For decades, the American system of health care has relied primarily on employer-sponsored insurance programs as a gateway through which individual's access health care services. Gaps have been filled in through public insurance programs - such as Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP) and other more locally-based programs - to cover elderly, disabled and certain low income populations who cannot access the employer-based market. In addition, the government (federal, state and local) provides certain limited subsidies (e.g., tax deductions for the self-employed) for individuals to purchase insurance policies in the private market on their own.

While this system has worked effectively for many Americans, it has left behind a significant number - approximately 42 million - who lack any form of health insurance coverage. For the