Members of the lower class struggle to pay their bills and may be constantly in debt. This is why pawnshops, car title, and payday loan services are located in low-income neighborhoods. Within the upper lower class and lower middle classes reside the near poor, which is a term used for people who make too much money to qualify for Medicaid and not enough money to pay for health insurance. When you hear about the millions of Americans who are uninsured, this is the primary group of people in reference. It only takes a minor incident such as needing to replace a transmission in a car that is used for transportation to work, or a child making a trip to the emergency room, to go in debt. Families who struggle to pay insurance premiums normally do not have a savings account or a “rainy day” fund and just have to quit paying their premiums resulting in the loss of health insurance. Another issue that is not well publicized is the concept of “balance billing” a patient. For example, if a family has insurance and their child has to go to the ER, their insurance will normally cover 80 percent of the cost. The problem occurs when some of the ER doctors do not participate in the health insurance plan and therefore bill the family 100 percent of the charges. This can add up to thousands of dollars the family has to pay out-of-pocket. Twenty states have outlawed balance billing and require the out-of-network providers to accept the charges that family’s insurance pays. This is an example of the government helping and protecting the near poor maintain their health insurance and not struggle with surprise healthcare bills. Regardless of the expense to the emergency department that cared for the patient, they must accept only what the insurance company pays for the encounter.