Prospects for a GOP compromise on managed-care reform this summer faded in the House yesterday, as Republican leaders appeared unable to reconcile warring factions around a consensus plan.

Republicans are divided on how strong a bill they should enact to regulate health plans. Most party members favor more limited regulations that would, among other things, strengthen the rights of patients to appeal coverage decisions. But a small faction, including some of the doctors in the House, want broader legislation that would give patients the right to sue health plans.

With Democrats united against them, the GOP leadership has relatively little margin for maneuver. But a day-long round of meetings failed to produce any compromise, and it seemed increasingly unlikely that leaders could schedule a vote on the subject before lawmakers adjourn for the August recess next week.

One key lawmaker said there was "almost zero chance" that the leadership would call for a vote on managed care by the end of next week, citing the vigorous efforts by Rep. Charles Whitlow Norwood Jr. (R-Ga.), one of the doctors, to craft a stronger plan.

"Norwood's goal is different from ours. He wants a bill signed into law," said this Republican, adding that Norwood was hoping to bring a sizable number of Democrats on board. "He keeps moving to the left to get them."

Norwood and his allies intensified negotiations yesterday with Michigan Rep. John D. Dingell, the top Democrat on the Commerce Committee, in an effort to forge a bipartisan compromise. Dingell had been negotiating a health care bill with Commerce Committee Chairman Thomas J. Bliley Jr. (R-Va.) earlier this week, until House leaders decided to bypass the committee process altogether.

"We're talking to anybody from any party and any state who wants to pass good patient protection," Norwood said, adding that the lawmakers representing a "bipartisan group of 300" were close to reaching consensus. "We've got the votes. It's only a matter of getting into position to have a bill so they can vote the way they want to vote."

Several Republicans, including Norwood, Greg Ganske (Iowa) and Tom Coburn (Okla.), said the GOP leadership has failed to ensure a thorough appeals process for patients denied medical care and the opportunity for doctors, rather than health plan officials, to decide what kind of treatment their patients need.

And some of these lawmakers were increasingly critical of the leadership, suggesting that they would consider forcing a vote on managed care through the use of a discharge petition if top Republicans refused to consider a bipartisan alternative to their plan.

"It just makes me so angry some of us Republicans are taking the lead on a good piece of consumer protection, and we have had to fight our leadership every step of the way for four or five years," Ganske said. He added that he and his colleagues would point out weaknesses in any leadership proposal: "I think we will be able to expose the emperor's clothes."