HARRISBURG -- Gov. Ed Rendell unveiled a sweeping health care plan yesterday that would impose new requirements on the state's health care industry and other businesses and could eventually require many Pennsylvanians who lack health insurance to obtain coverage.

		Related coverage Graphic: Rendell's health care proposal Health-care changes to require extensive action by Legislature Reaction mostly favorable to Rendell health-care change proposals

The plan, "Prescription for Pennsylvania," calls for a variety of measures aimed at cutting costs and improving quality. It also would expand affordable health care insurance options, with the goal of increasing access to coverage for nearly 1 million uninsured Pennsylvanians, most of them adults.

The governor wants to phase in a mandate requiring health insurance for people with incomes greater than 300 percent of the federal poverty level, about $60,000 for a four-member family. People with lower incomes would not be required to purchase the coverage, though they could receive it at reduced cost.

The plan's effects would extend beyond making coverage more affordable for people who lack insurance. For example, the governor wants to ban smoking in workplaces, restaurants and bars.

At a news conference, Mr. Rendell said the complex proposal would require a package of several dozen bills in the Legislature, as well as regulatory changes and approval from the federal government. He predicted that reaction to the proposal would be mixed.

"But it's absolutely crystal clear we have to do something," he said, presenting charts suggesting billions of dollars in health care costs could be avoided annually and that increases in wages are being far outstripped by rising health insurance premiums.

Every year, the state's businesses, consumers and taxpayers bear a $7.6 billion cost to care for the uninsured and pay for preventable problems like hospital-acquired infections, he said.

In general, health care groups said they needed to review details of the plan, but applauded the governor's interest in expanding access to care and taking other steps.

House Speaker Dennis O'Brien, R-Philadelphia, praised the governor for fostering "an energized conversation about health care." But he said significant amendments to the governor's legislative proposals are likely.

Under the governor's plan, universities would face new requirements for offering coverage or medical care to students, and businesses that did not offer coverage would face financial penalties. Health insurers would face new scrutiny and restrictions on the types of coverage they offer. Hospitals would be asked to change some ways of doing business, and could face new review procedures for planned purchases of expensive medical technology, real estate or other capital investments.

Hospitals also would be asked to invest in new computer systems aimed at reducing medical errors, including electronic systems to cut down on mistakes in prescribing medications. They would be expected to install other computer technology to track the expensive, often deadly infections that patients can acquire in hospitals.

Hospitals also would face new incentives to devise less costly procedures for treating patients with non-emergency health problems who appear for care in emergency rooms. Eventually, the state plans to no longer pay hospitals extra for emergency room care it considers inappropriate, or for the added cost of treating hospital-acquired infections, for enrollees in Medicaid or other health programs that it administers.

In another attempt to prompt improvements, the governor plans to call a meeting with other large purchasers of health care to develop a "pay for performance" initiative that would link payments to good care.

The plan would shake up the health care system in other ways. Nurse practitioners, who work in collaboration with physicians, along with midwives, dental hygienists and other licensed health care providers, would be granted expanded ability to practice to the fullest extent of their training, with the goal of enhancing access to care.

The plan is similar to proposals in other states, but Pennsylvania officials said it is unique in some respects.

"The governor's vision is to reform health care, not just provide coverage to all Pennsylvanians," said Rosemarie Greco, director of the Governor's Office of Health Care Reform.

Officials did not immediately disclose how much the plan would cost or detail how it would be funded. But they said sources would include federal matching funds, redirection of some state funds for other health care programs, proceeds from an assessment on businesses that choose not to offer health insurance, an increase in the cigarette tax, and a tax on smokeless tobacco and cigars. The governor will provide more specifics when he unveils his proposed budget early next month.

Among other provisions, the plan would expand a planned initiative to provide affordable coverage for children, known as Cover All Kids, to adults who are uninsured. The new program, Cover All Pennsylvanians, would provide affordable basic coverage to small businesses and uninsured people through the private insurance market.

Uninsured adults earning more than 300 percent of the federal poverty level would pay about $280 per month. Uninsured adults who earn less could get help paying for their premiums.

State officials said the plan would target about 767,000 Pennsylvania adults who now are uninsured. About 133,000 children also lack coverage, but could obtain it through Cover All Kids or other programs. Cover All Pennsylvanians would be similar to the current adultBasic program, which provides a basic benefit package to certain Pennsylvanians with low incomes. AdultBasic members would be automatically enrolled in the new program. Unlike adultBasic, however, the new initiative would provide coverage of behavioral health care and prescription drugs.

The governor's plan also would:

Limit the ability of health insurers to consider certain factors such as health history in setting rates for plans offered to individuals and small businesses.

Impose limits on the cost of monthly premiums for plans offered to small businesses.

Develop a review process for various regions of the state to assess the need for new technology or other investments planned by hospitals. Officials believe the provision could help stem the "medical arms race" for new equipment among health facilities.

Require insurers to spend 85 percent of premiums paid through small group plans on health care. Those who did not meet the standard could be required to issue rebates to policyholders.

Set new guidelines for rate increases requested by insurers.

Require insurers to offer plans that could provide coverage for dependent children up to age 30, and require universities to provide clinics or insurance coverage to full-time students. Officials believe the provisions would help provide insurance for the nearly 50 percent of uninsured people in the state who are between 19 and 34.

Require hospitals to redirect patients in emergency rooms who do not have emergency needs to lower cost care -- for example, by providing an area where they could be treated by a nurse practitioner.

Promote use of a model program to manage treatment for such chronic diseases as heart disease, diabetes and asthma.

Require hospitals to make foreign language interpreters more readily available.

Provide additional funds to federally qualified health centers to provide care in areas of the state where medical treatment is scarce.