The number of people without insurance was already a big problem well before the recession started in September. An estimated 45 million Americans, including 300,000 Utahns, had no insurance, and the numbers of the uninsured and underinsured will likely increase significantly across the country, Pollack said.

"The right to COBRA health coverage is a tragic ruse for millions of families whose breadwinner was laid off," said Pollack. "Unemployed workers need either premium subsidies to help them afford COBRA benefits or temporary health safety-net coverage through Medicaid."

Medicaid, the joint universal state/federal insurance plan for the poor, isn't much of an alternative, short of a major infusion of federal dollars President-elect Barack Obama again called for on Friday.

"That safety net is already more holes than net," Pollack said.

According to the Utah Health Policy Project, the leading local health policy research and advocacy group, people currently on the plan are having trouble finding access as it is. The number of doctors and other health-care providers who will accept Medicaid patients has been declining and isn't expected to increase without a major bump in the compensation paid by Medicaid.

According to the state Department of Health, of the 4,700 estimated physicians practicing in the state, 3,540 billed Medicaid for services in fiscal year 2007, compared with 4,210 in 2000. That's a 16 percent decline. The number of dentists who treat Medicaid beneficiaries also has decreased by 14 percent since 2000.

Lawmakers are recommending a $48 million general fund cut to Utah's Medicaid program, which would mean a loss of $122 million in federal Medicaid funding for fiscal year 2010, according to UHPP. In addition, said UHPP Medicaid policy analyst Lincoln Nehring, Utah would also forfeit between $175 million and $315 million in federal economic recovery money because Utah will likely fail to meet the economic recovery plan's maintenance-of-effort requirements.

"Utah already ranks 49th in per-capita Medicaid spending," Nehring said. "A 15 percent cut to Utah's Medicaid program will leave Utah with the barest safety net program in the country. It will force the state to eliminate or close enrollment."

Laid-off workers who have earned too much to enroll in Medicaid, can't afford COBRA and might want to purchase their own plan will find a catch-22, Pollack said.

"Even if they find a policy, it will be expensive," Pollack said. "And if any have chronic health problems, even common conditions such as high blood pressure or diabetes, they are likely to find that any insurer who is willing to sell them a policy will not cover their pre-existing conditions at any price."