Gov. Ed Rendell is threatening to retaliate against legislators who don't support his efforts to offer more affordable health care to the state's nearly 800,000 uninsured adults.

A year has passed since the governor introduced Cover All Pennsylvanians, his plan for making affordable insurance available, but lawmakers showed little interest in helping to fund it with a tax on businesses that did not offer health insurance to workers.

Now, the Democratic governor is back with a new plan that would draw on more than $400 million accumulated in a state fund that helps doctors pay their malpractice insurance costs.

In an interview last week in Pittsburgh, Mr. Rendell said he was willing to entertain other ideas from lawmakers. But he wants action.

The state's doctors could pay a price if no agreement is reached soon. The governor has declined to approve medical malpractice subsidies, known as abatements, through the state's MCare program until lawmakers agree to fund Cover All Pennsylvanians. If no deal is struck by March 31, the unsubsidized bills will come due.

The governor said he linked the abatements with Cover All Pennsylvanians to try to gain leverage with lawmakers.

If Republican legislators still refuse to endorse extending health insurance coverage to the uninsured, the governor pledged to campaign tirelessly against them next fall.

"You will find me in every contested electoral district, Senate or House," he said, adding he would be a "whirling dervish" in his campaigning. "I will hit every district time after time after time."

"I don't like to do that," he said. "I consider many of the Republicans my personal friends."

But if GOP lawmakers "turn their back on health care for Pennsylvanians," he said, he would be "out there every day, doing my very best to change Harrisburg."

"If he wants to use his political capital to try to strong-arm Republican legislators, that's his prerogative,'' said Charlie Gerow, a Harrisburg political strategist. But he added that many GOP senators "are from relatively safe seats so I'm not sure how seriously political observers would take that threat.''

G. Terry Madonna, a pollster and political analyst at Franklin & Marshall College in Lancaster, called Mr. Rendell's remarks "a pretty tough statement."

"He is putting on a full court press and letting legislators know how huge a priority this is for him," he said, referring to health insurance coverage. "It's a big issue for many voters, too.''

The governor plans to discuss the need for Cover All Pennsylvanians tomorrow at a news conference at the Philadelphia College of Osteopathic Medicine.

MCare is a state insurance program that provides doctors with catastrophic coverage for medical malpractice. Doctors in Pennsylvania purchase $500,000 worth of insurance from a primary carrier and then another $500,000 worth of coverage from MCare.

In 2003, state lawmakers approved the governor's proposal for a program that helps doctors pay for their MCare coverage. The proposal, known as the abatement program, was a response to concerns that rising malpractice insurance costs could discourage physicians from practicing in Pennsylvania.

Though he worked to establish the abatement program and has been its champion, Mr. Rendell said he was willing to risk its future on behalf of uninsured Pennsylvanians.

"If I have to choose between taking care of doctors and taking care of someone who has cancer and doesn't have health insurance, it's an easy choice," he said.

Mr. Rendell, who hopes the March 31 deadline will allow time to craft a compromise, also has suggested that the abatements be extended for 10 years -- as long as funds are allocated for Cover All Pennsylvanians.

Sen. Don White, R-Indiana, chairman of the Senate's Banking and Insurance Committee, said the Senate passed reauthorization bills twice to continue the abatement program for 2008, "only to see them derailed by the governor and House Democrats."

He charged that Mr. Rendell "is holding doctors and hospitals hostage" while he tries to force the Legislature to approve the plan.

Mr. White said many legislators also oppose Mr. Rendell's proposal to increase the cigarette tax by 10 cents a pack (to $1.45 a pack) and to extend the sales tax to smokeless tobacco and cigars as other ways to pay for his health plan.

The Rendell administration estimates that the program could cost about $1 billion in its fifth year, but said much of the funds needed would come from federal monies and redirection of funds from other programs that would be replaced by Cover All Pennsylvanians. Officials estimate that about $78 million would be needed that year from MCare funds and about $120 million from new tobacco taxes.

Winning approval for Cover All Pennsylvanians could make Pennsylvania among the few states that have managed to extend more affordable health coverage to nearly all state residents.

It is a key part of Prescription for Pennsylvania, a sweeping health plan the governor unveiled last January at the start of his second term. The plan aims to cut the costs of health care, as well as improve access and quality.

Significant progress has been made in some parts of the plan, Mr. Rendell said.

Lawmakers have approved provisions that address expansion of practice capabilities for nurse practitioners, midwives, nurse specialists, physician assistants and dental hygienists. They also have approved new reporting requirements concerning infections acquired in hospitals and nursing homes, provisions that were modified from the original plan.

And through executive order, the governor has created a commission aimed at improving care and reducing costs of treating chronic disease.

But no progress, the governor acknowledged, has been made in Cover All Pennsylvanians and reducing the cost of health insurance.

But he believes House Democrats are prepared to act on those measures.

"I think they're ready to go," he said. "Each month they realize, more and more, health care is a premier issue in people's minds."

He made no similar predictions for Senate action.

Doctors around the state are beginning to realize that abatements from MCare may not be available this year, said Dr. Peter Lund, an Erie urologist and president of the Pennsylvania Medical Society.

On its Web site, the society has posted the question, "Would you continue to practice in Pennsylvania if you no longer received relief (abatement) from MCare?"

Only 52 replies were listed last week, but about two-thirds of respondents said they would not.

Dr, Lund acknowledged that linking the abatement program to Cover All Pennsylvanians has "turned up the heat" on officials to reach an agreement and said doctors are concerned about the need to extend coverage to the uninsured. But he regrets that physicians have been placed at the center of the debate.

Without the MCare abatement this year, a doctor in a rural area might have to pay about $700 more to the program, and a neurosurgeon in Philadelphia about $37,000. But overall malpractice costs have declined and could virtually offset the increase, even without the abatements, said Peter Adams, deputy insurance commissioner for MCare.

"That doesn't mean there's not a problem," he said, noting that Pennsylvania competes with other states for physicians.

While the state medical society believes the MCare abatements should be extended in the short term, not all members are attracted to the offer of a 10-year extension, Dr. Lund said, noting that many favor phasing out the program in favor of coverage in the private market. Doing so would require retiring MCare's estimated $2 billion unfunded liability, or cost of future claims.

State officials have devised a plan for reducing that obligation based on the recommendations of a state commission, Mr. Adams said, but so far it has attracted little interest.

The improving malpractice climate contributed to the sizable surplus in MCare funds. While they could be used to pay down the unfunded liability, state officials have sought to tap that money for other purposes.

Earlier this year, Senate Republicans proposed using some of the funds to help hospitals with infection control and information technology.

But House Democrats suggested drawing on the fund to extend coverage to the uninsured, and Mr. Rendell said he supported the idea.

"It's about the opportunity to help people who are deeply challenged," he said. "That's exactly how I feel."