Health care expenditures and utilization have increased dramatically in recent years, but gaps in health insurance coverage restrict access to care for a growing portion of the population. Women are especially vulnerable given the structure of insurance coverage and demographic factors. The erosion of insurance coverage can be attributed to several trends, particularly employer cost containment strategies, restricted public program eligibility and changes in the characteristics of the work force. Numerous measures have been adopted at the federal and state levels to maintain or expand coverage on an incremental basis. As broader segments of the population suffer reduction or loss of coverage, a comprehensive approach will be necessary to ensure universal access to health care.