We have often argued for a renewed push to do something about the historically high level of Americans who do not have health insurance. But until Congress can be convinced to join forces across party lines on a comprehensive approach (including refundable tax credits and state-level insurance purchasing pools), it's imperative that we cover as many of the uninsured as possible in the existing health care programs administered by the states: Medicaid (the major health insurance program for low-income families) and CHIP (the Children's Health Insurance Program set up to cover low-income children not eligible for Medicaid). Indeed, of the 11 million uninsured children in America, an estimated 7 million are thought to be eligible for one of these services.

In the past, and to some extent even now, some states are very passive about helping low-income families sign up for Medicaid or CHIP on grounds that state budget costs will increase, even though taxpayers are already paying for the uninsured through unreimbursed care in public hospitals and higher insurance premiums for everybody. Moreover, public health insurance programs are notoriously complex systems to enter, with highly detailed eligibility rules and confusing layers of administrative bureaucracy.

We're pleased to report that Gov. Gray Davis' Administration in California has taken a big step towards making it easier to enroll the uninsured by creating a first-in-the-nation online application (dubbed Health-e-app) that guides citizens through the eligibility process in a user-friendly way, gets them in touch with the appropriate public agency for immediate help, and even helps them choose health plans and providers based on their particular needs. Developed in partnership between the state, the California HealthCare Foundation, and the Medi-Cal Policy Institute, the online application (www.healtheapp.org) is being currently tested in low-income neighborhoods in San Diego County. It is available anywhere there is Internet access, including schools, libraries and public health clinics; and community organizations and other advocates for low-income Californians are being encouraged to access the application and help families get enrolled. In most cases, applicants can get a decision on eligibility in real time.

According to the California HealthCare Foundation, 75 percent of California's two million uninsured children could potentially be covered by Medicaid or CHIP (100,000 could be signed up in San Diego County alone) under current eligibility rules. Health-e-app could help enormously in moving the state in that direction. It's an excellent example of a "digital government" initiative: using technology to make government services uniform in every location and user-friendly for every citizen, while cutting through complex bureaucracies electronically. And Health-e-app also shows how information technology can make choice and competition in health care work for consumers, with its database of health plans and providers tailored to the specific location, health needs, and language of each family.

We hope health-e-app works in San Diego, and is soon replicated elsewhere.