WASHINGTON (AP) _ House members today rejected the most modest of four competing patient-protection bills as they confronted the politically charged issue of HMOs and whether injured Americans should be allowed to sue them.

Managed care has dominated the health debate on Capitol Hill all year, as Congress responds to voters' frustration over cost cutting and fears they may be denied needed care.

Casting their first votes on the politically hot topic, the House defeated, 284-145, a bill sponsored by Rep. John Boehner, R-Ohio, which would have given patients no new rights to file lawsuits. Federal law now effectively bans such suits for millions of Americans, even if they are injured or die because of an HMO's decision.

Conservative Republicans and their allies in the business and insurance industries preferred this bill, but Democrats and many Republicans felt it didn't go far enough.

``It does not hold insurance companies accountable when they make medical decisions that harm people,'' said Rep. Sherrod Brown, D-Ohio.

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