Anxiety on Hill as House awaits patients' rights vote

WASHINGTON (CNN) -- House Republican leaders, eager to prevent a legislative meltdown akin to the campaign finance imbroglio seen on the floor earlier this month, are awaiting the deployment of one big gun before they decide when to move forward with House debate on the patients' bill of rights.

And that big gun is President George W. Bush, who arrived back in Washington on Tuesday after a week in Europe.

The House leaders need Bush back in the nation's capital because they don't think they've got the votes to bring a GOP-championed patients' rights bill across the finish line by the end of the week.

That bill, drafted by Kentucky Republican Ernie Fletcher, a physician by trade, rivals a longstanding measure backed by a bipartisan coalition that includes Republican Charlie Norwood of Georgia, and dean of the House John Dingell, the Michigan Democrat.

EXTRA INFORMATION Big Picture: House to begin debate on patients' bill of rights     RESOURCES Message Board: Health care

Bush, they say, will have to ride the phone hard starting Wednesday morning to secure the estimated 10-15 votes needed to boost the Fletcher bill over Norwood-Dingell. The bills had been scheduled for debate Thursday, but House leaders are now quietly saying that the final vote may not occur until Friday at the earliest.

The Republicans acknowledge that the vote, whenever it comes, will be close, and are waiting patiently for the president to return so he might have the last word with the handful of Republicans who are considered likely to vote either way.

"It's close, very close," said House Majority Leader Dick Armey, R-Texas, on Tuesday morning. "Right now, it is a jump ball."

Democratic leaders, meanwhile, have expressed confidence that all of their caucus will fall in behind the Norwood-Dingell bill, previous versions of which have passed the House in recent sessions with significant Republican support. This year's version of Norwood-Dingell closely resembles the patients' rights bill that passed the Senate by a 59-36 vote at the end of June.

The two bills, which are intended to broaden the options granted to medical patients who are covered by health maintenance organizations, are similar in many respects. Each would guarantee more access to specialists, such as obstetricians, when needed, and would make admittance to emergency rooms much easier.

A patients' rights bill drafted by Rep. Ernest Fletcher of Kentucky may not have the votes needed to pass in the House

And, if an HMO disallows a doctor's treatment recommendation because of cost concerns, patients will be able to appeal that decision to an independent review board in the hopes of getting it reversed, or of receiving compensation for any damage they may have suffered as a result of the HMO ruling.

But, as in the protracted Senate debate last month, there are major differences between the bills over how HMOs should be made to make restitution for coverage decisions found to have caused harm, or even death.

Both bills would allow suits to be heard in federal and state courts, but the GOP bill places more restrictions on those suits. Republicans have generally regarded federal courts as more friendly when it comes to medically related lawsuits, arguing that state courts often dole out more generous cash awards if the insurance provider is found liable.

Under the Fletcher bill, injured parties would only be allowed to file suit in state court if their provider outrightly ignores the decision of a review panel. And, the Fletcher bill would cap pain and suffering damages awarded by federal courts at $500,000, while the Norwood-Dingell bill would include no such award limits.

Norwood-Dingell would also allow punitive, or "civil" damages, of up to $5 million. There are no such provisions in the Fletcher bill.

Fletcher supporters argue that the Norwood-Dingell bill would bring about an explosion in lawsuits, which could result in higher premiums for those covered, or worse, in small businesses jettisoning their health coverage because it has become too expensive to maintain.

"There's not much sense in allowing … passage of legislation that is harmful," Armey said. "So you should give yourself all the time you can to make sure you can pass the best legislation for the president."

Democrats, on the other hand, argue that lawsuit filings will be few and far between under their legislation, saying HMOs will be more conscientious of the coverage decisions they render, should their bill become law.

CNN's Ian Christopher McCaleb, Ted Barrett and Kate Snow contributed to this report.