Topeka ? Kansas has joined the list of states where officials are attacking rising health care and insurance, deciding not to wait for the federal government to provide relief.

“Now that it’s affecting the middle class, something may be done,” said Cynthia Pernice, a project director for the National Academy for State Health Policy. “It’s a hard thing to tackle.”

Maine plans to tap $53 million in existing revenues to expand health insurance coverage for its residents. Voters in Colorado, Montana and Oklahoma recently approved tobacco tax increases to provide money for health care.

In Kansas, Gov. Kathleen Sebelius and Insurance Commissioner Sandy Praeger have outlined a $50 million plan to attack administrative costs within the health care system and provide state insurance coverage to 70,000 additional residents. The plan would increase the state’s cigarette tax by 50 cents a pack, to $1.29.

Also, Sebelius and Praeger are proposing that the state subsidize health plans for small businesses, hoping to provide coverage to an additional 30,000 to 40,000 low-wage workers through their employers.

Sebelius said she was considering participation in Illinois’ prescription drug program, which connects residents to foreign pharmacies and wholesalers in hopes of saving them up to 50 percent off U.S. retail prices.

Sebelius and Praeger said rising drug and medical costs were making insurance more expensive for many Kansans, while nearly 300,000 of the state’s residents are uninsured.

“We’re really heading for a crisis, so I think we’ve got to take some very aggressive action and do it now,” Sebelius said.

Richard Cauchi, health program director at National Conference of State Legislatures, said initiatives began in the early 1970s, when Hawaii required all employers to provide health coverage. Each year, he said, legislators balance the desire to help their residents stay healthy with limited resources.

There are pitfalls.

Ten years ago, Tennessee created TennCare, an expansion of the state’s health care program for the working poor, covering about 25 percent of the population. However, consumer advocates objected to proposed benefit changes, and Tennessee can’t afford the program in its current form. The state announced this week that 430,000 people could lose coverage next year.

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Meanwhile, Maine is enrolling residents in its new DirigoChoice health plan, subsidized by the state but offered through a private insurance company. The program is designed to provide coverage for the state’s 138,000 uninsured residents by 2009.

In addition, Maine created a new agency to examine the quality of care and set goals for containing administrative costs. The state also is encouraging consumers to seek preventive care and educate themselves about health care choices.

“We’re really trying to do a big system change,” said Pernice, whose office is in Portland, Maine. “That takes time. As Americans, we want instant gratification. That’s going to be one of the biggest hurdles.”