The climate for health care in the United States was bleak. Per capita spending was among the highest in the world, and even though more than four in five Americans had health insurance, health care costs continued to rise and services continued to decline. Insurance companies had the ability to deny coverage when people became ill and limited their liability to policyholders by imposing annual and lifetime limits. Those with pre-existing conditions had great difficulty obtaining insurance. Insurance company profit margins became higher, but Americans' health suffered. The number of uninsured or underinsured people due to insurance costs has increased, and the debt from medical bills has increased and is crippling the American people. About 20 percent of all bankruptcies were related to medical bills, and hospitals were spending well over $1 billion a year on uninsured patients and uncompensated bills. (Stephens and Ludlow 98, 101) The costs of this health care crisis have gone beyond just monetary. People without health insurance were less likely to receive regular physical exams and preventive care. A disease that progresses can become not only more expensive, but also more difficult to treat. (Stephens and Ludlow 100, 101) Society also bore the burden of inadequate health care, as uninsured people spent more time out of work due to illnesses or injuries longer than they might have. not be able to deal with it. Business productivity could decline, and the nation as a whole could be affected. In March 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, stating: "The United States Congress has finally...... middle of paper ...... Bill Philips and Terry L. Schmidt. “The Intended and Unintended Consequences of Health Care Reform.” » 64.10 (2010): 50-55, February 23, 2014. Holguin, Jaime. “America The Unhealthy – CBS News.” Breaking News Headlines: Business, Entertainment & World News - CBS News, February 26, 2013. Web, March 1, 2014. "Physical activity is fundamental to preventing disease." Office of the Assistant Secretary for Planning and Evaluation, HHS. U.S. Department of Health and Human Services, June 20, 2012. Web. March 6, 2014. .Stephens, James H. and Gerald R. Ledlow. “Real Healthcare Reform: Focus on Access to Primary Care.” Hospital Topics 88.4 (2010): 98-106. Academic Search Premier. Web. February 23. 2014.