As more Americans lose health coverage because of unemployment, the latest snapshot of the uninsured reveals a grim picture: It's not just the poor and unemployed who now go without health insurance.
The percentage of uninsured among families earning between $50,000 and $75,000 annually has nearly doubled over the past decade.
"It's exactly the trend that's been driving the conversation around health-care reform," said Anthony Wright, executive director of Health Access California, a consumer health advocacy group.
"As this has become a real crisis in the middle class, it required a bigger fix -- which is why the big push for a federal health law," Wright said.
Even as the country begins rolling out President Barack Obama's Patient Protection and Affordable Care Act, which was signed into law in March, the number of Americans without medical insurance continues to grow -- to an estimated 50 million nationwide.
Robbin Gaines, a senior program officer with the California HealthCare Foundation, said she couldn't fully explain the increase in the uninsured, but said joblessness is certainly one reason.
"As people lose their jobs, they are also losing their health insurance," she said.
Fifty-two percent of working-age Californians and their families now get health insurance from work-based coverage -- down from 65 percent in 1987, according to the foundation.
As a result, more people are buying health coverage on their own, as smaller companies do away with the benefit.
Often, though, they can't afford the same coverage they once had through work, and many opt for policies with higher premiums and deductibles.
The cost of prescription drugs and medical services also continues to rise, adding to the financial burdens on families, said Patrick Johnston, president of the California Association of Health Plans.
"The increasing cost of health care inevitably will put pressure on more people and leave them uninsured, unless we can drive down medical treatment costs and assist those families who are really unable to pay for coverage with a subsidy," Johnston said.
The rise in the number of uninsured may go unabated for another few years, until key provisions in the health-care law are put into effect.
The good news, said Wright, is that help is on the way.
"The bad news is that key provisions don't kick in until 2014," he said.
That's when many key features of the federal health law go into effect, including the opening of health insurance exchanges, where millions of Americans who are struggling with the cost of health insurance will be able to take advantage of government subsidies, if they qualify, to purchase coverage.
It's also when most Americans will be required to obtain coverage -- through their employers or through the exchanges -- or face tax penalties that will eventually exceed $695 annually for an individual or more than $2,085 a year per family.
The federal law, the subject of months of intense debate in Congress and public forums across the country, was meant to increase access to health insurance to the country's millions of uninsured.
Over the years, the percentage of lower-income families without health insurance has generally held steady -- with about 37 percent of those earning $25,000 annually or less going without health coverage.
From 2000, about a fourth of families earning between $25,000 and $50,000 had no health-care coverage. And about a tenth of those who earned more than $75,000 annually weren't enrolled in a health plan.