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Bucking Republican leadership, the House voted 275-151 to pass the so-called Patients' Bill of Rights -- a bipartisan bill that provides a laundry list of consumer protections to all Americans enrolled in managed-care plans.

"We've taken a huge first step in the House and now we have to go the rest of the way and get this done," said Rep. Charlie Norwood, R-Ga., who flew in the face of the House Republican hierarchy by co-sponsoring the controversial bill.

Bill opponents had argued that rather than improve health care for Americans, the legislation would throw open the doors to a whole new universe of ugly legal warfare, ultimately benefiting nobody but the nation's trial lawyers.

Before passing the legislation Thursday, the House defeated three Republican-sponsored alternatives to the managed-care bill, all of which would have either neutered or severely limited the rights of patients to sue their managed-care companies.

"The Republican leadership has been rolled today ... because of the power of [this proposal] at the grassroots level," said Sen. Ted Kennedy, D-Mass., following the vote.

But the bill still faces a steep uphill climb to become law.

Earlier this year, the Senate passed its own bill, which contained far fewer patient protections than the House legislation. Powerful Senate Republicans, including Majority Leader Trent Lott, R-Miss., and Assistant Majority Leader Don Nickles, R-Okla., have indicated that they will not support legislation that includes "right-to-sue" provisions.

Nickles and Lott can easily tie up the conference process -- wherein a joint Senate and House bill is drafted and sent to the president -- and the senators appear in no hurry to begin debating the politically loaded managed-care issue any time soon.

Observers on both sides of the debate doubt that the Senate and House will go to conference on the managed-care legislation before the end of the year, and when the two houses do finally start hashing out their differences, they will have some thorny issues to tackle.

Today's passage represents one of the most significant blows to the Republican leadership's hegemony since the GOP seized control of Congress in 1995.

Massive public outcry stemming from the proliferation of managed-care "horror stories" helped to solidify the Democrats' support and win over a bevy of Republican members.

Aligned against the House legislation is a powerful group of insurers and large employers who argue that the legislation will cost them millions of dollars, forcing health plans to jack up prices and leaving employers no choice but to stop offering medical benefits.

"Instead of enacting reforms that could have allowed patients to settle disputes quickly and independently, the House has moved instead to open the litigation floodgates and empower trial attorneys," said American Association of Health Plans (AAHP) president Karen Ignani in a curt written statement following Thursday's vote.

As the managed-care industry's premier lobbying group, the AAHP vowed to fight hard for a conference bill that does not include right-to-sue provisions.

In addition to allowing patients to sue their managed-care plans, the legislation passed by the House Thursday would:

• Require HMOs to offer full access to a wide array of medical specialists at no extra cost to their members;

• Severely curtail the ability of HMOs to limit the medications to which their patients have access;

• Require HMOs to fully disclose information about their policies, procedures and benefits; and

• Prevent HMOs from denying payment for many emergency room visits.

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