North Carolina's health care system is in trouble. According to the latest estimates, 1.4 million state residents (over 17 percent of the population) lack health insurance.

As the costs of health insurance premiums rise and businesses cut back on coverage, the number of uninsured North Carolinians will surely grow in coming years. North Carolina cannot count on the federal government to fix this problem.

To be sure, what to do about the uninsured is a national dilemma that requires a national solution: across the country, 46 million Americans lack health insurance and all states are wrestling with the impact of rising costs. Yet, even as the ranks of the uninsured have grown in the last decade, the federal government has done nothing.

Even worse, recently enacted cuts in federal Medicaid spending actually make it more difficult for states to afford their health care bills. And with a sizable federal budget deficit and continued partisan polarization in Congress, it appears that help from Washington is not on the way.

If North Carolina wants to make progress on health reform and expand access to affordable insurance for its citizens, the state has no choice but to take the lead itself. Doing nothing only assures that North Carolina will confront a much greater problem down the road.

There is one obvious starting point for health care reform in North Carolina: covering all children. There are currently 264,000 children under the age of 18 without health insurance. Whatever their political differences, can't our state legislators agree that every child in North Carolina should have comprehensive health insurance?

Extending health coverage to children should not be the end point for health reform. We must also pursue policies that make affordable coverage available to low-income working adults and small businesses. But expanding children's health insurance is a promising place to start.

Covering children is relatively cheap and represents an investment in the state's future. Research shows that uninsured children are less likely than insured children to have a regular source of medical care, less likely to receive preventive services, and more likely to go without needed care.

For example, children with asthma who are covered by public insurance have better health outcomes and require fewer hospitalizations than uninsured children with the same condition. "Leave no child behind" is a familiar refrain in public policy, yet in health care we have been doing exactly that.

We can build on existing state programs (Medicaid and North Carolina Health Choice) that already provide public insurance to many children. Indeed, one of the state's challenges will be to enroll the estimated 147,000 children who are eligible but not now enrolled in these programs.

North Carolina can also build on the experiences of other states: Illinois recently enacted legislation aimed at covering all its uninsured children and Oregon is considering a similar measure.

Of course, making a political promise to cover all children in North Carolina means nothing without a financial commitment to pay for that coverage. In part, state expansions of children's health insurance can be financed by available federal matching revenues. North Carolina will still need to raise its own funds.

One possible solution, though not the only one, would be increasing the state cigarette tax. Even after the cigarette tax rises to 35 cents per pack this summer, North Carolina will have the eighth-lowest cigarette tax in the country, lagging far below the national average of 92 cents.

Unless another funding source is found, North Carolina is going to have to choose: does the state want to maintain low prices for cigarettes or does it want to ensure that all its children have health insurance?

This is cache, read story here