The overall ranks of the uninsured continue to swell, to nearly 46 million Americans at the beginning of this year. But a landmark federal program begun in 1997 to provide health coverage to poor and working-class children and additional measures taken by states across the country have provided health insurance to millions of children who might otherwise go without.

In just the past year, 20 states have taken steps to increase access to health coverage for children and their parents and nine states have reversed actions they took during the 2001-03 economic downturn to limit benefits, according the Kaiser Commission on Medicaid and the Uninsured, part of the Kaiser Family Foundation, which tracks health care trends. As a result of these and other steps, there are 350,000 fewer uninsured children in the United States than there were in 2000, the foundation reported. Over the same period the overall number of uninsured rose by 6 million.

Ambitious steps like the child health bill just signed in Illinois and the "Dr. Dynasaur" children's health program in Vermont have broadened coverage for children.

Alan R. Weil, executive director of the National Academy for State Health Policy, a nonpartisan research group, said that children's health was one area of state spending that had consistently risen, at a time when most other programs -- including health care for adults -- have suffered cuts.

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