If a pastor gets sick, given a choice between "a wing and a prayer" or "a wing and a prayer and health insurance," he or she would probably choose the second option—if it's available.

A recent survey by the National Association of Evangelicals found that the churches and related evangelical organizations are having the same challenges as other Americans, and jerry-rigging some of the same partial solutions. But significant numbers of pastors—the format of the NAE's survey wasn't designed to produce a precise estimate—go uninsured. Others get their coverage through their spouse's job, or by holding down a second job outside their church that gives them access to coverage. Those over 65 can get Medicare. Some are poor enough to qualify for Medicaid. Young pastors who are relatively healthy sometimes opt to get a private policy instead of buying into a church or denomination-sponsored plan, meaning the bills go up for the older and sicker.

"Only a few of our churches are adequately addressing this problem," one denominational leader was quoted as saying in an NAE report. "We tried two or three items to provide health insurance, but we have not been able to make it work," lamented another.

We perk up when we hear phrases like "bipartisan support for a major healthcare initiative," especially when the bipartisan push is coming from Senator Edward Kennedy. Today's Boston Globe reports that while Kennedy recuperates from his brain tumor surgery, his office has begun a series of bipartisan meetings with an array of health care specialists to prepare for a major push to cover all Americans when the new president takes office next year. The paper reported:

Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration.

Kennedy is chairman of the Senate Health, Education, Labor and Pensions Committee; Obama is a member, and his Senate staff has attended the roundtable discussions, the Globe reported. But Republican staff is also involved, as Kennedy tries to identify areas of agreement, possible starting points. Kennedy has made health care a signature issue in his 45 years in the Senate, and even before his aggressive brain cancer was diagnosed he made no secret that he wants to seize the moment and act next year.

Even in a time of very tight state budgets, New Jersey's governor and legislature are taking major steps toward covering all of the state's residents, according to the Philadelpia Inquirer. This week the state Senate and Assembly both passed a measure (S-1557) that would require all children to be covered and would also cover some low-income parents. They provided $8.9 million in new funds to expand FamilyCare, (the state's health insurance program for low-income children and some adults), and moved to allow insurance premiums offered on the individual market to vary based on age to make plans more affordable for younger adults and help bring them into the health insurance pool.

One of the myths about health care in the United States that really bugs us is that everyone gets good care, rich and poor, insured and uninsured. Well, tell that to the one-in-five people—59 million people, some of whom are insured—reported skipping or delaying care in 2007. Cost was the biggest, although not the only, factor.

It’s a big alarming jump from the one in seven who reported access problems in 2003 when the Center for the Study of Health System Change did a similar survey.

In 2007, more than 36 million reported delaying care and 23 million people skipped care. That’s 59 million people reporting access problems, according to findings from the center’s 2007 Health Tracking Household Survey. The group has done the survey five times since 1997, and this is the biggest jump in a decade, particularly among Americans with insurance.

Cost was cited as the main access problem, along with rising rates of health plan and health system barriers, such as a doctor or hospital not accepting their insurance, or a health plan not covering a treatment, the study found.

In case you needed another reminder of the burden of health care costs, a new Kaiser Health Tracking Poll: Election 2008 finds that nearly six-in-ten adults report that the economic slump is causing serious problems for them—and one in four say they are having trouble paying for health care.

People surveyed were asked about seven economic stresses. Gas prices topped the list (43 percent). About one in four cited health costs and a similar number were concerned about getting a raise or a well-paid job. Next came food prices (19 percent), credit card or other personal debt (16), stock market losses, (15) and housing costs (14).

In thinking about health care, voters are more troubled by what health care costs individuals and families than the national spending levels. Almost half (47 percent) report being most worried about what the average American pays for health care and insurance. In comparison, two in ten (19 percent) say they are most concerned about how much the nation as as a whole spends. Fewer cited worries about public health insurance programs (14 percent) or increases in what employers pay for health benefits (10 percent).

"The standard that most voters will use to gauge health reform proposals is, ‘Will it make health care more affordable for me?' " said Drew Altman, Kaiser's president and CEO.

Dr. Nancy Neilsen is not the first woman president of the American Medical Association but there's a darn good chance she is the first AMA president who at one point had no health insurance for the first three of her five kids, and accepted diapers and free samples of antibiotics from a generous pediatrician.

That was back in the 1960s, when she was a microbiology graduate student, the Chicago Tribune reports. She has also been a primary care physician, an associate dean at a medical school and a health insurance executive. She has seen contemporary U.S. medicine from an unusual number of angles, and at her inaugural speech at the recent AMA annual meeting in Chicago, she put covering the uninsured as the top priority. She declared she would use "all of the power" she has at the helm of the nation's biggest doctors' group "to let the nation know that we must cover America's uninsured."

We mentioned bank robber Willie Sutton earlier this week in our initial recap of the Partnership to Fight Chronic Disease's recent policy symposium. Sutton was one of the first criminals on the FBI's Ten Most Wanted Fugitives list. We heard another infamous list during former Senate Majority Leader Tom Daschle's symposium keynote speech when he listed the major myths standing in the way of health reform. His top three:

We had a little e-mail chat with James Guest, president of Consumers Union, the other day about the organization's activities in educating (or empowering) health care consumers, and its role in the efforts for comprehensive national health reform. We liked that he mentioned the underinsured, a topic that's been getting a lot of deserved attention in the last few days (for instance, see today's New York Times editorial) since the recent Commonwealth Report which we wrote about earlier this week. Here's what Guest had to say:

A lot of people think of Consumers Union as a place you turn for help buying a car or a household appliance. Can you explain why national health reform is a consumer issue?

Forget about the Nationals' new stadium (you already had?), the hardest seat to get in town this summer has been at the Senate Finance hearings on health reform. We arrived 20 minutes early yesterday to find the halls of the Senate's Dirksen building packed. And for good reason, as the day's testimony on 47 Million & Counting: Why the Health Care Marketplace is Broken was as refreshing as the room's AC (68.2 degrees!)

The hearing opened with video testimony from Lisa Kelly, of Lake Jackson, Texas. Kelly is one of the 25 million underinsured Americans we wrote about yesterday. Kelly purchased a limited benefit plan with a $189 monthly premium that provided fine coverage for her allergy pills but was woefully inadequate when she was diagnosed with leukemia in 2006. Kelly's trials were the subject of a recent piece in the Wall Street Journal. Forced to dip into her savings and currently saddled with nearly $137,000 in medical debt, Kelly, was asked what she thought Congress should do. Her answer was particularly moving:

As if we didn't have enough to worry about. Not only are we worried about the care and cost of the uninsured, now we have to worry about people who have health insurance too. According to a new study released today by the Commonwealth Fund, a whopping 25 million Americans with health insurance are "underinsured" or financially vulnerable due to the high costs of medical care. That's nearly a 60 percent increase from Commonwealth's last study on the underinsured five years ago.

How underinsured are these 25 million Americans? The study, published in Health Affairs, defined the underinsured as individuals with either out-of-pocket medical expenses equal to 10 percent of their income, (5 percent if they were low-income) or with deductibles that exceeded 5 percent of their incomes. The authors attributed much of the rise to the growing prevalence of insurance plans with limited benefits and or high deductibles. They also found that the underinsured behaved similarly to the uninsured, avoiding care when they were sick, forgoing checkups and not taking their prescriptions because of high medical costs.