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Bush, Norwood agree on patients' rights bill

Norwood and Bush
Norwood and Bush meet the press: The president made key concessions in the negotiations.  

WASHINGTON (CNN) -- President Bush and a top Republican backer of a patients' bill of rights set for debate Thursday in the House announced Wednesday they had reached a compromise Bush would sign. The bill's other supporters, however, were less enthusiastic.

The joint announcement came after days of White House negotiations with Rep. Charlie Norwood, R-Georgia, who still needs to present the compromise to the bill's supporters in the House and Senate.

"We have reached an agreement on how to amend this bill that will meet the principles I outlined," Bush said. "I wanted a bill that was good for patients, allowed people to air grievances, and did not encourage frivolous lawsuits."

The right of managed care patients to sue their insurers is at the heart of the long-hovering issue for Bush and the House GOP leadership. Until now, they have supported a rival bill drafted by Rep. Ernie Fletcher, R-Kentucky, that would place restrictions on lawsuits against health maintenance organizations and would cap damage awards.

President Bush reaches a compromise with a key GOP lawmaker on patients' bill of rights. CNN's Kelly Wallace reports (August 1)

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U.S. President George W. Bush and Rep. Charles Norwood, (R) Georgia, jointly announce revised Patients' Bill of Rights legislation (August 1)

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Comparison: Patients' Bill of Rights  
Background: The issues in the House debate  
CNN Access: Patients' bill of rights  
Message Board: Health care  
MORE STORIES White House to Charlie Norwood: Let's make a deal  

"We wanted to make sure people can choose their own doctor," Norwood said, "wanted to make sure people would have recourse in some kind of court setting, wanted to have good external review by independent folks to give patients a place to go when nobody would help."

The development stunned key players in the patients' rights issue on Capitol Hill. Many of Norwood's allies, including Sen. Ted Kennedy, D-Massachusetts, did not even know Norwood was at the White House.

The sticking point in the talks dealt with whether consumers can sue their HMOs in federal court or state court. The administration preferred to limit suits to federal court, where damage awards are capped. Norwood wanted to include state courts, where in most cases damage awards are not capped.

Norwood met late into the night Tuesday with White House chief of staff Andrew Card, other administration officials and aides to House Republican leaders who opposed Norwood's version of the bill.

A Norwood spokesman characterized the talks as "intense and high-pressured." A White House official said the time had come for Norwood to decide to "hang out with the team he's been with or join another team that's going to get a victory."

But according to officials familiar with the deal, Bush made a big concession by agreeing to support "pain and suffering" and punitive damage awards in lawsuits -- up to $1.5 million in each category.

Punitive damages could be applied when a jury finds an HMO refused to provide care even after an independent review sided with the patient. Bush previously had agreed to support non-economic damages up to $500,000 and was opposed outright to punitive damages.

Bush and Norwood agreed patients should have the right to sue even if the independent review board agreed with the HMO's decision to deny coverage. In these cases, however, the patient would face a higher burden of proof.

Norwood and Bush will back language allowing patients to sue in state or federal court, depending on whether they are suing their employers or their insurers.

Lawsuits against an employer would be filed in federal court, but insurers could be sued in state court under federal rules. White House aides said Bush insisted that federal rules be used in state suits to set a uniform standard in all 50 states.

House leadership sources told CNN the compromise would be offered as an amendment Thursday to the Dingell-Ganske measure. Since Ganske and Dingell were not parties to the deal cut Wednesday, they were not expected to support the compromise.

"We are confident we can pass it with the majority of Republicans and some Democrats," said one top aide to the House GOP leadership. Whatever passes the House would need to be reconciled with a Senate-passed version Bush has said he would veto.

House Speaker Dennis Hastert  

Until the Bush-Norwood announcement, no one sounded optimistic about the chances of agreement before Thursday's debate. House Speaker Dennis Hastert, R-Illinois, had said he would go ahead with debate Thursday morning regardless of whether there was an agreement.

Norwood sponsored the patients rights bill in the last Congress and had supported this year's bill, sponsored by Reps. John Dingell, D-Michigan, and Greg Ganske, R-Iowa. White House officials voiced confidence Norwood could help sell the measure to a majority of House members.

Kennedy, who sponsored a Senate version of the Dingell-Ganske bill that passed in May, said Bush had given supporters most of what they wanted.

"All of those are provisions that this administration has attempted to undermine over a long period of time. They have tonight accepted all of those provisions," Kennedy said.

But he said the president still supports provisions that "protect HMOs instead of patients." And Sen. John Edwards, D-North Carolina, noted that the Bush-Norwood agreement "does not have the approval of the principal sponsor and does not have the approval of the United States Senate."

"The bottom line is, it continues the special status that HMOs have," Edwards said.

-- CNN correspondents John King, Kelly Wallace and Kate Snow contributed to this report.

• The White House
• Rep. Charlie Norwood
• Rep. Greg Ganske
• Rep. John Dingell
• Congressional Budget Office
• U.S. Congress

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