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GOP slows debate on patients' rights

WASHINGTON - House Republican leaders yesterday delayed a long-awaited debate on competing patients' rights bills as they scrambled to seek support for the bill that President Bush favors.

Mr. Bush and House GOP leaders are trying to persuade undecided lawmakers and the American public that it's possible to protect against health-insurance abuses without spurring frivolous lawsuits, inflating health-care costs, and escalating the number of uninsured Americans.

They have an uphill battle to pass their bill, sponsored by Rep. Ernie Fletcher (R., Ky.). House Republican leaders decided to delay debate, scheduled to start today, until at least tomorrow, but more likely until next week or even after Congress reconvenes after an August recess.

Mr. Bush is making personal appeals to House members to support Mr. Fletcher's bill, holding a meeting yesterday with a dozen lawmakers to plead his case.

House Democrats and some moderate Republicans, led by Reps. John Dingell (D., Mich.), Charlie Norwood (R., Ga.), and Greg Ganske (R., Iowa), contend that their bill offers “real'' patient protection, with potent remedies against abuses. They believe that after years of effort, they are on the verge of passing it.

If Mr. Bush and his allies eke out a majority, Mr. Bush could retake the offensive in the patients' rights debate, and Republican leaders who control the House could cap a tumultuous month with a triumph.

The Senate last month disregarded Mr. Bush's pleas and passed a bill that gives patients broad ability to sue their health plans in state and federal court.

House Democrats are pushing a nearly identical bill, which Mr. Bush has threatened to veto. Cabinet members and House GOP leaders are using that threat to try to sway wavering lawmakers.

“What sense does it make to go through this effort and end up with nothing?'' asked Health and Human Services Secretary Tommy Thompson.

The Democrats' bill would impose a $5 million limit on federal court damages designed to punish an insurer and would place no restrictions on damages for pain and suffering.

Mr. Fletcher's bill would permit patients to sue in federal court but would permit only lawsuits in state court if a health plan disregarded a decision by an independent review panel. It would cap pain and suffering damages in federal court at $500,000 and would not allow damages intended to punish a health plan.

Both bills would permit patients to see needed specialists or seek critical care at the nearest emergency room. Both would grant women direct access to gynecologists and obstetricians.

During the last patients' rights debate two years ago, 68 Republicans bucked their leaders and joined Democrats to pass the bill that Mr. Dingell and Mr. Norwood support. The Senate passed a weaker version, but lawmakers were unable to meld the two.

This time, House Speaker Dennis Hastert (R., Ill.) is trying to achieve more unified support from his party, which holds a six-vote majority in the House.

But Mr. Hastert has had a difficult month. First, an unusual coalition of 19 Republicans defied him by preventing debate on overhauling the nation's campaign finance laws. Then, GOP moderates almost derailed a vote on one of Mr. Bush's top priorities, a bill to boost money to religious charities.

“Hastert is in a very difficult position,'' said Jack Pitney, a political analyst at Claremont McKenna College in California. “On the one hand, as speaker he is accountable for what happens in the House. On the other hand, with such a narrow majority, his influence is limited . One of the most painful positions to be in is to have the responsibility of majority status but not have the votes to control the House.''

Both sides are focusing on 17 Republicans who voted only for Mr. Norwood's bill last time and opposed the Republican alternatives. This group includes moderates such as Rep. Connie Morella (R., Md.) and conservatives such as Rep. Bob Barr (R., Ga.).

“I want a good bill the President can sign,'' said Rep. Peter King (R., N.Y.), who supported Mr. Norwood's bill in 1999 but now plans to vote for Mr. Fletcher's version.

If the House passes a bill, lawmakers would need to reconcile it with the version that passed the Senate. The compromise bill would then face final votes in the House and Senate before Mr. Bush could decide whether to sign it.

If Democrats prevail, Mr. Bush could find himself in the politically delicate situation of vetoing a bill that most Americans support.

“He's in a bit of a box, but in a box of his own making,'' said Mark Mellman, a Democratic pollster in Washington. “He either sticks his thumb in the eye of 80 percent of the public who wants this or looks like a wimp to 100 percent'' by reversing his position.

Republicans are trying to portray a likely veto as an effort to save the public from bad policy.

Ed Gillespie, a Republican strategist, said: “I think that he would explain to the public that he is for patient protection and has been calling for a good patient protection bill and that the Democrats in Congress would rather have an issue than a solution.''

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