Last month's election broke for Democrats nationally not only because of anger over Iraq and congressional corruption but also because moderate and independent voters want to see action on issues affecting the lives of their families.

Moderates sent a clear message that years of spending billions on tax cuts aimed at the wealthy, while doing nothing to create good jobs, make it easier to send kids to college, or put the brakes on health insurance costs was simply not acceptable.

Affordable health coverage is high on the list of issues people care most about. However, don't expect major health-care reform in Washington next year when the newly elected Congress convenes.

Five years of massive federal tax cuts are the major cause of a truly dismal fiscal situation, with annual federal deficits averaging $350 billion each year for the foreseeable future.

Simply put, for every $10 in tax revenue the federal government takes in, it currently spends $11. Getting the nation's fiscal house in order will clearly have to take place before major health reforms are possible.

A good way to start? Reinstitute the "pay-as-you-go" budget rule that produced federal surpluses in the 1990s. This rule requires that any proposal for either tax cuts or new federal spending must show clearly how 100 percent of the proposal will be funded.

Despite staggering federal deficits, voters are clearly interested in solutions to problems that affect their families. That's why there are likely to be serious (but limited) proposals to expand coverage families can afford -- both at the federal and state levels.

To start, only about 86,000 kids in North Carolina don't have affordable health coverage available to their families.

Children are the cheapest group to cover, and implementation of an affordable kids' health-care plan is likely to be considered in Congress and in Raleigh over the next year. Parents in lower-income families would get sliding-scale help with premiums, and over a certain income level any parents in the state could buy coverage for their kids through the plan as long as they paid the full monthly premium.

Additionally, maintaining affordable coverage now available should be a top priority for politicians in Washington. Congress should reject likely proposed cuts for the poor and elderly proposed by the Bush administration and fix some of the most egregious and radical policies passed over the last several years aimed at denying families affordable healthcare.

Unfortunately, because of federal inaction, North Carolina's current children's health insurance program remains on track to lose between $40 million and $50 million over the next two years in federal funding it needs to keep serving all children getting health coverage.

In North Carolina, there are other proposals to expand affordable health care that should receive consideration next year.

Topping the list is creation of a high-risk health-insurance pool where people with chronic illnesses who are rejected or can't afford the astronomical premiums private insurers charge can go to buy affordable coverage.

While such a plan will help a relatively small number of people, these are individuals who are the hardest to insure, and the pool is a critical first step to larger health reforms.

A deep-discount health insurance plan aimed at small businesses should also be on lawmakers' to-do lists along with a plan to allow parents whose kids are already covered to buy into a limited health plan set up through the state Medicaid program.

Despite the clearly expressed desire of moderates that politicians tackle tough pocketbook issues, major health reform appears off the table over the next year.

However, that doesn't mean that more limited and targeted solutions aimed at making health coverage more affordable can't be accomplished in both Raleigh and Washington.

People just have to make sure the folks they sent to Congress and the General Assembly don't forget that mandate.

Adam Searing is the director of the North Carolina Health Access Coalition.