The Legislature is in a good position to make health care improvements. Real progress will depend on political determination and smart budgeting.

Gov. Chris Gregoire has put forward a five-year plan for trying to provide health coverage for all residents by 2012 and all children by 2010.Senate Bill 5093, would give a good start to work on children's coverage by making more people eligible for Medicaid-supported care. But the large unmet needs for health coverage among children and adults, the strong economy and a bit of history all argue for focusing on several areas where gains can be made at reasonable cost.

The history revolves around a voter-approved initiative from 2001, I-773. That measure raised tobacco taxes to expand enrollments in the state's Basic Health Plan, which provides insurance at relatively affordable rates to many people who otherwise would have no coverage. During a budget crunch earlier in the decade, the Legislature made a tough but probably necessary decision to end the link between the tax and BHP enrollments. But I-773 was the rare initiative that actually provided a funding source for good intentions. With the budget picture dramatically changed, the Legislature should honor voters' wish for more coverage among people who are often the hardest workers.

Dr. Richard Kovar of Country Doctor Community Health Centers says he recently saw a 51-year-old woman who works two jobs that combine pay about $42,000 annually but she had not had any health care for six years. She would be well served by the addition of 20,000 slots in BHP, about a 20 percent expansion. Advocates include the Washington State Hospital Association, which notes the potential cost savings from reducing emergency-room visits.

To get more low-income people into regular medical care, the Legislature also should raise the reimbursement rates it pays for Medicaid patients. That requires paying full costs for care of children as well as better fees for health care of adults. Fairer rates would expand families' options.

It's also important, as the Washington State Medical Association advocates, to provide better funding for public health programs run by the state and counties. Everyone's health depends on the infrastructure of a public health system that carries out day-to-day duties, in fields as different as restaurant inspections and AIDS prevention, while it prepares to respond to any sudden crisis. Now is the time to look ahead.

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