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The median American would not have to pay out of pocket, as nearly every American has health insurance (since the ACA, it is actually illegal not to have insurance).

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I think it's accurate to say that the median American is insured, with only 8% of the population uninsured [1]. Although, to put that percentage in perspective, that's 26 million people and likely thousands in excess mortality relative to the insured poplulation.

I believe you're referring to the ACA's "individual mandate", which imposed a federal tax penalty for being uninsured. I won't argue whether that makes it illegal or not, but I can say that the individual madate was eliminated by the Tax Cuts and Jobs Act in 2019 [1]. There's no longer a federal tax penality for being uninsured.

[1] https://www.census.gov/library/visualizations/interactive/pe...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944881/

This is purely anecdotal, but of that 8% (26 million), I would posit that most of those people are uninsured by choice. e.g., probably mostly young, maybe part-time workers without chronic illnesses.

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