Sometimes, local efforts are not enough. Child health offers a good example of an issue that needed a national campaign for success.

For years, local child advocates struggled to find health care for children from families with no health coverage. Individual stories would occasionally make the news, inspire sympathy, and generate the needed care, but each individual case took prodigious efforts, and left millions more - nearly 11 million by 1997 - without coverage. Meanwhile, advocates were also working hard to win expanded coverage under Medicaid - a strategy that worked least well for the children in the poorest states, and required massive efforts by groups with tiny staffs and shoestring budgets.

Frustrated, advocates requested a meeting with President Clinton's health policy staff. In December of 1996, just about the time decisions on the next year's budget were being decided, thirty advocates went to the White House. Each represented an organization directly involved in maternal and child health - everyone from the Children's Defense Fund and The Arc to the March of Dimes and Children's Hospitals. Their plea was simple: put money in the budget to cover uninsured children. When the President's budget proposals went to the Congress a few months later, there was some money, but the amount was disappointingly small.

Lacking robust help from the White House, the advocacy groups turned to their elected officials in the Congress, and by March two senior U.S. Senators had agreed to introduce a bill to create a new Child Health Insurance Program, or CHIP: Republican Orin Hatch, of Utah, and Democrat Ted Kennedy, of Massachusetts. In the House of Representatives another bi-partisan pair of champions was found: Republican Nancy Johnson of Connecticut, and Democrat Robert Matsui of California.

Some of the more traditional health groups balked at joining the effort - a few regarded it as a hopeless case, others disagreed over how it might be funded. Ironically, that problem proved to be an advantage because it forced supporters to look for new allies. Before long they had enlisted groups that cared about children but were not necessarily identified with health (PTA's, and school administrators), groups that worked on adult health issues (the American Cancer Society, the American Heart Association), and a growing list of other odd couples (e.g., business groups and sororities, the American Muslim Council and the National Black Police Association). Every week support grew broader, and deeper.

In a parallel effort the state Attorneys General of nearly 40 states were already suing the tobacco industry for the costs of tobacco-related medical care, and calling attention to the harm that tobacco does to children's health. That spring, the first big tobacco settlement was reached with the states, and the idea that tobacco was bad for children seemed to be on everyone's lips. Suddenly the idea of funding CHIP with proceeds from a tobacco tax looked winnable.

At the same time advocates worked with the media: scheduling editorial board meetings, giving background information to journalists, writing commentaries that began appearing in local newspapers everywhere, and spreading the word through countless newsletters.

Plus, they used the Internet to activate grassroots networks of potential supporters all across the country. (By modern standards this was a primitive internet organizing effort, with the various campaign partners simply feeding their e-mail address lists to "...this guy at a computer, creating an internet tree..." according to one participant). Ultimately, the Campaign for Child Health Now included over 200 national and state organizations from across the political spectrum and the U.S. - all of them spreading the word and informing their members. They kept the pressure on their members of Congress, and the White House.

Two more breakthroughs provided momentum. In June the tobacco industry agreed to a massive 8 billion, multi-year settlement with the states - at least part of which could be used for child health. A few weeks later the White House and Congressional leaders reached agreement on a budget, including authority for CHIP. Advocates still had to work to make sure the various agreements did not unravel, but by early August of 1997, legislation authorizing CHIP had been passed and signed into law.

It remained for each state legislature to design the version of CHIP that would make the most sense for them. That fall, just about one year from the initial meeting at the White House, California and Connecticut became two of the earliest states to pass their own enabling legislation, and start drawing on the $ 24 billion federal CHIP dollars available to provide health insurance for children from low-earning families. Two years later, Texas was the last state to act, when a reluctant Governor George Bush signed the Texas version of CHIP into law.

Those advocates in the Campaign for Child Health Now did many things right: they pressed ahead when others thought they could not win, they built on already-established relationships with elected officials, they seized opportunities, they organized beyond the usual suspects to create a politically powerful coalition, and they made sure all three legs of the advocacy stool were firmly in place.

Today millions of children have health coverage who would not have it otherwise, and more than a dozen web sites provide up-to-date information for local advocates working to make CHIP available to eligible children in their states.

If you think legislative victories are only won by powerful lobbyists wandering the halls of Congress, writing big campaign checks and throwing lavish parties, think again. The campaign for CHIP is proof once again that our democratic system still works. Those billions in the budget were not a payoff for fancy parties; they are there because of good old-fashioned hard work and grassroots organizing. And everyone who spoke up, wrote a letter, signed a card, made a call, contributed money, questioned a candidate, or raised the issue at a community event, played a part. That is how democracy works.

Before any national campaign is over, it involves everyone from super-sophisticated D.C.-based lobbyists who arrange White House meetings, to absolute beginners writing their first letter or making their first phone call. National campaigns do not always win, but in this case they won big-time - and every year children everywhere win again.

As you are by now quite aware, getting a law passed by Congress is only one stage in the process, and it is a process that must be re-engaged every few years, along with annual battles over funding. In the case of CHIP, advocates who worked to get the federal law passed, then had to work with their state legislatures for a bill to adapt and carry out the federal law in their own state. After that the actual implementation of the law has to be monitored. Even as this is written, children's advocates are serving on local CHIP committees, planning the next CHIP event, inviting their state legislators and Members of Congress to visit their hospitals and clinics to meet with the families helped by CHIP, and keeping one another informed as each new step unfolds.

Being a good citizen is a bit like being a good parent: the job may change, but it never really ends.