Question refers to the image below.

Cartoon illustration has the title, Health Coverage. It shows two beds, each with an occupant who appears stressed and sweating. In the first, the person is crushed by a pile of papers labeled, Multi-billion dollar paperwork costs. The footboard of the bed has a line graph labeled, U.S. Healthcare System, with a line that extends upward beyond the edges of the graph. In the second bed, the person is uncovered and shivering. The footboard of this bed has text that reads, Over 33 million Americans not insured.
Library of Congress [LC-USZ62-126890]
"Health coverage," by Herb Block, published in the Washington Post, May 3, 1991

Why was health care reform a significant public debate in the 1990s?

The majority of people who were unable to access medical care were illegal immigrants.
Free trade agreements had led to a surge in demand for American health care.
Most people agreed changes were needed, but they opposed raising taxes for it.
Costs for medical care were rising, and fewer people had access to adequate care.