HARRISBURG - More than a year after Gov. Rendell called on the legislature to approve a plan to provide health-care coverage to nearly 800,000 uninsured Pennsylvanians, a scaled-down version of his plan is finally moving through the General Assembly.

The measure, expected to get final House approval Monday, would provide coverage to close to 300,000 uninsured residents. The bill, which passed a crucial 114-81 vote Wednesday night on its second reading, also would extend malpractice-insurance subsidies by 10 years in an effort to keep doctors from leaving the state because of high premiums.

The billion-dollar plan would be funded with state and federal money and individual premiums.

"We face many challenges in Pennsylvania, and health care for the uninsured can no longer wait," said Rep. Todd Eachus (D., Luzerne), who sponsored the measure.

Rendell's plan would have provided subsidies for families of four making up to $62,000 a year. The House plan would cover fewer people, with a threshold of $42,000. Under a formula that considers income and family size, most recipients would have to pay a small premium.

To address criticism from business groups that fear small employers will be crushed if required to provide health insurance, the measure includes grants to help them cover costs.

The proposal will likely face intense scrutiny in the Senate, where Republican leaders say they plan to raise the question of how to pay what they anticipate will be a huge long-term cost.

A spokesman for Rendell praised the Democratic proposal. "If the final version of this legislation reaches his desk in the approximate form it is now, he is likely to support it," Chuck Ardo said.

The vote Wednesday followed a nine-hour debate during which Republicans voiced concerns about the availability of federal money and the guarantee of funding in the future, while Democrats made the case that a solution to the state's uninsured population was necessary now.

Eleven Republicans supported the Democratic plan, among them six from the Philadelphia area and others from rural areas with high numbers of uninsured.

'Health-care crisis'

Rep. Matthew Baker, a Republican from northern Tioga County, which borders New York state and where almost 36 percent of the residents are uninsured, said his vote was a reflection that "something had to be done about the health-care crisis."

Rep. Nicholas Micozzie (R., Delaware), who voted for the measure, said that 25,000 of his constituents had no health coverage, and that hospitals in his county spent $2 million a year to care for the uninsured.

"Those are the things I'm concerned about," he said. "When I go knocking on doors, the two big issues are property taxes and health care."

But some Republicans predict that a tax increase would be needed to support the program down the road.

"This program, fully implemented as it's proposed, is going to require a huge increase in revenues to properly run it and execute it in a fashion that would meet the expectations that are being set forth," House Minority Leader Sam Smith (R., Jefferson) said.

Members of Pennsylvania Health Access Network, a coalition of groups representing consumer and faith-based organizations, applauded the House vote.

The proposal "addresses both sides of the access problem: keeping doctors in Pennsylvania and enabling more Pennsylvanians to afford to visit these doctors," said Sharon Ward, director of the Pennsylvania Budget and Policy Center, a nonpartisan, nonprofit research group.

Doctors see funding risk

But some doctors argue the plan could be jeopardized because of uncertainties over the funding plan for extending subsidies for medical-liability insurance.

Funding sources in the bill include Medicaid, state tobacco settlement money, and a fund that helps doctors pay for malpractice insurance. Individuals in the program also would contribute through monthly premium payments.

The proposal anticipates insuring 272,589 adults by 2013.

The program would offer better coverage than the state's adultBasic program for lower-income residents, which has 80,000 people on the waiting list. It also would add four types of coverage to what is available under adultBasic: prescriptions, behavioral health, prevention and wellness, and chronic-disease management.

Families with incomes above a threshold would pay a premium under the House proposal. For instance, a family of four making $42,400 would pay $50 a month.

Companies with fewer than 50 employees could receive grants to help offset the cost of insurance. Under the proposal, the average salary must be no more than $32,000, coverage must be offered to each employee, and half the employees must participate.

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Contact staff writer Amy Worden at 717-783-2584 or aworden@phillynews.com.