Updated on September 10, 2009.

A new estimate of the number of Americans without health coverage showed little change from the prior year, but the data could still fan the flames on both sides of the ongoing national debate over health-care reform.

The report on health insurance, poverty and income released Thursday by the Census Bureau shows that the number of uninsured Americans a figure often cited in the push for universal coverage and scrutinized in the pushback against it ticked up slightly in 2008. The number of people without health insurance rose to 46.3 million last year (15.4% of the population), up slightly from 45.7 million in 2007 (15.3%) a statistically insignificant change, according to the Census Bureau.

The increase [in the number of uninsured] was not as large as you would expect given the recession and high unemployment rate, says Brad Herring, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

One reason why the overall number of uninsured people increased by fewer than expected: The expansion of government safety-net programs like Medicaid and SCHIP for the poor may have helped workers laid off during the recession retain coverage. The percentage of people covered by government health insurance increased to 29.0% in 2008, up from 27.8% in 2007, according to the report.

The new numbers were released less than a day after President Obama reiterated his case to Congress and the nation for overhauling the health-care system.

The Census data came with some caveats. The results were collected in March 2009, but the survey asked respondents if they had coverage at any time during 2008. Someone who had insurance for the first half of the year and then lost it would have been counted as having medical coverage. Given that 3.85 million people have lost their jobs this year through August, according to the latest figures released by the Labor Department, the number of people without insurance in 2009 could be far greater, barring a broad economic pickup at the end of the year.

For those recently without coverage, navigating the health-care landscape can seem daunting. While Congress debates reform and the expansion of coverage, here s how the uninsured can regain insurance on a tight budget.

Retain Coverage Through Cobra

If your company has more than 20 employees and you lose your job, you can extend your coverage through Cobra for up to 18 months.

Cobra allows you to continue the plan you had under your employer, and no pre-existing medical conditions will have an impact on cost (like they might with a private plan).

The biggest barrier to entry is the cost. Monthly premiums averaged $400 for individuals and $1,200 for family coverage, according to the latest data from eHealthInsurance, an online insurance marketplace. But the stimulus bill is helping to reduce those costs by providing a 65% subsidy for laid-off workers who pay for Cobra. Those eligible will pay just 35% of the premiums. The subsidy is available to workers who lose their jobs between Sept. 1, 2008, and Dec. 31, 2009, and is limited to nine months.

You can also take steps to lower your future financial burden if you think your job or company is on shaky ground. During your employer's open-enrollment period, you can shift to a lower-cost plan at work. That way, if you need Cobra coverage later on, your premiums will be lower. It s still going to be expensive, but moving from a PPO to a less-pricey HMO now could end up saving you a chunk of change each month, says Sam Gibbs, a spokesman for eHealthInsurance.

To be eligible for Cobra, workers must have been enrolled in their employer's health plan when they worked, and the plan must continue to be in effect for active employees. That means if your company declared bankruptcy and is liquidating its assets, it will likely terminate its health plans, making Cobra unavailable.

If you ve exhausted your Cobra coverage or simply don't qualify for it, start shopping for an individual plan. Keep in mind that private health-insurance policies can get pricey and may not always offer comprehensive coverage, says Jennifer Tolbert, a principal policy analyst at Kaiser Family Foundation, a health policy nonprofit. The premium you can afford, but it might come with a $2,000 deductible, she says.

Coverage in the private market is usually based on health status. So a pre-existing condition like asthma or a family history of diabetes can mean a higher premium. But if you re relatively young and healthy, a low-premium, high-deductible plan might be right for you. Prospective buyers should consider the plan s monthly premium (which are usually lower when the deductible is high) and the co-pay amount. Also, make sure any policy you're considering covers the services you use most (say, prescription drugs) or ones you expect to use in the near future (like maternity care), Gibbs says.

To compare features and costs of available health plans, check your state s health insurance department s web site, eHealthInsurance.com, or the sites of big insurers like Aetna (AET) and UnitedHealth (UNH) . (Read our story on help with cutting drug costs

Turn to Associations and Professional Groups

If you're a card-carrying member of organizations like your state s bar association or a freelancer group, you may be in luck. Many professional and trade groups and even alumni associations offer group-based health plans at a discount. Under these plans, the health risk is spread across the group, so members premiums tend to be a little bit lower than if they bought a policy on their own. Just be prepared to pay more than you did for your employer-based insurance because you'll be paying the full premium, Tolbert says.

Negotiate With Medical Providers

Prices are not always final. If you need to see an eye specialist or undergo a procedure that s not covered by your plan, it s possible to negotiate a lower price with your doctor or hospital, says Alan Sager, a health policy professor at Boston University. You'll probably have the best luck at your nearest public hospital, many of which have open-door policies and charge on a sliding scale based on need, Sager says. If negotiating a lower price doesn't work, ask if you can be put on a payment plan.