46 million Americans currently lack health insurance and middle-class households are increasingly among them. Health care costs have skyrocketed in recent years, even as fewer employers offer benefits to their employees: health care coverage costs have outpaced increases in wages by a ratio of more than 3:1 since 2000 and premiums have increased 78% since 2001. Faced with high health care costs, families skip necessary medical procedures or become mired in debt trying to pay bills. The National Health Insurance Act would provide health coverage to all Americans. The bill establishes a single-payer system of national health insurance to be administered by state and local authorities. The legislation makes health benefits including medical, dental, and home-nursing services universally available, provided a minimum income requirement is met. A National Health Insurance Board of political appointees, with input from a National Advisory Medical Policy Council composed of experts, would supervise the national health insurance system. A 5% Value Added Tax (VAT), similar to a national sales tax, would fund a National Health Care Trust Fund to pay for the program. The VAT, collected from businesses at each stage of goods production, would not extend to food, housing, medical care, or nonprofit organizations.