Census officials said the change constituted nearly half of the 2.2 million people who were added to the ranks of the uninsured in the past year, bringing that total to 47 million. The number of uninsured was 44.8 million in 2005.

“We are making the 2008 elections a mandate on fixing our broken system,” AFL-CIO president John Sweeney told reporters.

Two days after the census data was released, a poll by the Kaiser Family Foundation showed health care reform as the most important domestic issue cited by Americans—second only to the war in Iraq.

“I certainly think this will get a lot of attention during the political debate,” says Stephen Zuckerman, principal research associate at the Urban Institute in Washington. “Whether there’s going to be consensus on reform is another question.”

Sweeney offered little detail of what a “high-quality health care system” would look like, other than saying the campaign was a sustained effort by the union’s 10 million members and 3 million union retirees to elect a candidate who can reform the health care system by 2009.

With more middle-class Americans unable to afford either employer-sponsored coverage or coverage they might find in the individual market, the solution may be a shift away from employer-sponsored health coverage, says Deborah Chollet, senior fellow at Mathematic Policy Research in Washington.

“It’s not clear to anybody that the employer-based system can be salvaged,” Chollet says.

Even the unions have realized that health care, once a key bargaining chip, has become a liability. High health care costs have stagnated wages and threatened employers with bankruptcy.

Current contract talks between the Big Three Detroit automakers and the United Auto Workers are centering on health care, with many observers predicting a resolution modeled on the creation of a union-managed health care trust fund.

Meanwhile, Chollet says, California insurance carriers are hearing from large employers talk about an endgame for employer-sponsored health care.

—Jeremy Smerd