The number of people in this country without health insurance continues to rise. There are 47 million uninsured people in this country and at least 20 million are employed by small businesses or work for themselves. This continues to increase by an average of more than 500,000 a year since 2000. Because smaller businesses cannot spread the costs and risks of an individual’s high medical bills over a large work force the way larger companies do, they often must settle for poorer coverage that leaves workers with substantial out-of-pocket medical expenses. Or, small employers just do not provide health benefits at all, which can cost $1,000’s a year for a family of four. This is nearing crisis proportions. Small employers who do continue to provide health benefits are asking employees to pay more of the overall premiums. So even when they offer coverage, their employees cannot afford to sign up. What is the solution? Skip to next paragraph States are approaching it in a variety of ways. Arizona is extending tax credits to small businesses employers that provide medical coverage. Montana and New Mexico considering allowing small businesses band together so they have the purchasing power of larger companies. Colorado has actually  passed laws governing what insurers can charge small companies. The cost of health insurance is a bigger burden for small business. Jon R. Gabel, a health policy expert at the National Opinion Research Center calculates that small firms pay 18 percent more for the same health coverage as larger employers. Meanwhile, large insurance companies lobby aggressively against cutting small businesses a break, arguing that it would do nothing to slow the rising health costs and high insurance premiums. This election year, both presidential candidates John McCain and Barack Obama must deal with this issue, otherwise the backbone of the American economy – small businesses, will have difficulty keeping workers healthy and employed.