This is Washington's plan: Spend $24 billion over the next five years, and an additional $24 billion over the following five years, to provide health insurance for American children currently without it.
How many children lack such insurance? Official estimates put the number at 10 million. Others say that's too high. What's sure is that the rising cost of health insurance has forced many companies to trim or eliminate family health benefits. And many Americans who want such benefits for whatever type of health care they seek for their children can't afford to pay on their own.
There's troubled Medicaid, of course. About 3 million of the estimated 10 million uninsured children are eligible for Medicaid health assistance for the poor - but they aren't receiving benefits, sometimes because parents simply aren't aware that they're eligible.
Enter the new program, part of the recently passed balanced budget law. It will give states flexibility: Under its guidelines, states can cover needy children either by expanding Medicaid or by designing their own programs. Funding becomes available Oct. 1.
The program generally has been well received. But there are still unanswered questions: How many of the estimated 10 million uninsured will the plan actually help? Will employers, with a new safety net available, now be more likely to drop family coverage? Will individual state programs become needlessly complex or too restrictive as to types of treatment that are covered?
Critics say federal help is unnecessary - that states and private insurers already are taking measures to meet the needs of uninsured children. But even the most successful state programs aren't reaching all families. Take Florida. A public/private partnership called Healthy Kids Corporation is billed as a model for other states. About 35 percent of the cost is paid for by parents; the rest is covered by county and state and by charitable donations from businesses.
The program uses schools as grouping mechanisms to create pools of children, allowing for lower premiums. The schools also act as information centers for contacting parents.
Still, there are only about 45,000 children enrolled out of about 500,000 uninsured children in Florida. State officials say they're likely to use their portion of the federal $24 billion to expand the program to as many as 100,000 new school-aged children.
Congress and the president wisely - and successfully - tried to avoid devising cookie-cutter solutions to this problem. States should have the flexibility to design programs that work for them. But they also can learn from each other - to find out what works and what steps to take. That's exactly what governors meeting in Washington this month for a National Governors' Association conference say they will do. It's a good place to start.
States should have flexibility to create the insurance programs that meet families' needs.