Hawai'i's laudable goal of providing at least minimal healthcare coverage for all of its citizens has faced a number of obstacles over the years — cost being the most critical.

As the range of benefits and the number of potential consumers expanded, both private employers and the state found it increasingly difficult to meet this objective.

While universal health coverage is the goal, the reality is that as many as 9 percent of our citizens (according to an estimate from one state task force) are without coverage.

This uninsured population places an extra burden on hospital emergency rooms and creates a situation where acute and treatable conditions become chronic and much more expensive to deal with.

In this context, it is good news that the Lingle administration has won federal approval, and $100 million in federal money, to expand its Quest medical insurance program for the poor over the next six years.

The goal is to bring as many as 20,000 adults and 9,000 children into the program.

Quest, which began during Gov. John Waihee's administration, is designed to offer at least basic healthcare services to individuals and families too poor to buy their own insurance yet with too many assets to qualify for public assistance programs such as Medicaid.

Meanwhile, Democrat lawmakers are working with the Hawaii Medical Service Association to devise coverage aimed at children from families who fall between Quest and private insurance.

All of these are worthy programs and are based on the sensible premise that preventive care and treatment are almost always cheaper than dealing with more serious medical emergencies later on.

But as the state moves toward true universal healthcare, it must recognize there are limits to any goal, no matter how worthwhile. At some point, it may become necessary to scale back services so that everyone has access to at least basic healthcare.

It also is important to avoid the temptation to pay for these programs by shortchanging medical providers.