Forty-five million Americans, many of them minorities or poor people, lack insurance coverage for basic health care. Research shows that people without health insurance receive less medical care and are in poorer health than insured people. This article explores three strategies the Robert Wood Johnson Foundation has followed over the past 30 years to try to increase health care coverage: promoting an overhaul of the system, without endorsing a specific approach; working to increase incrementally the numbers of Americans with health insurance; and funding research to provide a better understanding of the system and provide a basis for policy decisions. Over the years, the Foundation's emphasis has shifted with public concern from issues of access to issues of runaway cost. According to the author, the Foundation's noteworthy achievements include publicizing the availability of government-sponsored health insurance programs; helping state and local officials to better administer their programs; stimulating state experiments in coverage; training local activists on this issue; and keeping the issue alive through a public communications campaign. The bad news is that the number of Americans without health insurance has remained relatively stable over the past 30 years and it is unclear whether universal health care can become a reality in the United States.