After years of fits and starts, it is encouraging that meaningful health care reform is finally on the fast track this year. We must build on what is best about our current health care system while fixing what does not work. We must create a system that works for all of us, and that means expanding affordable and quality coverage to the millions of uninsured and underinsured.

We all have a stake in health care reform, including the 80 million Americans who suffer from heart disease, stroke and other cardiovascular diseases. And as the debate takes shape, the American Heart Association urges Members of Congress to address critical coverage and cost issues that must be part of any reform package.

Adequate and affordable health insurance coverage can literally mean the difference between life and death for individuals with cardiovascular disease. Unfortunately, more than one-third of uninsured Americans with cardiovascular diseases and stroke find themselves priced out of life-saving health care. Moreover, those born with congenital heart defects have difficulty obtaining any health insurance because of their pre-existing condition, or the cost of a policy is prohibitively high. The results? The uninsured suffering from cardiovascular disease and stroke experience higher mortality rates, poorer blood pressure control and longer lengths of hospitalization than their insured counterparts.

Karen and Dwight are a real-life example of a couple whose life was turned upside down by our broken health care system. They were debt-free and living the American dream when Karen suffered a heart attack at age 46 and subsequently needed several operations, including quadruple heart bypass surgery. Although the couple had health insurance, their cost-sharing for covered benefits was nearly $1,000 a month — almost 40 percent of the family’s income. After the heart attack, returning to work was not medically possible for Karen, so instead the couple took out a second and then a third mortgage to keep up with medical bills. Today, their mortgage is more than what it cost to build their house and Karen isn’t sure her family will survive the financial burden of being underinsured.

Sadly, Karen’s story is not unique. It plays out daily across America, from the smallest town to the biggest metropolis. Overwhelmed by crushing health care costs, many of our family members, friends and neighbors are making choices they never believed they would — or should.

Parents are filing for bankruptcy because of the staggering bills they have incurred to keep their children with congenital heart disease alive. All too often, patients with cardiovascular disease are forced to choose between life-saving treatments and medications or putting food on the table and paying their mortgage or rent. The American Heart Association believes such choices are simply unacceptable.

But with comprehensive health care reform, quality care is finally within the reach of all us. Here is what we propose:

In the insurance market, we strongly support efforts to eliminate pre-existing medical condition exclusions or waiting periods that harm so many Americans. No one, including heart disease and stroke patients, should be denied health insurance coverage because of a pre-existing condition or be charged more because of their medical condition.

Health care also needs to be affordable to preserve the American dream for families that are one serious illness away from financial disaster. There should be strict limits on the rating rules that health insurance companies are allowed to charge, and there should be reasonable limits on what families are required to pay in out-of-pocket medical expenses.

Health insurance companies charge older consumers five times or more what they charge younger adults, erecting barriers to affordable, quality coverage for many individuals, particularly those with chronic disease. We believe no one should be charged higher premiums because of their health status, gender or lifestyle factors, and premium variations based on age should be limited. Limits on total out-of-pocket costs are also important to ensure that families are truly protected from catastrophic medical costs.

Consumers should also be empowered to choose the health insurance that best meets their needs. And they should be confident that they’re getting the right care when they need it, including coverage for a broad range of necessary medical benefits spanning the continuum of care from prevention to rehabilitation.

Meaningful health reform must fix the many broken parts of our current system, including those that affect Americans with or at risk for heart disease and stroke, still the nation’s No. 1 and No. 3 killers. This is a complex and arduous task; however, we are confident that Congressional leaders will seek solutions that will make a real difference in the lives of Karen and millions of other cardiovascular disease patients. They are counting on us, and we cannot let them down.

Nancy Brown is CEO of the American Heart Association.