Ten years of progress on children’s health care coverage is threatened by increasing unemployment, declining state revenues, and a growing affordability gap between family income and the cost of healthcare coverage. This report estimates that over the past year, 4.1 million people have lost their employer-based coverage, including 1.2 million children. It offers options to address the crisis, including temporarily increasing federal support for Medicaid and promptly reauthorizing SCHIP to soften the impact of the economic downturn on uninsured children.