Many People Lack Health Insuranceand For How Long?," suggest the uninsured populationas a far more fluid group than is generally acknowledged: a significant number are chronically uninsured, but many are without insurance for a short period only.

Regardless of the actual number, as the world’s most affluent nation, we have problems with access to health insurance. Some cannot obtain insurance, others choose not take insurance and we remain a nation with costs being shifted from those insured to those uninsured.

This question was asked on the wiki: American Health Care Wiki.

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