HARRISBURG -- To spur action on one of his major legislative goals, Gov. Ed Rendell has altered the funding for a bill to provide health coverage for nearly 800,000 uninsured adults in Pennsylvania.

He unveiled the initiative, Cover All Pennsylvanians, in his state budget speech in February, but so far the plan has fallen flat. One reason is because he called for imposing a 3 percent tax on the payrolls of businesses that don't offer health insurance for their workers.

Mr. Rendell, a Democrat, called it a "fair share assessment," but many Republicans said it was just another tax on businesses and refused to support it.

"That payroll tax is a non-starter," Sen. Don White, R-Indiana, said last week.

So Mr. Rendell dropped the idea. Now he wants to use half the revenue in the state's Health Care Provider Retention Account, which is fueled by 25 cents of the state's $1.35 tax on a pack of cigarettes. It is projected to be at $414 million by Dec. 31.

The Retention Account, started in 2003, helps Pennsylvania doctors and hospitals afford the steep cost of medical malpractice insurance. The goal is to get doctors, especially specialists like neurosurgeons, orthopedic specialists and gynecologists, to stay in Pennsylvania rather than moving to other states.

Mr. Rendell said state officials should care about people who can't afford to buy health coverage and those denied insurance because of pre-existing medical conditions. He said the state can afford to tap the Retention Account's surplus, which resulted due to fewer malpractice suits being filed against doctors in the past four years and lower malpractice insurance premiums.

The House Insurance Committee, which includes Rep. Dan Frankel, D-Squirrel Hill, approved the measure, Senate Bill 1137, last week. A vote could come as early as tomorrow in the full House, along with a vote on a new open records law.

"As Democrats, there's been frustration in dealing with this problem of the uninsured," Mr. Frankel said. "The 3 percent tax on employers didn't get much traction, but now the bill is moving and getting a lot of people's attention. We want to accelerate the discussion."

Besides using $207 million from the Retention Account, Mr. Rendell wants to raise the cigarette tax by 10 cents a pack, to $1.45. That additional tax would generate $65 million a year to cover the uninsured. He also wants to impose a first-time tax on the sale of cigars and smokeless tobacco, which could produce $50 million a year.

Republicans don't like those taxes either, but Mr. Rendell said Pennsylvania is the only state that doesn't tax cigars and chewing tobacco. He also wants to use $40 million from a fund that pays for care of victims of catastrophic auto accidents.

While not all 800,000 adults may sign up for health coverage, Mr. Rendell anticipates that at least 100,000 would in the first year and more thereafter. By providing coverage for the uninsured, it also will lower premiums for insured people, Mr. Rendell said, because they won't have to pay to cover the uninsured.

Many Republicans oppose Cover All Pennsylvanians, claiming it's just another "massive, expensive government entitlement program." They said the state shouldn't "raid" the Retention Account that benefits doctors and hospitals.

Instead of taxing a company's payroll, Rep. Scott Boyd, R-Lancaster, proposed tax credits and incentives. Firms that offer health savings accounts for workers could get credits against their state taxes. Firms that offer "wellness programs" of exercise, diet and other steps aimed at keeping workers healthier, also could get tax breaks.

Some Republicans complained Democrats were moving too fast on such an important bill, pushing it through the Insurance Committee last week and preparing for a final House vote as early as today. "This is not a way to operate,'' said Rep. Mario Civera, R-Delaware.

Republicans also criticized a provision of the Insurance Committee-passed bill. It says that if health coverage for the uninsured isn't ready within 90 days after the bill is approved, the state's $207 million in malpractice aid for doctors would end on June 30. That would upset doctors and hospitals and puts added pressure on the Legislature to act.

Mr. Boyd said that sounded like "blackmail" of doctors. Mr. White said "(It's) basically holding doctors and hospitals hostage in an attempt to hijack the (provider retention) fund."