The Pennsylvania House approved a bill yesterday that would extend more affordable health coverage to hundreds of thousands of uninsured adults.

The proposal, fashioned by House Democrats and similar in some ways to a plan advanced earlier by Gov. Ed Rendell, was approved by a 118-81 vote in the Democrat-controlled chamber. It now moves to the Republican-dominated Senate, where it faces an uncertain future.

Among other provisions, the bill would create Pennsylvania Access to Basic Care, a program offering subsidized coverage to adults earning up to 200 percent of the federal poverty level, about $35,200 a year for a three-member family.

The plan also would give grants to small employers who already offer health insurance coverage to their low-income workers, provide a health savings account option and phase out the MCare abatement program, which helps doctors pay their malpractice insurance costs.

The plan also would phase out MCare, a state insurance program that provides doctors with catastrophic coverage for medical malpractice, and retire the program's $2 billion unfunded liability, or cost of future claims.

Also yesterday, state Sens. Jay Costa, D-Forest Hills, and Vincent Hughes, D-Philadelphia, introduced legislation similar to the House bill. Doing so, Mr. Costa acknowledged, would give Democrats multiple vehicles to advance their proposals.

In a statement, Sen. Don White, R-Indiana, chairman of the Senate's Banking and Insurance Committee, gave some suggestion of the reception they may receive in the Senate, saying he had "serious concerns about the scope and costs" of the House bill.

He also noted that the legislation does not specify how about $120 million needed the first year would be raised, although Democrats have suggested that options could include higher taxes on cigarettes or new taxes on tobacco products.

A steady stream of House Republicans raised those and other concerns before yesterday's vote, though others supported the Democrats' plan.

The Hospital and Healthsystem Association of Pennsylvania called yesterday's vote an "important step," but expressed concerns that approval of an extension of health coverage has been linked to continuing the MCare abatements. The governor has said he will not approve the abatements if no agreement is reached by March 31 to extend coverage to the uninsured.

"Given the magnitude of the insurance plan, final debate in the General Assembly is going to take time," said Carolyn Scanlan, the association's president.

Mr. Rendell has scheduled a news conference at 10 a.m. today to discuss the House vote.

His spokesman, Chuck Ardo, said the governor considers the House action "a step forward" but did not plan to separate the abatement issue from a coverage extension or move the deadline beyond the end of the month.