Health insurance is important because it improves access to health care, which protects health, and provides needed financial protection, both of which are objectives of a just system (Saloner and Daniels 2011). In a system that ensures universal coverage-whether it includes private insurance or not-the term “universal” suggests that all people have insurance coverage. Despite this, in most such systems, unauthorized immigrants are excluded from coverage. In the United States, unauthorized immigrants number in the millions and form a significant part of the uninsured population, even under the 2010 Patient Protection and Affordable Care Act (PPACA). Is such exclusion justified? To be sure, unauthorized immigrants have access to some medical care and are guaranteed access to emergency medical care (Emergency Medical Treatment and Active Labor Act (EMTALA) 1996). Still, exclusion of unauthorized immigrants from PPACA begs the question: Is it ethically justifiable to exclude unauthorized immigrants from the comprehensive nonacute care provided by most insurance policies?