Health insurance became a hot topic in 2009 and 2010 as U.S. government leaders debated the need for health care reform. According to the U.S. Census Bureau, more than 46 million Americans had no health insurance in 2008. For the poor, though, there are options. Several federal and state programs provide assistance with health care costs for the poorest Americans. This assistance comes through various programs, and most require formal application and approval.