The availability and cost of health care is a national concern that has not escaped southeastern Ohio.

To solve these problems for the nation, the U.S. Congress is debating several bills that aim to expand and reform the health insurance system. But what these attempted reforms, like the access health care bill, would mean for Athens County is debatable.

The access health care bill, if passed in the U.S. Senate, would allow small business to pool their purchasing power to supply employees with health insurance. It also would allow people to create medical expense savings accounts. These accounts would be tax-free and eventually could lead to increased premiums for people who continue to receive their insurance traditionally.

In Athens County, the high number of uninsured workers is a major problem because most people work for small businesses, said Jack Frech, director of the Athens County Department of Human Services.

"Athens has a disproportionately large number of people working at low-wage jobs and they don't get any government help," he said. "People at these low income levels can't afford premiums. Nothing Congress is doing will hurt in any way, but I am sure it won't solve our problem."

Frech said, in theory, the ability for small businesses to come together to get insurance would be a positive step. But in reality, it might not work.

"There is a chance that it could help the small employers, but I am not optimistic that a lot of folks would be doing that," he said. "What the government needs to do is expand Medicaid to cover people below the poverty level."

Right now, Medicaid does not cover regular doctor appointments. But when an impoverished person has a medical problem and cannot afford to visit the doctor, he or she usually goes to the hospital where Medicaid can cover their care.

What Frech suggests is to have Medicaid cover these doctor visits, so patients can avoid ending up in the hospital.

O'Bleness Memorial Hospital participates in the Ohio Hospital Assurance Program, which helps the uninsured get the medical care they need.

The program operates on some state money, but the hospital absorbs a lot of the costs, said Colleen Miller, public relations manager for O'Bleness.

"We have guidelines based on income for charity care, and we put an average $1.5 million into this program," she said.

Miller added that in the past three years, O'Bleness has seen a tremendous increase in outpatient care. This, she said, translates into a growing number of patients without insurance.

"People that don't have insurance don't have primary care physicians, so they go to the emergency room when they have any sort of problem," she said.

If small businesses are able to band together to purchase insurance and premiums do go up for other businesses as a result, Miller said there could be more people without insurance.

"What could end up happening is, if the employers absorb the additional cost of an increased premium, then the cost could be passed on to the employee," she said. "Not all employees can afford the premiums. It is an unfortunate situation and would definitely be an issue in Athens with more people in need of charity care."

Because there are few big businesses in the county, a shift in health care costs would greatly affect residents, said Larry Payne, president of the Athens Area Chamber of Commerce.

"(Health care for businesses) is a big problem in this area - we get calls from businesses about that every month," he said. "But anything that would make it easier for small businesses to get health care is good."