The Democratic plan appears to have enough votes to pass, but President Bush supports the alternative Republican plan and has vowed to veto the Democratic plan.

Senate Majority Leader Tom Daschle (D-S.D.) is pushing for a vote before the July Fourth recess, but has threatened to hold the Senators in Washington through the holiday if agreement can't be reached before the holiday.

Both parties agree that a patients' bill of rights should include guaranteed payment for reasonable emergency room visits, mandatory hospital stays for breast cancer patients, and access to certain specialists (i.e. pediatricians, obstetricians, and gynecologists) without advance approval from insurance companies.

Beyond these points, however, there are major differences on the right to sue, limits on damages, and employer liability.

Senate Democrats favor a far-reaching bill by Sen. Edward Kennedy (D-Massachusetts) and Sen. John McCain of (R-Arizona), while most Republicans favor an alternative proposal by Sen. Bill Frist of (R-Tennessee), and Sen. John Breaux (D-Louisiana).

Under current law, patients who have been denied care may sue health care companies, but they can only recover the cost of treatment. Both the Democratic and the Republican plans allow patients to sue for damages, not just for the cost of treatment.

The Kennedy-McCain bill would allow patients to sue in state or federal court, while the Frist-Breaux bill would allow patients to sue only in federal court. The Democratic bill places no limits on economic and non-economic damages, and caps punitive damages at $5 million. The Republican bill places no restriction on economic damages, but limits non-economic damages to $500,000, and does not allow for punitive damages.

On employer liability, Republicans fear that allowing patients to sue their employers will force some employers to stop offering benefits. Employer liability is backed by Senators Edward Kennedy (D-Mass.), John Edwards (D-N.C.), and John McCain (R-Arizona), who insist that the legislation protects employers unless they are directly responsible for a decision that negatively impacts the patient's health. Senator Edwards comments, "We're very specific in the bill. There's actually one sentence in the bill that says employers may not be held liable under this bill with that one exception."

Healthcare companies maintain that a patients' bill of rights is unnecessary because most unpopular policies already have been changed by state regulation or by the healthcare companies themselves. Insurers argue they have reduced much of the "hassle" previously associated with managed healthcare and resent the efforts of the Senate.

President Bush supports a patients' bill of rights, but clearly favors the Republican's version of the bill. Bush threatened on Thursday, June 21, to veto the Democratic bill, saying he feared it would inflate the cost of health insurance and promote unnecessary lawsuits. According to the White House statement, "The president will veto the bill unless significant changes are made to address his major concerns."

The Senate continues debate over the patients' bill of rights this week and is scheduled to vote on the bill before the Fourth of July recess.