After a lengthy debate, the Pennsylvania House moved forward yesterday with a plan to extend more affordable health care coverage to hundreds of thousands of uninsured adults.

The House voted 114-81 in favor of a proposal crafted by Democrats that is similar in some respects to Cover All Pennsylvanians, a plan proposed by Gov. Ed Rendell early last year.

Final approval of the House Democrats' plan is expected Monday, but it faces an uncertain future in the Republican-controlled Senate.

Rep. Todd Eachus, a Luzerne County Democrat who spent much of the afternoon defending the proposal, called the vote "a first step in a serious debate about access to affordable health care" in the state.

Steve Miskin, spokesman for House Republican leader Sam Smith of Punxsutawney, said the plan relies on "questionable finances."

House Democrats estimate that revenues needed the first year would total about $579.2 million, with $291.4 million coming from state funds.

By the fifth year, about $1.11 billion would be needed, including $370.1 million in state funding.

Democrats have outlined a number of financing options that would be used, including transfers from existing programs, federal funds, payments from individuals and employers, and part of a $500 million state fund that helps doctors pay their malpractice insurance costs.

But the plan also would require at least another $120 million in the first year. Democrats have said earlier that lawmakers might consider some sources Mr. Rendell has proposed, including an increase in the cigarette tax and new taxes on cigars and smokeless tobacco.

Like the governor's plan, the House Democrats' plan, known as Pennsylvania Access to Basic Care, would build on the state's adultBasic program, adding coverage for other services such as behavioral health care and prescription drugs. AdultBasic currently offers physician care, in-patient hospitalization and other services to low-income uninsured people ages 19 to 64.

But unlike the governor's plan, the lawmakers' proposal would subsidize coverage for people with incomes up to 200 percent of the federal poverty level, about $35,200 a year for a three-member family. The governor's plan calls for subsidies up to 300 percent of the poverty level.

Like Mr. Rendell's proposal, small businesses could participate. And adults who did not qualify for subsidies could buy into the program.

The House 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 abatement program over 10 years. 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.

During a six-hour floor debate, a parade of Republicans raised objections and urged more discussion.

But Rep. W. Curtis Thomas, D-Philadelphia, said "the people of Pennsylvania have demanded we do something and do it now."