A rebate program that helps Pennsylvania doctors pay for costly malpractice insurance appears to be on life support, but doctors are scheduled to rally in Harrisburg's Capitol rotunda today in hopes that the state Legislature and the governor's office don't pull the plug.

For years, Pennsylvania doctors have relied on abatements to help them obtain medical malpractice insurance coverage through the state's Medical Care Availability and Reduction of Error fund. State law requires doctors to obtain $500,000 of med-mal coverage through the open market and another $500,000 through the Mcare insurance fund, which charges doctors a fee, then pays malpractice claims out of the fund.

The abatement subsidies cut the cost of the Mcare coverage in half for most doctors, while high-risk doctors -- OB-GYNs, brain surgeons and so on -- are eligible for a full abatement in their Mcare assessments, meaning the extra $500,000 in coverage costs them nothing.

But the fund abatements haven't been renewed. Gov. Ed Rendell and House Democrats say they won't move on the Mcare abatement program unless the state Senate, controlled by the GOP, first agrees to a plan to extend health-care coverage to greater numbers of Pennsylvanians, a central theme in the governor's budget proposal from this year.

Senate Republicans, meanwhile, say they won't reauthorize the Pennsylvania Health Care Cost Containment Council without resolution of the Mcare abatement issue. The original authorization is set to expire this November.

And with only a handful of days left in this year's legislative session, doctors are worried the program may expire for good, permanently increasing med-mal rates for doctors across the state by tens of thousands of dollars.

"We're not certain what would happen," but there is the ever-present threat that doctors might leave the state in favor of places with lower insurance premiums," said Chuck Moran, spokesman for the Pennsylvania Medical Society, a physicians' lobbying group.

When faced with higher premiums, "For [independent] physicians, it comes down to simple business math," he said.

Because the Mcare subsidies haven't yet been authorized this year, doctors already have been paying extra premiums (or the hospitals that employ them have been paying on their behalf). If a compromise is reached before the fall recess, doctors could be reimbursed for the extra premiums paid so far this year.

But the governor's office says the state has a moral obligation to take care of uninsured Pennsylvanians, as well as the doctors who care for them.

"We certainly believe that the Mcare extension should be done, but also believe that uninsured Pennsylvanians deserve as much consideration from the commonwealth as do doctors," said Chuck Ardo, the governor's spokesman. "If we can add a 25-cent levy on cigarettes to benefit doctors, we can certainly add an additional dime, and tax cigars and smokeless tobacco, to benefit the uninsured."

The governor's office is seeking to tie the "Cover All Pennsylvanians" program to a 10-year extension of the Mcare program. After 10 more years of abatements, the Mcare insurance pool would dry up, replaced, in theory, by cheaper insurance on the private market.