Health care reform is a national challenge, and ensuring that all Americans have access to affordable, quality health care coverage will ultimately require action by the federal government. But in the absence of federal action, governors and legislatures in all parts of the country have begun launching ambitious efforts to expand coverage, control costs and improve quality.

One especially comprehensive initiative, called "Prescription for Pennsylvania," was recently proposed by Pennsylvania Governor Ed Rendell.

"We can no longer stand by while health care costs spiral out of control, leaving some 767,000 adult Pennsylvanians without the basic health care they need. It's creating a drag on our economy," Rendell said. "It is no longer a question of whether we can afford to act. The cost of inaction is far greater in terms of individual health consequences and from the increasing burden on taxpayers."

There are three major elements of the Prescription for Pennsylvania.

First, in an effort to provide health care coverage to all Pennsylvanians, the plan creates Cover All Pennsylvanians (CAP), an affordable, basic health insurance plan that will be available to the uninsured and to eligible small businesses that do not presently offer health insurance to their employees. Those individuals earning more than 300 percent of the federal poverty level (or $60,000 for a family of four) would pay the full premium. They would also be subject to a new individual mandate to purchase insurance, which will be phased in. Those earning less than 300 percent of the federal poverty limit or working for a small business whose average wage is lower than the state average will receive discounts and subsidies. Employers would be required either to offer their employees health insurance or pay a 3 percent, fair share assessment on their payroll, which will be used to partially offset the predicted $324 million first-year cost for the plan.

Second, Prescription for Pennsylvania aims at reducing costs by reducing expensive, unnecessary emergency room care, a significant problem in the Keystone State. The plan focuses on promoting non-emergency settings for non-emergency care, in part by increasing the number of care centers in areas of need and providing incentives for providers who offer services on evenings and weekends.

Finally, the governor's plan addresses health care quality through a crackdown on hospital-acquired infections and avoidable medical errors; improvements in care for those with chronic conditions; and the introduction of state-of-the-art patient safety and electronic health records systems. The plan also promotes a common-sense payment system that would reduce unnecessary medical services, while also including consumer incentives that reward healthy lifestyles.

"Government alone cannot -- and should not -- attempt to solve every problem facing our state's health care system," Rendell said. "However, simply maintaining the status quo will needlessly cost billions of dollars and countless lives."

Rendell's plan is a bold step towards providing affordable, quality healthcare to all Pennsylvanians.