The AIDS crisis poses a special challenge for American health care, which depends heavily on private insurance to pay medical bills. Can we provide adequate health care to all who need it and still meet the financial requirements of the private health insurance industry? More insurance carriers are turning to antibody testing in order to eliminate poor risks from non-group, direct-pay pools. Some cost-conscious employers have attempted to fire AIDS patients summarily or to exclude AIDS coverage from group insurance policies. Various remedies are available for spreading the financial risks of the epidemic, such as covering persons with AIDS under Medicare or in state-sponsored health insurance pools. Ethical questions about cost and access may also rekindle the debate about the need for national health insurance.