I work with people daily who often face the difficult choice of either paying for food, housing or health care. Needless to say, when forced to choose between feeding their family, keeping a roof overhead or paying for health coverage, buying health insurance is low on most people's lists -- especially if they are healthy.

A recent report released by the Working for Health Coalition -- a broad-based Washington state group of churches, civic organizations, unions, providers of health care and education and children's groups -- highlights the plight of many Washington citizens who lack access to affordable health care and are paying the price by going into debt or forgoing care.

Personal bankruptcy has nearly tripled in Washington state since 1991. About half of the 40,000 people who declared bankruptcy in 2003 did so because of medical debt. And, almost all of these were underinsured and uninsured working people.

Are these people acting irresponsibly by not buying health insurance?

Many people across the state can barely pay for necessary expenses like housing, food, taxes and transportation -- let alone pay for health care. The result is that people either forgo health care altogether or buy bare-bones insurance plans that do not adequately cover major medical expenses.

However, one illness could put these people at great risk of accumulating unaffordable medical bills. Although people are taking a calculated -- and probably an appropriate -- risk given the option of not paying for food, housing or taxes, they are playing roulette with their health and their family's livelihood when they cannot afford health care or health insurance.

Unfortunately, this is becoming a very common problem, and it is one that directly or indirectly affects most of us. We all pay for uncompensated care provided at hospitals for children who are not ready for school and for the opportunities lost for these families.

As a community, we can do better than this. We need to make sure we have a safety net that is available for our neighbors. Working people should have access to affordable basic health services.

Access to timely primary care is needed to keep all of us healthy, better prepare our kids for school and ensure that we adults can work and continue to responsibly care for their families. While some safety net providers -- community health centers and some private doctors and most hospitals -- have traditionally provided this preventive care, the growing pressure of uninsured and underinsured patients is straining these providers beyond their limits.

We must address this issue by working together to reduce health care costs, support the public insurance safety net programs like Medicaid and the Basic Health Plan, and live healthy lives.

We all must take a stand and not let people with bad luck end up getting hurt by our health care system. When hit with a major accident or health crisis, no one should face the prospect of financial ruin in order to get care.

Kristen West is executive director of the CHOICE Regional Health Network.