Reading about free medical procedures in English is always an experience

Was looking into the procedure of vasectomies (which are freely available in my country) and I always see some line like this in Wikipedia for most interesting medical procedures or other important services.

The U.S. Affordable Care Act (signed into law in 2010) does not cover vasectomies, although eight states require state-health insurance plans to cover the cost.

Why the heck are Unitedstadians even patriotic at all if they live on the basis of "this basic thing is only ensured on a state-by-state basis".