Nearly 40 million Americans between the ages of 18 and 64 carry no health insurance coverage. In the past, only the poor or the unemployed faced this problem. Today, with health care costs rising dramatically each year, the threat of being uninsured now extends to low- and moderate-income people as well. Between 1980 and 1998, according to the Health Care Financing Administration, the amount of money Americans spent on health care quadrupled. In 1998 Americans spent $1.1 trillion on health care, roughly $4,000 for every person in the United States.
Health insurance costs have continued to rise, a problem that has been particularly difficult for small companies and the self-employed. Small companies often have less clout with insurers because they have a smaller premium base and thus cannot negotiate large-scale deals. For the self-employed it is worse. Insurance companies that in the past have offered health insurance policies to individuals have gradually been eliminating this coverage. Even if a person is willing to pay high premiums, there is simply less to choose from in the insurance market. Some people get around this dilemma by getting their insurance through professional associations; others get insurance through a spouse. Some take insurance policies with high deductibles of perhaps $5,000 or even $10,000. These are known as “catastrophic coverage” and are meant to protect individuals from unforeseen major medical events (such as cancer). An alarmingly large number of people, however, seem to be saying that it may be easier and more cost-effective to take their chances and go completely without coverage.
The number of uninsured people had actually been falling since the late 1990s, in response to the strong economy. But with the economic downturn beginning in 2000, the belief was that numbers would begin to rise again. Even if those numbers were to remain steady, the grim fact remains that the most recent figures translate into one in four working-age people.