During the past couple of months, I have held roundtable discussions on the lack of health insurance across the state of Iowa. I have listened to heart-wrenching stories from Iowans who face devastating circumstances due to a lack of affordable health care. The subcommittee for which I am ranking member, the Appropriations subcommittee on Labor, Health and Human Services and Education, has held a series of hearings on health care access and affordability. After these meetings, I am more convinced than ever that Congress must take up this issue immediately.

I recently spoke with a farmer going through bankruptcy. He has

lupus and his insurance costs rose to $13,000 per year. I also spoke with a 55-year-old man who became ill, lost his job and could not afford COBRA insurance. He and his wife could not afford to buy insurance in the individual market because of his pre-existing conditions, so they are forced to bide their time until they are covered by Medicare.

At a meeting in Fort Dodge, Iowa, I met a dentist who volunteers at a free health clinic. She told the story of a patient without insurance who suffered from an infected tooth. The patient was so concerned that she could not afford a doctor and was in so much pain, she actually tried to knock the tooth out with a screwdriver and a hammer before finally visiting the clinic.

These people are not alone. The number of uninsured Americans has increased to almost 42 million; 2.6 million Americans lost their jobs during the past two years; and nearly 75 million — almost one in three — Americans have been without health care coverage during the past two years.

With job loss and health coverage loss, families are forced to buy health insurance in the individual market or simply go without. In Iowa, an individual buying health coverage experienced average increases of 22 percent each year since 1999. Premiums more than doubled for a family with two children from 1999 to 2003. If families go without, they can be driven into severe debt as a result of health care costs. What’s worse is that the uninsured pay the “sticker price” for health care services because no one is negotiating on their behalf. [IMGCAP(1)]

However, this issue does not affect only individuals. Around my state, I have heard stories about how this issue harms businesses, labor, health care providers, school districts and others.

For example, insurance premiums for employers rose 14.7 percent in 2002. I have spoken with businesses in Iowa that have seen 30 percent increases in annual premiums. Many businesses had to stop offering health insurance as a benefit.

Some school districts in Iowa are experiencing premium increases of more than 50 percent in one year! Because there a few places to cut costs, they say that this will lead to eventual layoffs, which, of course, leads to larger class sizes.

The health care system itself faces incredible strain because of the high number of uninsured Americans. Emergency rooms are overcrowded, hospitals are strapped from providing uncompensated care, and our public safety net is stretched to the limit. Uninsured individuals are more likely to receive too little care too late, which costs more in the end.

Unfortunately, the situation doesn’t look to be getting any better. Health care security is slowing, becoming more and more out of reach for the average, working Americans in this country. The number of uninsured Americans is projected to rise to 52 million by 2009.

Allowing millions of Americans to remain uninsured damages every sector of society: business and labor, individuals and families, communities and the economy. The United States is behind the times — many other countries offer universal coverage to their residents, and they manage to spend less money on health care than we do in the United States. The United States has the highest per capita health expenditures in the world. Both Canada and France have lower per capita costs and higher life expectancy.

This is not to say that we should copy a plan that works for another country. However, it does mean that health care security for all Americans must be a priority. The United States recently celebrated the mapping of the human genome, the map of human life. We have the best scientists and the best technology in the world, yet we have not determined how to round up the political will to cover the uninsured.

Part of the problem is that those of us with insurance have not cared enough, special interests have obstructed, and partisan politics have left the uninsured behind.

We have debated this issue for 100 years. It is time to stop debating, stop stalling and come together to make a commitment to address this issue. Any health care reform plan must achieve universal coverage, reduction of bureaucracy, introduction of information technology to prevent errors and increase efficiency, and disease prevention and health promotion. Health coverage for all is what our children, families and communities deserve.

Sen. Tom Harkin (D-Iowa) is ranking member of the Appropriations subcommittee on Labor, Health and Human Services and Education.