One of the primary goals of health reform is to ensure that all Americans have health insurance. Yet it is generally overlooked that the proportion of Americans without health coverage has been relatively stable over time. According to the Census Bureau, in 2008 the number of individuals in the United States lacking health coverage rose from 45.7 million to 46.3 million. The proportion of uninsured Americans remained virtually unchanged, rising from 15.3 percent to 15.4 percent. In fact, the proportion of people with¬out health insurance in 2008 is virtually unchanged from a decade ear¬lier. The increase in the number of uninsured over the past decade is largely due to immigration and population growth–and to individual choice.