States from coast to coast are seriously contemplating some form of universal health insurance, not just for children but for adults as well.

Gov. Rendell, stumping across Pennsylvania this week to promote his plan for affordable insurance, is a prime example. Expanded coverage for the uninsured is high on the agenda in more than a dozen state capitals and is being considered in at least a dozen more. Four already have it.

The trend can be seen across the country:

Gov. Arnold Schwarzenegger, a Republican, is negotiating with Democratic legislative leaders in hopes of passing bill to expand coverage to California's 6.8 million uninsured residents.

A Colorado commission established last year is due to issue recommendations on how to expand health insurance to the uninsured by January.

Massachusetts is implementing a 2006 law that requires every resident to have health insurance and providing subsidies based on a sliding scale of income.

"There is clearly broad interest across the country and in many states in developing broad strategies to address the problem of the uninsured," said Jennifer Tolbert, a policy analyst with the Kaiser Commission on Medicaid and the Uninsured in Washington.

Sid Smith says he is a good example of the need for change. Before his first heart attack in 1995, Smith, who lives in West Philadelphia, trained disabled people to work as janitors.

But the damage to his heart left him unable to work; that, in turn, ended his health insurance. Now 58 and the survivor of two more heart attacks, Smith has been found to have heart failure, prostate cancer, diabetes, and high blood pressure.

Social Security disability income barely covers his rent, utilities and food, he said, and he depends on a city health center to manage his diseases and provide the 15 drugs he takes. "The care I get from the health center, I know it's not the best in the world, but they do their damnedest," Smith said.

Traveling across Pennsylvania, Rendell says he has met many Sid Smiths this week. He is midway through a five-day "tour to insure" - State College and Johnstown today, Scranton and Wilkes-Barre tomorrow - seeking citizen support for his plan. He talks on his bus with small groups of uninsured residents at each stop.

In Warren County yesterday, a middle-aged man told the governor that he had built an addition to his house and given up his job - and his employer-provided health insurance - to care for his twin brother.

A short time later, Rendell reflected over lunch on that man's situation. "As I listen to some of the stories of the uninsured," he told his staff, "it's just heartbreaking to know that there are so many people who are hurting, and it reinforces the need to act."

Rendell's proposal, introduced in the General Assembly last week, would make individuals eligible to buy state-sponsored health insurance from private insurers for about $280 a month. Premiums would be subsidized for people with low incomes.

Businesses with 50 or fewer employees could enroll their workers in the plan as well. The employers would pay $130 a month; employees would cover the remainder, with state subsidies for those with low incomes.

Rendell would pay for the subsidies with a new tax on smokeless tobacco and cigars, an increase in the cigarette tax, a 3 percent payroll assessment on most businesses that do not offer health benefits to workers, and federal matching funds.

While many states are moving to make health insurance affordable to more of their residents, Rendell's plan is just one part of his broader initiative to increase access to care, control costs and improve quality. His "Prescription for Pennsylvania," announced in January, put the commonwealth at the forefront of states that are advancing changes in health care.

For governments, health insurance for children - provided for the last decade through a jointly funded state-federal effort known as the State Children's Health Insurance Program (SCHIP) - is a very different issue. Like coverage for adults, however, proposals to expand insurance for children are working their way through state capitals nationwide.

More than 30 states were considering additions to the program within their borders when President Bush last week vetoed federal legislation to reauthorize and fund an expanded SCHIP for $60 billion over five years. Congressional leaders are now counting votes to determine whether to attempt an override or come back with a bill more palatable to the White House.

Legislators in states that have passed or are considering laws to expand coverage for adults are closely following the Washington debate over health insurance for children.

"Those broader based reforms in many cases seek to build on existing public programs such as SCHIP," Kaiser's Tolbert said.

Rendell, for example, modeled his cover-all-Pennsylvanians proposal to offer affordable health coverage to the state's estimated 767,000 uninsured adults on an already approved effort to expand the children's health program to all 133,000 uninsured children.

Gov. Corzine was thinking along similar lines when he announced preliminary plans for universal health insurance in New Jersey in January. That proposal, like some other Garden State initiatives, still awaits a politically palatable source of money - and has not been introduced in the Legislature.

Corzine has acted aggressively, however, in pursuing health insurance for children. Two days before Bush vetoed the national expansion of SCHIP, New Jersey sued the federal government over regulatory restrictions that were put in place in August. Seven states said they would join him.

At issue is how generous states can be in providing insurance to children above the poverty level. Although the program was originally intended only for the poor, most states have received federal approval to insure children of families earning 200 percent of the poverty level.

Pennsylvania covers 300 percent. New Jersey's cost of living is particularly high, as is its threshold for coverage: 350 percent of poverty level.

Depending on what happens with SCHIP in Washington, Pennsylvania and other states may have to modify their plans for expanded children's health insurance.

Meanwhile, citizen task forces and legislative committees in dozens of states churn ahead with proposals for universal health coverage for all ages.

"This activity is genuinely local, not national," Richard Cauchi, the health program director for the National Conference of State Legislatures, said yesterday. "Each state is calculating its own needs and resources and checking finance realities. With 2008 sessions just 12 weeks away, it should be an interesting year."