There is widespread agreement that the American health care system needs comprehensive reform. This kind of reform will take time, however, and millions of Americans have urgent health care needs that must be met now. This is especially true for the nation's poor children, for whom the health care "safety net" has greatly eroded in the past decade. New Jersey's health care reform initiatives will ultimately provide for accessible preventive and primary pediatric care, with a community-based "medical home" serving as a child's gateway to the health care system. In the meantime, New Jersey has established programs dealing with such urgent problems as infectious childhood diseases, lead poisoning, AIDS, and infant mortality. While in the spirit of the state's long-range planning effort, these programs are up and running now, their impact maximized in this period of budgetary constraints through coalition- and network-building.