The BRICS (Brazil, Russia, India, China and South Africa) have emerged as potentially robust economies with considerable international influence. Nevertheless, essentially all of these nations have fallen short of simultaneously developing strong economies and health care systems, contributing to the emergence of health care inequalities, such as inadequate access to medicine, health care treatment and out-of-pocket spending. This is puzzling considering that most of these nations’ economies burgeoned during the 1990s and early-2000s, thus potentially providing additional revenue for health care spending, while constitutional guarantees of universal access to health care and the presence of democratic electoral institutions in most nations should have incentivized governments to successfully address these inequality issues. Nevertheless, with the exception of South Africa, this study finds that waning political commitment to health care spending, increased foreign aid commitments and tenuous state-civil societal relationships accounted for these ongoing inequality challenges.