THE WAVE of change that produced the landmark Massachusetts health reform law has also prompted the national association of health insurers this week to lay out its vision of how to expand coverage for the 46 million Americans without it. Massachusetts has gone far beyond the conceptual stage. A meeting of healthcare policy makers yesterday offers hope that the coalition behind the state law will maintain its cohesion as new insurance plans are rolled out over the next few months.

The national group, America's Health Insurance Plans, borrowed some ideas from the Massachusetts law, approved last April. The group wants coverage for all 12.7 million adults below the poverty line -- $9,800 of income for a single person -- who are now without insurance. On Oct. 1, Massachusetts began offering coverage to its 50,000 poor people in this category. The national insurance association also wants to cover all American children in families with incomes under 200 percent of the federal poverty line. Massachusetts already covers these children at no charge.

As Robert Blendon, Harvard School of Public Health professor and veteran healthcare pollster, said yesterday, "There is no other state doing what we are talking about" -- providing health insurance to just about everyone through a combination of state subsidies, employer-based coverage, and an individual mandate.

The meeting was convened by the Blue Cross Blue Shield of Massachusetts Foundation, which has spearheaded the campaign for expanded coverage in Massachusetts. It was encouraging that several hundred health-care executives, activists, and political leaders, including, briefly, Governor-elect Deval Patrick, gathered to discuss ways to maintain support for the law.

Blendon emphasized the significance of the reservoir of support throughout the state for the concept that everyone should be covered. Political consultant John Marttila stressed the need to maintain the support of owners of small businesses. They got off lightly; those with fewer than 11 employees are exempt from assessments, and larger businesses that fail to cover their workers will incur in most cases only modest penalties. It will be continuing test for the Patrick administration to balance the need for more money with the reality of small business clout.

The insurance association was offering its plan in part out of self-interest. Insurance companies hope to make money by administering government-subsidized programs. Despite the association's initiative, it is far from clear that Congress will do anything significant to expand coverage soon. If the Massachusetts coalition works through the inevitable implementation problems, this state will provide a model of success for the rest of the nation.

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