HARRISBURG -- Democrats and Republicans both say they want more Pennsylvanians to have health insurance, but that's about the extent of their agreement on the issue.

Lawmakers are at loggerheads over how to improve the cost, quality and availability of health care.

The Senate Policy Committee's Republican caucus held a hearing today to vet alternatives to the one House Democrats passed last month.

Sen. Mike Folmer, R-Lebanon offered a plan to phase out a state program that subsidizes doctors' medical malpractice premiums. Meanwhile, House Democrats want to extend that program for 10 years.

Other GOP proposals would require health care facilities to provide lists of fees for certain services, reduce the number of adults and children participating in state-subsidized insurance programs, and eliminate mandates that require insurers to cover certain people such as adopted children, providers such as lay midwives and services such as breast reconstruction.

Senate Republicans also want to allow insurers to decline coverage to people at high risk for severe health problems. The state would create a high-risk pool, allowing companies to charge them double premiums. Subsidies would be available for those below the federal poverty level, which is now $22,200 for a family of four.

"Insurance ought to be priced in proportion to the risk," said Rick Dreyfuss, of the Commonwealth Foundation, during testimony at yesterday's hearing. "People rated as high risk should also have access to health care, but at a higher price. ... Smokers should probably pay more for insurance based on their risk profile."

Republicans said their proposals are aimed at keeping government out of the health-insurance business, reducing costs and giving consumers more choices.

"Government run medicine doesn't work," Mr. Folmer said. "There is never enough money to do all the things that people want or need. We would constantly be looking at ways to either impose higher taxes or cut services."

The governor's office said most of the GOP proposals are in direct opposition to measures passed by the Democratic-controlled House and supported by Gov. Ed Rendell.

"Their plan doesn't expand health care coverage to the uninsured and really does nothing to address the crisis we face. At a time when the administration is looking for ways to expand health care coverage, the Senate plan would reduce it," said Churck Ardo, spokesman for Mr. Rendell.

"It's a long way from reaching the governor's desk, but it does not sound like the kind of legislation the governor could sign," he said.