Congress' health-care reform efforts have paused for the August recess, and polls show Americans are confused about what reform would mean for them. With the media focusing on the political chess match in Washington and the protests at recent town-hall meetings, the confusion isn't surprising.

Lost in the news coverage is just how important health-care reform is to working Americans who have health insurance.

It isn't just that many Americans are one illness or job change away from losing their coverage or facing medical bills they will never be able to pay. That is a real problem, but the larger problem is about escalating costs.

Rapid increases in health-care costs mean workers who have insurance through their employers may lose it unless reforms make it more affordable and secure.

Most working Americans underestimate how much they are already paying for health insurance, since most get it through their employers. Their pay stubs may show their contributions to health-insurance premiums, but those contributions are typically less than 25 percent of the full cost of the insurance.

Their employers' share is really paid through lower wages. If insurance were cheaper, workers would take home more money.

In an analysis recently published in the New England Journal of Medicine, a colleague and I showed how health-care costs are already eroding standards of living for middle-class families with private health insurance. Health-care costs are rising at more than three times the rate that middle-class wages are. Any pay increase workers might receive is chewed up by rising health care costs, and many workers have less money available for things other than health care with each passing year.

Consider a family with a total income of $50,000 and health insurance provided through one wage-earner's employer. At first glance, this family appears to be paying about 10 percent of its income for health insurance, in the form of employee contributions.

Actually, though, health-care costs consume almost a quarter of their income. The rest is in the form of lost wages they otherwise might have received if health insurance were cheaper, as well as in taxes that support public insurance programs.

This family does not see those costs, but it feels them. Because health-care costs are growing five times faster than their wages are, they have less and less money available every year after paying for health care. When they sit at the kitchen table, they know their finances are getting worse, but they don't know health care is largely to blame.

Congress has proposed several ways of addressing the health-care crisis for such middle-class families: containing health-care costs, asking higher-income households to pay a bigger share, and making sure premiums are priced fairly.

Containing costs is challenging, but Congress has proposed reforms that hold promise, such as researching the relative effectiveness of medical treatments, paying care providers in ways that promote quality and efficiency, and offering Americans the choice of a public health-insurance option.

The House health-care legislation would require higher-income households to pay a bigger share of the nation's health-care bill through a surtax. Since wealthy households contribute a relatively small fraction of their income to health care, it is reasonable to ask them to shoulder a bigger share. This surtax would help lower- and middle-income families maintain coverage by offering subsidies. Without this help, more and more families will be forced to drop private health insurance.

Health-care reform would also change the ground rules for pricing health insurance. Insurance companies would no longer be able to deny coverage or charge higher premiums to those with preexisting conditions. This would go a long way toward eliminating the fear that an unexpected illness or job change will lead to loss of coverage or soaring medical bills.

Many middle-class families know that they are in financial trouble, but many don't realize how much of that trouble is rooted in health care - or how much they stand to gain from health-care reform.

Unfortunately, when they turn on the news, most of what they hear is about political jockeying and fringe protests. But if we miss yet another opportunity to fix health care, the middle class will be among the losers.

David Grande is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. He can be contacted at dgrande@wharton.upenn.edu.