By the end of 2008, there will be 50 million Americans without insurance, and for those with coverage, total costs will exceed $2 trillion. We are in the midst of a health care crisis.

In the absence of leadership from Washington, state legislators are stepping up to provide their citizens with access to medicine and treatment.

In 2006, the Massachusetts legislature created a law to ensure that nearly all of the state's residents have health insurance. The structure for that plan became the inspiration for the health care proposals by Sens. John Edwards and Hillary Clinton in the presidential primary.

In 2007, legislators in Washington passed a bill to offer families time away from work for up to five weeks for the birth of a child. Those who take advantage of the leave will be paid for the time they spend with their newborns and see their jobs protected.

This year, the Iowa General Assembly passed legislation which provides health coverage to many of the state's least advantaged children, expands coverage for uninsured adults, creates a system of electronic health care records, and offers the means for an increased focus on managing chronic diseases.

These efforts improve the lives of each state's citizens and offer a model for legislation elsewhere. More Democratic majorities will lead to better health care everywhere.