A majority of the lower middle class population are uninsured because they are neither able to afford a formal insurance scheme nor do they have any access to other health insurance schemes in operation. This is because most of them are temporary workers, employed in the unorganized sector where the possibility of availing a health insurance scheme is low. Besides, firms in the organized sector are largely ill-equipped to provide health insurance coverage to their employees. As such, there is a need for evolving a health insurance scheme for the lower middle class. 

There are several avenues open for the upper class and the upper middle class citizens from the organized sector for availing healthcare services. While some of them opt for health insurance schemes that formal insurance service provider's offer, most others opt for benefits accruing through group medical insurance plans for the whole family that their employers provide. Even citizens from the unorganized sector belonging to the upper class and the upper middle class meet their healthcare expenses either by paying hard cash or by going in for health insurance.

However, the lower middle class, comprising a considerable majority who are slightly better off than the impoverished poor, share the same problem and the same plight of unaffordability with the 90 million poor people living in urban areas, except those who are part of organized employment. Some of these lower middle-class urban poor live in hazardous environments and are prone to contract diseases; also, they are addicted to bad habits or vices like smoking, drinking, doing drugs, etc. In spite of healthcare units located close to them, as they are often found in every urban center, they hardly avail the service as a result of high cost of healthcare services.

The government, in spite of its noble intentions and efforts to provide healthcare services to all its citizens, keeps under-servicing the lower middle class and the poor owing to financial constraints that delimit the scope of services offered in its healthcare outlets. Apart from this, the private sector business community, which is active in making profits, is not interested in reaching out to the lower income groups and people with poor health in the neglected areas of cities.

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