WASHINGTON — Democrats and Republicans working on a patients' bill of rights in the Senate are set to debate whether employers should be held liable when their workers are denied medical care.

        For years, the question was whether patients should have the right to sue. Now, the question is not whether they can sue — that's a given — but who they can sue.

        Democrats don't want to give employers who help make medical decisions blanket immunity from lawsuits. Many Republicans fear that holding employers liable will drive up the cost of health insurance and ultimately force many companies to drop coverage altogether.

        “Do people have to provide this benefit? No. It's very expensive, in many cases not even appreciated, so I'm afraid the net result is a lot of employers would drop health care,” Sen. Don Nickles of Oklahoma, the Republican whip, said Sunday in CBS' “Face the Nation.”

        “We shouldn't do harm. We shouldn't increase the number of uninsured. We shouldn't make health care so expensive that people can't afford it,” Nickles said

        A sponsor of the Democratic-backed legislation, Sen. John Edwards, D-N.C., agreed that employers should be exempt from liability, “unless they actually make individual medical decisions ..., unless they're in the business of overruling doctors, which, of course, the vast majority of employers don't do.”

        Sen. Phil Gramm, R-Texas, plans to offer an amendment this week to give employers full immunity. Sen. Olympia Snowe, R-Maine, has been trying to craft a compromise.

        President Bush last week threatened a veto, saying the Democratic bill would encourage costly lawsuits and drive up the cost of health insurance.

        Sen. John McCain, R-Ariz., who is siding with the Democrats on this issue, said Sunday he did not want to force the president's hand.

        “The president knows that we need a patients' bill of rights as well as anyone, and he doesn't want to have to veto, so I am cautiously optimistic that we can reach an agreement on a bill that he can sign,” McCain told CNN's “Late Edition.”

        Another point of contention is whether patients should be required to appeal a decision to a medical review board before going to court.

        Sen. Tom Harkin, D-Iowa, criticized the GOP-based bill of rights for letting insurance companies choose and pay for the appeals panels. “Talk about putting the fox in charge of the chicken coup,” Harkin said on NBC's “Meet the Press.”

        Minority Leader Trent Lott, R-Miss., said that question can be worked out. The crucial point, he said, is to direct patients to appeals board that can act quickly on what could be life-or-death decisions, rather than allowing for lawsuits that can drag out for years.

        “What you need is an internal review by experts, expeditiously, inside and outside, to get a result for the patient,” Lott told NBC.

        Under current law, patients in federally regulated health plans may sue if they are denied care, but they can only recover the cost of the treatment, with nothing for the damages a denial may have caused.

        For years, most Republicans insisted that patients be given no new right to sue. Now, they are trying to keep these cases confined to federal court, where the damage awards are typically smaller.

        The bill backed by most Democrats would allow unlimited compensatory damages and cap punitive damages at $5 million.

        An alternate bill backed by the GOP would allow lawsuits only in federal court, cap non-economic damages at $500,000 and would bar punitive damages. It also would require patients to exhaust internal and external appeals before filing a lawsuit.

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