Today, the loneliest job in American isn’t being the Maytag repair man. And the hardest job in America isn’t necessarily the Presidency. It’s being a state governor.

Take Pennsylvania (the state I call my home). Governor Ed Rendell sought the position with an explicit goal of expanding health insurance to uninsured Pennsylvanians. After two years in the job, Rendell is facing declining tax revenues, increasing costs. Rendell is already facing a $281 million deficit in this fiscal year, which could increase to over $1 billion. A detailed analysis of this story was published by PR Newswire, Pennsylvania’s Loss of Employer Health Coverage Outstripping National Average.

The Kaiser Commission on Medicaid and the Uninsured has been studying other state initiatives targeting covering the uninsured. The Commission has found that in California, Illinois and New Mexico, for example, have been unable to broaden health insurance access to citizens without it.

That’s because, as Diane Rowland, the Executive Director of the Commission said, “Health reform … is easier when economic times are good and more difficult to accomplish and more difficult to sustain when the economy goes down.”

Health Populi’s Hot Points: The U.S. Census Bureau found that the level of uninsured in the U.S. actually fell by 1.5 million between 2006 and 2007. Where did most of those uninsured people find insurance? Through growth in public programs funded by public (read: taxpayer) sources: Medicaid and Medicare, and in military programs including the VA and TRICARE.

The Kaiser Commission on Medicaid and the Uninsured issued a paper on The Decline in the Uninsured in 2007: Why Did It Happen? which speaks to this statistic in great detail.

The point is that the economic growth enjoyed in 2006-7 will not occur in 2008-9, and based on what macroeconomic forecasts are saying, into 2010.

Growing unemployment and the decline in the U.S. economy will inevitably result in an increase in the number of uninsured Americans.

The Commission expects this number of uninsured Americans will be no fewer than two million in 2008, and more if unemployment exceeds 6.1%.

Will these uninsured citizens, living throughout the 50 states, find a health insurance haven through public programs? Probably not. That’s because Governor Rendell and his colleagues in the National Governors Association will have less money to spend on Medicaid and children’s health (S-CHIP) programs compared to 2006-7.