Hard to believe it’s been six years since this country was gripped by health care fever. While the rift between those who saw that new Clinton couple in the White House as visionaries or meddlers was deep and wide, there was, amid those hardened positions, general agreement that something was wrong when some 35 million residents of the richest, most powerful nation on Earth had no health insurance, no affordable access to health care.

Now it’s up to nearly 44 million, about one in six; more than 175,000 Mainers, also about one in six. Although recent efforts to cover more children under Medicaid have been moderately successful, the overall number of uninsured grows with every downsizing and out-sourcing.

And with every welfare-to-work initiative. Since Congress enacted sweeping welfare reform in 1996, there has been a substantial drop in the number of people on public assistance — that’s good — and a substantial increase in the number of uninsured. For the 675,000 who have lost health coverage since moving from welfare to work, and or the millions of insured who end up paying in the end, that’s bad.

This is a trend with no end in sight. By law, former welfare recipients lose their Medicaid health benefits a year after Temporary Assistance or Needy Families (TANF) benefits end as a result of employment. That employment, of course, often is entry-level, perhaps a mix of part-time jobs at small businesses, the type of work that usually doesn’t come with health benefits.

Rep. John Baldacci is introducing legislation that will expand access to health care for those getting off the dole and on the job while at the same time helping small businesses become more competitive in attracting and retaining the best workers. The law currently prohibits federal welfare funds from being used for health care. Baldacci’s bill would allow states to use these funds to form health care purchasing alliances for groups of small businesses, making coverage more affordable for the employer and actually available for the employee. It calls for flexibility, a trait conspicuously absent from the last national health care debate.

The phrase “self-sufficiency” has a noble sound to it, but it rings hollow unless accompanied by the creation of jobs that are rewarding and family-sustaining. Rep. Baldacci’s proposal could be an important step toward doing that; it may even help eliminate that hateful phrase “the working poor” from the national vocabulary.