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Over the past fifty years, a majority of non-elderly Americans workers and their dependents have relied on employer-sponsored insurance for health care provision. In the absence of universal, publicly financed coverage, this “accidental system”, born of the tax and labor policies of World War II and firmly established as part of the collective bargaining process in the 1950s, came to be perceived as the foundation of earned social rights, at least for employees of large firms. It always fell short of being an entitlement, though, since only bargaining was mandatory, not coverage, and since the tax incentives attached to the provision of benefits only benefited higher income workers.Over the past two decades, this implicit social contract between workers and employers has been revised, and having a job and “playing by the rules” of the American work ethic no longer guarantees access to health coverage. Of the 45 million uninsured Americans, 80 % are workers or dependents of workers. If most of them are low-wage earners in the service (mostly retail) sector, highly skilled contingent workers are not spared.This paper aims first to provide an overview of the characteristics of uninsured workers. It will then outline the consequences of being uninsured or underinsured on workers and their families, with a focus on medical debt. Finally, it will take a look at recent labor disputes over the right to health care benefits and the 2004 defeat of Proposition 72 in California