Shelley Ross sees with both eyes now. This was accomplished, in part, with her own money, which wasn’t supposed to be possible.

Ms. Ross, 40, a community college instructor and a divorced mother of two, by chance was the first to test drive how her state, Indiana, now covers uninsured adults.

She signed up in December. She soon had a cataract excised and got the mammogram she’d been putting off. “It has taken a huge weight off me,” she says.

This was the result of something that looks like a health savings account, long derided as no solution to the health care woes of the poor. Most of the bill was paid by Indiana’s Medicaid program, but only after Ms. Ross paid a $1,100 deductible out of an account the state helped her to fill.

This is one of a thousand flowers blooming — or 50, as the states take varying approaches to covering uninsured people. Some, such as Massachusetts, try ginning up an artificial market and making people buy in. New Jersey would do something similar under a bill introduced this week, only the state would run the subsidized health plan. In New York, Assemblyman Richard Gottfried has proposed a single-payer plan.

Indiana’s gone in the other direction. Its Healthy Indiana Plan saves the state’s money for those who most need it — people earning up to twice the poverty level who can’t get insurance at work. Brainchild of Governor Daniels, who used to be President Bush’s budget chief, it’s built like consumer-driven health insurance.

This has worked for Ms. Ross. She’d been gradually losing sight in one eye. As she’s adjunct faculty, her public college won’t cover her. Though she could make out only shadow and light on one side, she put off seeing a doctor — not because of the cost directly but “because I thought, ‘I don’t know what I’d do if I had a brain tumor.'”

When she heard about the soon-to-start plan, she signed up. Under Healthy Indiana, Ms. Ross pays her first $1,100 in care out of an account that she contributes to according to a sliding scale. She puts in 5% of her income; the state adds the rest of what’s needed.

It sounded like a good deal. “There were moments I was thinking about getting remarried into a very miserable marriage just to get the insurance,” Ms. Ross says. Instead, she applied with cash for the first month’s contribution to make sure she could get her eye fixed over Christmas break. “It’s gone without a hitch,” she says. About 28,000 other people have applied, far more than expected. The plan passed in 2007 with bipartisan backing. It’s funded with an increased cigarette tax, which critics disliked, while others, including national groups favoring single-payer plans, suggested that the poor would find the health savings account-style system hard to afford.

That hasn’t come to pass, says David Roos of Covering Kids & Families of Indiana, a group that’s pushed for more government coverage. “From the applicant’s point of view, it’s a really nice program,” he says. So far, most of the applicants have been people with very low incomes.

This is worth other states’ notice. Despite an unfair reputation as the iciest of laissez-faire ideas, consumer-driven health coverage can be made to work for people who aren’t either rich or healthy. Neither applies here: Ms. Ross makes $25,000 a year and needed a doctor quickly.

She pays $91 a month now, and “I’m smiling when I’m writing that check,” she says. “It’s not like I wanted a free ride.”

Her ride is subsidized, but she nonetheless has substantial money on the line: Her payments virtually fill the account. Anything left over at year’s end, whether she or the state put it in, rolls over, reducing next year’s contribution. The state covers $500 in preventive care without deductible, and the rollover happens only if Ms. Ross gets an annual physical.

All this works like private-sector HSAs do, with incentives on the low end and insurance to spare you from truly catastrophic costs. This was intentional. The plan was built, its designers say, to be compatible with private insurance and with reforms that make health care act more like other markets. It explicitly differs from government-centered plans that give up on markets or, at best, seek to simulate them.

“It’s a great model,” says Grace-Marie Turner of the Galen Institute, a free-market health policy shop. It gets the incentives right, making clients think like consumers, even using existing insurance networks. It does it without fouling up the market for private insurance, she says.

It does it without being cruel, either. Critics speak of market-centered reform as a Darwinistic chaos where the hapless poor go untreated, but Indiana demonstrates that individualism need not be rugged. What counts is that patients have real money to spend or keep, Ms. Turner says. The incentives work whether the state or an employer help fill the account or not: “It really is your money, no matter where it comes from,” she says.

If you have to tap the taxpayers, this seems a sensible way to do it, yet it’s benign enough to surprise Ms. Ross — “not exactly the most conservative sort of person,” she says — that it was pulled off by a conservative governor.

“It’s worked really well for me,” Ms. Ross says. Maybe for her state, too.

Mr. McIlheran is a columnist for the Milwaukee Journal Sentinel.