House Republican leaders scrambled yesterday to cope with a growing faction of party dissidents who favor strong new regulation of managed-care plans, giving encouragement to a pair of GOP lawmakers who have drafted a more limited set of patient protections.

House Speaker J. Dennis Hastert (R-Ill.) said he backs the basic principles behind a new patients' rights blueprint unveiled yesterday that would give patients a limited right to sue health maintenance organizations for malpractice and includes several GOP-backed tax incentives to help certain people buy insurance.

While stopping short of endorsing the latest approach, designed by Reps. Tom Coburn (R-Okla.) and John Shadegg (R-Ariz.), Hastert signaled that GOP leaders will work to refine their plan and bring it to a vote of the full House when Congress returns to work after Labor Day.

The speaker's encouragement seemed designed, as much as anything, to slow momentum behind bipartisan legislation, introduced Thursday by House Democrats and a group of rebellious Republicans who say they have dozens of GOP supporters for their bill. The bipartisan legislation, sponsored by Reps. Charles Whitlow Norwood (R-Ga.) and John D. Dingell (D-Mich.), calls for significantly tougher regulation of HMOs and is opposed by the House leadership as well as business and insurance interests.

The public jockeying, just as Congress adjourned for its August recess, reflects how much pressure House members feel to pass legislation on an issue that polls indicate is of personal importance to many voters.

Yet the jockeying also reflects the difficulty the House, which narrowly approved a Republican patients' rights bill a year ago, is having agreeing on an acceptable course. In the last year, the GOP majority in the House has dwindled to a mere five votes, and lobbying on both sides of the issue has intensified.

The pressure on the House is particularly great now because the Senate adopted a GOP bill to regulate managed-care plans last month.

Coburn and Shadegg released their plan yesterday after negotiating with House leaders until the early morning hours, and their approach remained sketchy in several respects.

Although Republican leaders generally oppose the idea of being able to sue health plans, the new blueprint would allow litigation when patients had first proved through an outside appeals process that they had suffered medical harm. It is unclear whether those suits could be brought in state courts, or only in federal ones, and exactly what kind of financial damages patients could win.

"We don't want to open up unfettered litigation," Shadegg said.

Unlike both the bipartisan legislation and the Senate bill, Coburn and Shadegg would not require HMOs to pay for patients to take part in clinical trials of new therapies. But their plan would help patients compel their health plans to pay emergency room bills, and would make it easier for women to visit obstetrician-gynecologists and for children to be taken to pediatricians.

Hastert yesterday said that the two lawmakers "have done yeoman's work" but indicated that House leaders and the committees with jurisdiction over health issues probably would alter their proposal.

Other Republicans disparaged the plan, however, and a few privately branded it "Dingwood Lite," a comparison with the bipartisan measure.

Rep. John A. Boehner (Ohio), one of the leading Republicans on managed-care reform, emphasized that House leaders did not endorse yesterday's proposal. Boehner urged employers and insurance companies, which contend such reforms would drive up medical costs and thus leave more Americans uninsured, to step up their efforts to defeat them.

"We have done everything we can to bring some sanity to this debate," Boehner said. "Now, frankly, it's up to the employers. . . . If they can't change the political dynamic in the next six weeks, it's going to be a problem."

While insurance trade groups would not critique the new plan, because it lacks specifics, they indicated they would heed Boehner's call to attack the bipartisan approach in the next month through a grass-roots campaign and advertising.