In 2008, the number of uninsured children in the United States hit the lowest level in two decades. If Congress weren’t in the middle of a fierce debate on health reform, there would be time for everyone to celebrate a remarkable achievement and maybe even pause to reflect on how it was accomplished. To paraphrase David Byrne of the Talking Heads: “We might ask ourselves, how did we get here?” We got here with federal fiscal support, leadership, state ingenuity and a willingness to make a sustained effort to address the issue of uninsured children. The states deserve a lot of credit. It’s been impressive to see how state policymakers from across the political spectrum have rallied to support children’s coverage, despite facing tough economic obstacles in recent years. Even in the midst of terrible fiscal problems, the vast majority of states have maintained children’s coverage in Medicaid and CHIP. This year so far, a whopping twenty-three states found a way to expand or improve children’s coverage, proving what can be accomplished when the federal government is a strong fiscal partner.