Roughly 300,000 Iowans lack health insurance, and of those 35 percent worked full time for all of 2008, according to a study by Iowa City-based Iowa Policy Project.

Insurance premiums in Iowa rose by 77.9 percent from 2000 to 2006. Iowans’ wages increased by only 20.4 percent over the same period. Enrolling in Medicaid in Iowa requires earnings of less than 71 percent of the federal poverty level, or $15,204 for a family of three. This formula keeps many Iowans from getting access to any health insurance.

“The majority of America’s uninsured cannot stretch their earnings far enough to cover health insurance, but their low incomes are too high for public assistance,” wrote the report’s author, Andrew Cannon, a research associate at the Iowa Policy Project.

As an example, the group points to Larraine Murray, independent child care provider in Des Moines whose income exceeds the threshold to qualify for Medicaid, but is not enough to cover the cost of a private health insurance plan. But even if she could afford private health insurance, Murray fears she would be excluded from insurance based on her pre-existing conditions.

“It really saddens me to be let down by a health care system over and over again [even though] I live in this great nation, in this great state of Iowa,” she said.

The group also found that the average annual health insurance premium for small businesses more than doubled in 10 years, rising 113 percent from 1999 to 2009. Employee contributions to health insurance premiums more than doubled since 1996.

Of the Iowa small businesses that do not offer health insurance to employees, 85 percent say that they cannot afford it. Of the small businesses in Iowa that do offer health insurance, 52 percent say that doing so is a large financial burden.

“Small-business owners cannot survive economically if they continue to face double-digit increases in health-care costs — and neither can their employees,” Cannon wrote. “Health-care reform must ensure that small business have access to affordable, quality health care coverage.”

Bill and Jeanne Hammen, owners of a jewelry shop in Grinnell for the last 23 years, said over the past 8 years they have seen their health care costs skyrocket so much that they have been forced to lower benefits.

“In order to be able to keep offering coverage we’ve had to cut benefits and offer a lower quality plan to be able to afford it,” Bill Hammen said.

Roughly 76 percent of small business owners see the current health care system as a barrier to entrepreneurship.