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The ranks of the uninsured continue to increase, posing an urgent challenge to lawmakers: how to help individuals and businesses afford health insurance. In this election year, voters should demand that both federal and state candidates provide at least some ideas about how to help the uninsured.

About 46.6 million Americans were uninsured in 2005. An estimated 850,000 South Carolinians and 40,000 Greenville County residents have no health insurance. Those figures imply a lot of suffering and perhaps even premature death for millions of people in the richest nation on the planet.

In truth, most every American has access to some health care -- in the form of hospital emergency rooms, which cannot turn away the sick. But that's the most expensive form of health care, and many of the sick often don't resort to the emergency room until an illness is well-advanced, and treatment will be costly. Getting more people insurance -- and providing access to primary care -- could reduce overall emergency room costs.

Gov. Mark Sanford supports health savings accounts and other measures to make coverage more affordable for small business, but his tenure thus far has not been characterized by a decline in the number of uninsured South Carolinians. As voters look toward electing a governor in a few months, the problem of the uninsured should be at the top of the debates between Sanford and his Democratic opponent, Tommy Moore.

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Some states -- notably Vermont and Massachusetts -- are taking aggressive action to extend coverage to the uninsured. Sanford and Moore might not agree with the strategies those states have for helping the uninsured but they should at least feel some moral obligation to thoughtfully address such an important issue.

As health-care costs increase, more than half of small businesses in this state can't afford health-care insurance for their employees. That not only leaves many workers with few health-care options but it mars the competitiveness of employers.

One new initiative might offer at least a partial solution. Small businesses without insurance are teaming up directly with community health centers, bypassing insurance, to make primary care affordable. The 19 community health centers in the state can offer lower-cost primary care for businesses because they are nonprofits and they can use federal funds for patients with incomes up to 200 percent of the poverty level.

Some lawmakers want the state to help small businesses pay for health-care expenses, and those efforts certainly are worthwhile. An increase in the cigarette tax could provide money to help small businesses afford health insurance or provide more coverage directly for poorer South Carolinians.

Voters should demand some leadership on this crucial issue. The rising cost of health care and the growing number of the uninsured require policymakers to offer some feasible solutions. It won't be easy but if other states have found ways to help the uninsured, why can't South Carolina?