An oversimplification but in general, health insurance is costly here in the U.S. because the quality of care is high. For millions of Americans, it is affordable only because they are employed. But for many more millions expensive health insurance is just not feasible.

When you or a spouse is employed you enjoy the benefits provided by your employer who makes contributions to your health insurance or pays the premium in full. However, once you leave the company (through voluntary termination or a lay-off), you're solely responsible for the full family premium and lose the advantages of a low group rate, no underwriting and no exclusion for prior health condition.

At this point, you have 30 days to convert to a COBRA policy. If you go beyond this period, you are subject to the rules surrounding self-funded insurance: you must undergo an underwriting process that will base your premium on your current age and health condition with exclusions. The less healthy you are and the older you are the more premium you are going to pay. Plus, there are new waiting periods before this now expensive health coverage is in effect which can be up to 90 days. Just when you are worried about meeting your mortgage or rent, utility bills, education for dependents and food you now have to figure out how to afford the expensive healthcare insurance provided through COBRA. Unfortunately, this is often an expense that goes by the wayside even if family members have chronic conditions.

Low-income wage earners are even less likely to continue health insurance coverage if they become unemployed because it is prohibitive to pay for this coverage on their own because unemployment benefits are low and savings may be non-existent.

There is a little relief for couples over 65 who are still employed since the employer is the primary provider of benefits with Medicare as the secondary provider. This can mean that most costs are covered. But once you retire, Medicare is the only provider unless you can afford supplemental health insurance to cover the gaps should you become ill. Medicare requires payment of premiums and deductibles for a doctor's care, prescriptions and long-term care. These supplemental policies can then result in expensive healthcare insurance packages.

For many millions of families, healthcare insurance is just too expensive. However, there are alternatives. Enroll in a government-sponsored program provided you pass their stringent income guidelines; apply for Medicaid, the government-funded program for families who are below the poverty program; or rely on mandatory emergency care at your local hospital. All of these alternatives, especially the latter, add to the cost of healthcare here in the United States.