A study published in the online edition of theAmerican Journal of Public Healthestimates that nearly 45,000 deaths annually are associated with a lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine in 2002 based on data from 1993. The researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993. We spoke to Steffie Woolhandler, study co-author and professor of medicine at Harvard University about the findings, why the problem has grown more acute in recent years and what the reserach adds to the ongoing debate over healthcare reform.