The United States is in the midst of another wave of interest in universal health insurance coverage, this time inspired by efforts at the state level. In this article I review what we know about the uninsured and why we should care about covering them. I then discuss the issues that must be addressed to achieve universal coverage, and discuss the Massachusetts reform which tried to navigate between the right and the left on this important issue. I then lay out a plan for universal coverage at the national level which builds on the Massachusetts model. Such a plan would cost $130 billion per year. I also show that such a plan could be readily financed by restructuring the exclusion of employer-sponsored insurance from taxation.