For a guy who relentlessly focused on health care as a candidate, Missouri Gov. Jay Nixon has been remarkably quiet of late.

At a time when health care dominates the national debate, Mr. Nixon is one of just six Democratic governors who declined to sign a letter urging Congress to act quickly on reforms to broaden coverage and control costs.

Mr. Nixon's aides say the governor acted — or rather, failed to act — out of an abundance of fiscal caution. He is concerned that health care reform bills might place too great a financial burden on state governments.

His spokesman, Jack Cardetti, pointed specifically to a provision that requires expanded Medicaid coverage for low-income families. Ironically, as a candidate for governor last year, Mr. Nixon relentlessly excoriated his Republican predecessor, Matt Blunt, for cutting Medicaid coverage.

Since July, Mr. Nixon has received at least $72,500 in campaign contributions from insurance and health care interests. He also got $7,500 from a lobbyist whose clients include health care and insurance companies.

Mr. Cardetti said those contributions are "absolutely not" related to the governor's refusal to sign the letter. He said Mr. Nixon supports federal health care reform, but he objects to "unreasonable unfunded mandates" that pending bills could place on state governments.

Both Senate and House reform bills would extend Medicaid coverage to families earning less than 133 percent of poverty, or about $24,000 for a family of three. Medicaid is funded jointly by federal and state governments.

But most of the money to pay for expanded Medicaid eligibility would come from the federal government.

Mr. Nixon's silence extends to more than just health care reform. In July, a coalition of child advocacy groups asked Mr. Nixon to adopt policies that would enroll more eligible children in Medicaid and the State Children's Health Insurance Program.

But 11 weeks later, Mr. Nixon has yet to meet with the advocacy groups. His office says it still is studying the proposed changes.

State officials estimate that more than 27,000 children who already are eligible could be enrolled simply by matching computer records with kids already enrolled in food assistance and other social service programs. What's to study about that?

Mr. Nixon deserves credit for trying to expand Medicaid coverage to about 35,000 working-poor parents earlier this year. That effort was thwarted by the Republican-controlled Legislature.

Since then, the number of uninsured Missourians has increased. A new report from the advocacy group Families USA estimates that about 65,000 people in our state have lost their insurance coverage so far this year.

There's no question that the recession has limited Mr. Nixon's options. But that shouldn't keep him from speaking out about the need for reform with the same urgency that he espoused on the campaign trail.

Mr. Nixon should be doing everything he can to expand coverage for children. He doesn't need to wait for legislative approval to take the steps urged by child advocacy groups almost three months ago.

Now, when the need is greatest, Mr. Nixon should be speaking out loudest. The people who elected him expect more than warmed-over Matt Blunt.