These are tough economic times. Since December 2007, the U.S. economy has shed 4.4 million jobs, and as of February, the unemployment rate had risen from 4.9% to 8.1%. Millions of Americans have seen their jobs disappear, incomes decline, and health care coverage become increasingly remote (see line graph). Many have sought public coverage from the states through Medicaid, but Medicaid's ability to fill the gap is becoming increasingly constrained, as state revenues decline and states turn to Washington for help in paying their share of the Medicaid bill. What are the implications of this cycle for families, for providers, and for state and federal policy? How does the recession jeopardize health care?