For decades, China pursued one of the most ambitious expansions of public health insurance in modern history, enrolling nearly its entire population in social health coverage. Yet a study by Chinese academics has found that beneath this achievement lies a persistent inequity: the financial burden of healthcare falls disproportionately on those least able to carry it. Universal enrollment, it turns out, is not the same as universal protection — and the distance between those two ideas is where the work of genuine reform must now begin.