Gov. Ed Rendell is telling the state's doctors they will have to pay more for their medical malpractice insurance coverage because no agreement has been reached on legislation to extend health care coverage to the uninsured.

Though he has championed payment reductions for doctors through the state's MCare abatement program, Mr. Rendell has refused to approve them again unless progress is made by Monday in reaching an agreement on affordable health insurance.

In a letter to doctors dated yesterday, the governor acknowledged that deadline will not be met.

"You are now required to pay your unabated MCare assessment," he wrote.

"I ask for both your patience in coping with the current situation and your help in ensuring that our legislators maintain their focus and attention and pass this critical piece of legislation."

If an agreement is reached, he said doctors could receive refunds of their abatement costs.

The governor wants action on a bill approved by the House last week that is similar in some ways to his earlier Cover All Pennsylvanians proposal.

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. It 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 after 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.

Republican leaders have raised serious objections to the bill, questioning its cost and how the approximate $120 million needed the first year would be raised. Democrats have suggested that options could include higher taxes on cigarettes or new taxes on tobacco products.

The state Office of Health Care Reform fielded a steady stream of calls yesterday from concerned, and sometimes angry, physicians, said spokeswoman Amy Kelchner.

If no agreement is reached, doctors in higher-risk specialties such as neurosurgery, orthopedic surgery and obstetrics will have to pay, on average, an additional $15,000, she said. Doctors in lower-risk practices would face paying an average of about $1,500 more.

Rep. Todd Eachus, a Luzerne County Democrat, said House Democrats have informally requested the governor to extend the deadline, perhaps to June 30.

But Chuck Ardo, a spokesman for the governor, said yesterday that Mr. Rendell stands by the Monday deadline.