Republican leaders in the Senate say they want to review the House bill before making any final decision.

Sen. Edwin "Ted" Erickson (R., Delaware), chair of the Senate Health and Welfare Committee, said the $130 million in waiver money for adultBasic would mean cuts elsewhere in the state's Medicaid budget.

Torregrossa agreed the waiver must be "budget neutral." She said the state would withhold unspent federal funds earmarked for hospitals that treated a disproportionate share of the uninsured and funnel that money into the waiver for adultBasic.

The first two years of expansion of adultBasic would be funded from waiver money, Torregrossa said. In years three and four, waiver funds would be supplemented by 8 percent of the state's Mcare Abatement Fund. That money comes from a 25-cent cigarette tax intended to help doctors pay malpractice settlements. The fund has a $700 million surplus, Torregrossa said.

Given the degree of crisis, she said, "isn't that reasonable?"

Republican leaders and Scanlan don't think so. Once the Mcare funds have been exhausted, they say, the state will expect taxpayers to pay for the expanded adultBasic.

"We think using that Mcare money is shortsighted," Scanlan said.

"They're using one-time moneys that have accumulated in various accounts that will pay for the program in the beginning years but will not pay for the long-term impact," said Senate Majority Leader Dominic Pileggi (R., Delaware).

Debts mounting

Since 2007, when his wife's employer folded, the Rev. George Petrella, 57, of North Philadelphia, has lacked health insurance. A diabetic, he applied for adultBasic - and went on the waiting list.

Since last fall, when his big toe was amputated, he has accumulated medical bills of more than $38,000.

One member of his church, Presbyterian Evangelistic Fellowship, is a doctor at Esperanza Health Center in North Philadelphia, which serves low-income, uninsured adults and children. He took Petrella as a patient, ensuring him access to primary care and discounted insulin - $80 a month - from the clinic's dispensary.

"I would say God is good and he's been caring for us," Petrella said. "But I don't necessarily know how this is going to end."

Rate too low for some

Scanlan said that her hospital group supported broadening programs for the uninsured, but that the House bill would reimburse doctors at a Medicaid rate, not a commercial rate. She said too many doctors already did not participate in Medicaid because the reimbursement was so low.

Torregrossa rebutted this, saying that adultBasic would pay "actuarially sound rates."

Under HB 1, benefits will also be expanded to include prescription drugs and mental-health care.

Scanlan favors adding more people but thinks the additional benefits would be too expensive.

But to Torregrossa, the drug coverage "only makes sense."

"We pay for them to go to a doctor, but they can't afford prescriptions that will make them better. It seems like a no-brainer," she said.