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The state of Americans' health care has been troubling, especially before health care reform.The Affordable Care Act (ACA) is often touted as universal health care, and the initial intention was for the U.S. to have universal health care. However, with all of the compromises involved in its passage, the ACA resulted in comprehensive health insurance reform, significantly increasing the accessibility, affordability, and quality of health care for most, but not all, Americans. The ACA is a substantial step toward universal health care-a near-universal mandate-that may soon provide coverage to all Americans, and even include undocumented immigrants. Americans can find excellent health care-if they can afford it. The key is health insurance. For those without health insurance, inadequate health care has been determined to be a chief cause of death, putting it statistically ahead of HJV/AJDS and diabetes. Uninsured adults often forego needed medical care or preventive care, and are twice as likely to have poor health as their privately insured counterparts. Furthermore, uninsured Americans with chronic conditions, such as diabetes, cancer, or heart disease, have difficulty managing their ailments precisely because they have no insurance. Lack of health insurance has been linked to "developmental and educational deficits for children, reductions in workforce productivity, and significant familial and community stresses." By the time uninsured adults reach the age of sixty-five and are able to qualify for Medicare, they generally require more care than their insured counterparts."' Uninsured patients are three times more likely to die during their hospital stays than insured patients, and they are 25 percent more likely to die prematurely than those with insurance. In addition, uninsured citizens use the emergency room as their primary source of care, placing a huge burden on medical facilities. Indeed, uninsured persons receive billions of dollars in care from emergency room services, for which they do not pay. Finally, uninsured individuals receive about $100 billion in health care services annually for diseases that could have been treated more cheaply and efficiently had they been diagnosed earlier, and that would have been more likely to occur if they had insurance and utilized preventative health care services. The number of uninsured Americans has soared due to rising "health insurance premiums, a changing labor market, and underfunded health care safety net programs" such as Medicaid and the Children's Health Insurance Program ("CHIP"). In the mid-2000s, America's uninsured population swelled to nearly 47 million, representing about 16 percent of the population. There were an additional 16 million Americans who were underinsured. Incomes of many uninsured individuals are below $25,000. While all racial and ethnic groups are impacted,' these problems disproportionately affect African Americans and Hispanics, who have significantly greater uninsured rates than whites. America's health care crisis is a societal concern, because Americans collectively shoulder the health care costs of its uninsured and underinsured citizens. Faced with the possibility of creating a permanent "health and health care underclass" consisting of African Americans, Hispanics, and the working poor, Americans needed a solution-a national health care system for its citizens