Not seeking medical attention: Correct, however in some cases the alternative to getting that attention is death or permanent impairment. The uninsured do not cost us: Those who do not or cannot pay cost us. Uninsured people who pay for their treatment do not cost us a penny in increased fees. States aren't exempt from the US Constitution, though in some cases I believe they are exempt from federal laws. Also in many cases, States have a greater ability to pass laws both restricting and putting burdens upon their citizens. Theft is not a Federal crime, in most cases murder isn't a federal crime. Buying Auto insurance is not a Federal law. These are all governed by State laws.