We know that the last US census data  found that about 46 million people were uninsured , a number that is rising with the jobless rate. Families USA analyzed two years of census data (2007–08) and found that one-out-of-three people under 65 was uninsured for some portion of that time—often for a rather long portion. The report released on Wednesday said:

This study sheds more light on one of the worst predicaments facing our country today: 86.7 million Americans went without health insurance at some point in the last two years, and nearly three-quarters of these people were uninsured for six months or more. With one out of three Americans uninsured, and with the weakening economy making job-based health insurance increasingly difficult to hold on to, American families are at risk.

Most of the uninsured were either working themselves or from working families. Low-income families were more likely to be uninsured, as were minorities. Young adults were more likely to lack insurance than older ones—half were 19- to 24-year-olds versus one-in-five aged 55-65. (Read more here about the high rate of uninsurance among "young invincibles" and the makeshift and sometimes dangerous ways they try to take care of their own health.)

Being uninsured means more than being at financial risk. It means having worse health, according to the prestigious Institute of Medicine. As the Families report says, the uninsured are less likely to have a usual source of care, to get appropriate screenings and preventive care, even to get prompt and adequate care when they get sick. They are more likely to die prematurely.

Congress and President Obama have begun work, seeking to expand coverage while reducing costly, wasteful and ineffective care that doesn't make Americans healthier.

Expanding coverage is only one step; coverage also has to be meaningful, and lawmakers recently have spent some time examining the underinsured along with the uninsured. The Commonwealth Fund has done a lot of work on underinsurance and the foundation's Cathy Schoen, along with Gail Shearer of Consumers Union, and Diane Rowland of the Kaiser Family Foundation, described the vast reach of the problem to a Senate HELP committee at a recent hearing. As Shearer said:

The key breakdowns of the health coverage marketplace that have fueled the growth in the underinsured included the increase in high deductible coverage, annual caps in coverage, lifetime benefit limits, limited benefits, pre-existing condition exclusions, higher copays, out-of-network charges, barebones policies, and a flawed individual health insurance market.

 As Schoen put it, with the increasing holes in insurance products, it's getting harder to tell the uninsured, the underinsured, and the insured apart. It would get a lot simpler if we could eliminate those first two categories, wouldn't it?