As Congress nears its historic showdown on health reform, a new state-by-state survey highlights how middle-class Americans were hit by the insurance crisis even before the worst of the recession took hold.

Here are some of the key findings of "Barely Hanging On: Middle-Class and Uninsured," which the Robert Wood Johnson Foundation released today. The analysis, based on U.S. Census data from 2000 to 2008, defines middle class as families earning roughly $45,000 to $85,000.

• Between 2000 and 2008, more than 2 million middle-class people became uninsured. Their ranks rose to 12.9 million of the estimated 46.3 million Americans without health insurance. • At a time when median household income fell 2.5%, a worker paid an average 81% more for a family policy as employers shifted the cost of premium increases. • In 2008, 12% of middle-class workers had job at companies that did not offer insurance, while 22% of workers at firms that offered health insurance were ineligible for coverage.

The San Francisco Chronicle looks at the situation in California, which differs significantly from the rest of the country on several measures.

(Posted by Michael Winter)