Exploding health care costs have created a health insurance affordability crisis in the United States. According to a Families USA analysis of U.S. Census Bureau data, roughly 81.8 million people under age 65, or one out of three, were without insurance for some or all of 2002 and 2003. Not only has the number of people without insurance increased, but even individuals who maintain their coverage have seen higher out-of-pocket expenses as employers and insurers have instituted additional cost-sharing mechanisms. Given the situation, it is not surprising that health care is a top priority for state policy-makers. As the 2005 legislative session begins, the search is on for solutions that will both stabilize health care spending and allow more people to access affordable insurance products.