The enactment of CHIPRA three years ago gave states additional tools and resources to maintain and improve children’s access to health care. In recent years, the number of uninsured children has decreased by one million, even as child poverty has jumped to alarmingly high levels and more parents and adults have joined the ranks of the uninsured. The Affordable Care Act has played a role in this success story by requiring states to maintain Medicaid and CHIP eligibility and enrollment procedures; however, the country has gone well beyond simply holding steady when it comes to children’s coverage. In a striking tribute to the effectiveness of CHIPRA, each and every state has benefited from one or more of the law’s opportunities to advance coverage for children, with some going much farther than others. Without these actions, it is difficult to imagine that the country would have made major strides in covering its children in the midst of the worst recession in decades.