COLUMBIA--Key members of the state Senate said Wednesday that they support raising South Carolina's cigarette tax to help fund Medicaid and offered tentative support for the governor's plan to lower the state income tax in return.

Meanwhile, Gov. Mark Sanford took his case to the people with a visit to a hospital here, arguing that there could be a hidden tax hike in rapidly increasing health insurance premiums if the state's public health care system isn't adequately funded.

House leadership is fired up and fighting mad over the building momentum for Sanford's plan, which would increase the cigarette tax by 53 cents per pack so long as it's coupled with a 15-year plan to cut the state income tax by 2 percent.

The fight is coming to a head at the Statehouse. The House, which wants to fund Medicaid by refinancing the state's tobacco bonds, could take up a Medicaid reform plan that doesn't include a cigarette tax hike as early as today. But if the plan makes it to the Senate, it could hit a brick wall there.

What's at play is an ideological battle that Sanford concedes could be a harbinger of how tough it's going to be to advance his idea of meaningful government restructuring in the state.

Some House Republicans remain opposed to raising any tax, and other lawmakers say they won't support one targeted at a voiceless minority -- smokers.

The governor Wednesday toured Palmetto Health Richland Memorial Hospital, where doctors told him that 51 percent of the children that they treat and 31 percent of the total number of patients are insured by Medicaid. Sanford said he couldn't sway the House to see the need for his plan but that he was asking regular folks to make their will known. Sanford argued that a lower state income tax rate is worth the cigarette hike.

"I'd give the Speaker and other like-minded Republicans in the House a hand for wanting to hold the line on taxes," Sanford said. "What our plan recognizes is that not all taxes are equal; some have a greater impact than others. There is literally a truckload of money in Washington, D.C., that could be coming to South Carolina" if leveraged by more Medicaid spending.

A 53-cent-per-pack increase in the tax would raise about $170 million annually, which if spent on Medicaid, would leverage between $200 million and $400 million in federal matching money.

On Wednesday, hundreds of people who support raising the tax on cigarettes converged on the Statehouse.

As they rallied in the lobby, Senate Finance Chairman Hugh Leatherman, R-Florence, stood nearby and praised Sanford's plan while bashing the House. Leatherman, backed by seven other senators, said the House plan to fund Medicaid by refinancing the tobacco bonds does not provide the "stable and reliable funding stream" the public health system needs. It echoed a charge made by House Democrats last week.

Failure to provide enough money for Medicaid, Leatherman said, would devastate not only Medicaid recipients, including 40 percent of the state's children and 75 percent of nursing home residents, but would cripple small businesses and consumers who pay for private health care insurance. Increases would come when charges rise to cover indigent care costs.

Fed up with the criticism, House Speaker David Wilkins, R-Greenville, and House Ways and Means Chairman Bobby Harrell, R-West Ashley, met with reporters after Leatherman's speech to restate the logic of refinancing the state's tobacco bonds, which House leaders conservatively estimate will bring $36 million this year. That alone is nearly enough new money to fund the current needs of Medicaid, they said.

"We have put a very real proposal on the table, and the people who are opposing it have a real goal of raising taxes," Harrell said.

Harrell has Ways and Means staff studying the governor's plan but said he has a problem with its premise. "It's a guaranteed tax increase and the hope for a tax decrease down the road. I think lowering the income tax is a good idea. I just don't want to raise taxes."

Senate President Pro Tempore Glenn McConnell, R-Charleston, said Wednesday that support for the cigarette tax is far from unanimous there. "It's punitive; it's selective taxing. I think it sets a bad precedent. What will they want next year? To raise the taxes on beer or high-cholesterol food? That's bad for you, too."

Sanford said getting his plan through the House may be next to impossible and that it indicates an unwillingness to look at these issues from a different angle. He criticized House leadership for hinting that the lower income tax is just a promise down the road.

"It depends on 6 percent growth, which is historically what we've had," Sanford said. "Everything they do in the Legislature they base on history. But they don't trust this?"