The two recessions that Americans have weathered in the first decade of the 21st century have taken a tremendous toll on people's ability to afford health insurance – and employers' capacity to offer it. A new report from the nonpartisan Robert Wood Johnson Foundation (RWJF), documents that while the situation has been tough for everyone, it's America’s middle class that has been hardest hit.

Without significant reform to the current health care system, the number of uninsured Americans could grow by 10 million people in just five years, and spending on government health care programs for the poor could more than double by 2020, according to a new report released today by the Robert Wood Johnson Foundation (RWJF).

Regardless of the outcome of national health reform, a number of states are contemplating creating a health insurance exchange as a way to improve the individual and small group markets. A new report by the Robert Wood Johnson Foundation-funded State Coverage Initiatives (SCI) provides an overview of the potential role of a health insurance exchange, state-specific issues that should be considered before establishing an exchange, and the different ways in which an exchange might be structured and operated.

The positive feedback on Medicaid and the State Children’s Health Insurance Program (SCHIP) from parents whose children were enrolled—and the strong desire of almost all parents of uninsured children to enroll their children—attest to the success that states have had in publicizing their public health insurance programs and addressing prevalent concerns associated with them. However, the administrative barriers faced by parents often serve as a deterrent to enrollment and renewal.

While national health reform continues to be debated in Washington, a Robert Wood Johnson Foundation national program is helping states continue to move forward in helping families fully utilize existing federal programs that provide health coverage to children and youth. These eight reports identify opportunities and challenges for improving enrollment of children in Medicaid and CHIP.