When Andrea Louise Campbell’s sister-in-law, Marcella Wagner, was run off the freeway by a hit-and-run driver, she was eight months pregnant. She survived—and, miraculously, the baby was born healthy. But that’s where the good news ends. Marcella was left paralyzed from the chest down. This accident was much more than just a physical and emotional tragedy. Like so many Americans—50 million, or one-sixth of the country’s population—neither Marcella nor her husband, Dave, who works for a small business, had health insurance. On the day of the accident, she was on her way to class for the nursing program through which she hoped to secure one of the few remaining jobs in the area with the promise of employer-provided insurance. Instead, the accident plunged the young family into the tangled web of means-tested social assistance.