Can you believe that nearly 45 million Americans do not have health insurance? Worse than this, can you believe that an estimated 16 million more are "underinsured" because they have high out-of-pocket expenses relative to their incomes? By now everyone should all know that the lack of adequate health insurance coverage makes it very difficult for people to get the health care that they need and when they do get care, it burdens them with large medical bills.

So who are these people who do not have health insurance? Since 2000 the number of people in the US without health insurance has risen by about 7 million, and the main reason is that this is caused by declines in employer sponsored coverage. Now some of the public programs are picking up some of this slack. The percentage of the population covered by Medicaid, Medicare, or the State Children's Health Insurance Program rose to 26.6 percent in 2004, from 24.1 percent in 2000.

Traditionally it has been employer-sponsored health insurance that formed the backbone of the American health insurance system, covering about 60 percent of all Americans. But rapid growth in health costs has forced employers, to share more of their costs with employees or drop coverage altogether.