As an entire state, Texas already has the highest percentage of its population without health insurance, just over 25% (compared with a national average of 15.3%, according to the 2005 U.S. Census). Indeed, every major city in Texas, including Dallas, Houston and Austin, have a higher percentage of uninsured than the national average.

In companies with fewer than 10 workers, most (52%) do not offer health insurance coverage, the main reason being affordability.

A report by the Task Force on Access to Health Care in Texas (Code Red: The Critical Condition of Health in Texas, April 2006), highlights the issues associated with the uninsured in the state, which include an overall lower quality of life, for individuals and the communities in which they live.

While offering a number of recommendations for improvement, the Task Force extensively outlines the magnitude of what is a growing problem in a state that is growing rapidly, thereby exacerbating an already deteriorating situation that is likely, without concrete solutions being offered, to significantly impact the future for millions of Texans.

Among the observations made, the fact that people living in Texas who have no health insurance do receive medical care. But who pays for it? The answer is: everyone else. The cost of providing healthcare to those who, for whatever reason, do not have it (affordability being the most obvious reason) is passed on to the insured through higher premiums and, in the case of government providing the service, through taxes.

More than one-third of the total $65 billion cost of healthcare services provided to people without health insurance is paid out of pocket by the uninsured themselves, but, of the remaining $43 billion, two-thirds is paid for indirectly by those who are insured, in the form of higher health insurance premiums.

Those who do need healthcare but do not have insurance to pay for it also tend to get the service in ways that are less efficient and more expensive. An example of this is the local emergency room at a hospital, where care is expensive and relatively inefficient, mostly due to the overhead and procedures required to evaluate even the most minor conditions.

Because uninsured residents typically do not have ready access to preventive care, when a health condition does become apparent, the cost to treat it is often more expensive with success rates often less than what would be seen if early diagnosis and treatment were to have occurred.

The extent of the human cost to Texas and its residents is staggering. As the Report indicates, some 2,500 Texas residents die prematurely every year, 1 million Texas residents with chronic illnesses do not receive adequate services, and 3 million residents are less likely to receive preventative and screening services.

Screening becomes particularly important when it comes to dealing with cancer, the Report notes. About half of all new cancer cases can be detected early through screening, including cancers of the breast, colon, rectum, cervix, prostate, oral cavity and skin.

As many as 35% of premature deaths could be prevented by early screening, according to the American Cancer Society. Early detection may also reduce the severity of the cancer, since treatment for earlier-stage cancer is often less aggressive than for the more advanced forms of the disease.

Another significant consequence of an uninsured population, such as that in Texas and the cities of Dallas, Houston and Austin, is the adverse effects of chronic diseases such as diabetes. In Texas, an estimated 1.3 million residents have diabetes, with an additional 300,000 estimated to be undiagnosed. Conservative estimates rank diabetes as the sixth leading cause of death in the state; uninsured people with diabetes are less likely to receive recommended services.

As the Texas Report indicates, the state's healthcare infrastructure is heavily strained by the large number of uninsured, with the burden of uncompensated care falling on a system already struggling to meet increases in the demand for services.

Experts agree that the impact on business in Texas from the healthcare issue involving uninsured is high. Nearly 66% of companies surveyed indicated that they have experienced more pressure to manage internal costs and healthcare costs are growing faster than production and wages, a trend that is unsustainable.

Access to affordable health insurance in Texas is an ongoing concern, not only to the healthcare industry but also to companies who have a small number of workers and cannot afford to pay for healthcare premiums