ASHINGTON, Aug. 2 — The House of Representatives passed a bill tonight that would create federal rights for millions of Americans in managed health care plans, after revising the legislation to limit lawsuits against insurance companies.

In approving the legislation by a vote of 226 to 203, the House handed an important political victory to President Bush, who had argued that earlier versions of the bill would encourage frivolous lawsuits.

Under the legislation, health insurance plans must provide patients prompt access to medical specialists, must allow women to visit obstetricians and gynecologists without a referral and must permit patients to obtain emergency care at the nearest hospital, even if it is not affiliated with a specific health plan.

The vote tonight followed a long, tumultuous debate in which Democrats denounced the legislation as a sham, providing less protection to patients than to health insurance companies. It was the third time in four years that the House had passed legislation to define patients' rights. Earlier bills died. Shortly after the vote the House recessed until Sept. 6.

No Republicans voted against the bill tonight, and only five Democrats voted for it.

At the heart of the latest bill is a compromise negotiated by the White House and Representative Charlie Norwood, the leader of a six-year campaign for patients' rights, who unexpectedly made a deal with Mr. Bush this week.

"This is a real victory for American patients," Mr. Norwood said. "We not only passed a bill tonight, we passed a bill that the president has agreed to sign into law."

Under the bill, patients could enforce their rights by suing H.M.O's in state court for medical decisions. But there would be limits on damages, including one of $1.5 million in punitive damages and another of $1.5 million for pain and suffering. Damages for economic losses if medical decisions were made improperly would be unlimited.

Mr. Bush welcomed the final vote, saying it "brings us an important step closer to ensuring that patients get the care they need and that H.M.O.'s are held accountable."

Mr. Bush had wanted to limit suits to federal court, where damages are often lower than in state court. Mr. Norwood had wanted higher ceilings on damages.

Before voting on final passage of the bill, the House approved the Bush-Norwood proposal as an amendment by a vote of 218 to 213. The tally seesawed, and the two sides were tied for a few suspenseful moments before the result was announced.

This vote also generally followed party lines. Three Democrats joined 214 Republicans and 1 independent in supporting the Bush-Norwood plan. Six Republicans joined 206 Democrats and 1 independent in opposing it.

In today's debate, Democrats criticized the compromise, saying it would cripple the enforcement of patients' rights. But Republicans hailed the agreement as a victory for consumers and common sense over trial lawyers, and they said it would inoculate Republicans against political attacks on the issue.

Mr. Bush praised Mr. Norwood, a Georgia Republican, as "realistic and reasonable." But the Senate Democratic leader, Tom Daschle of South Dakota, and the House Democratic leader, Richard A. Gephardt of Missouri, were among the members of their party who said they had been betrayed by Mr. Norwood, their former ally. They denounced Mr. Norwood and the deal he struck with Mr. Bush to limit lawsuits against insurers and health maintenance organizations.

Today's House vote sets the stage for negotiations with the Senate, which passed a similar bill in late June by a vote of 59 to 36. Patient protections in the two bills are nearly identical, but the means of enforcing those rights are different.

Under both bills, people with insurance are guaranteed access to clinical trials of new drugs and an independent medical review of decisions denying claims for health benefits. The Senate bill gives patients a much more extensive right to sue health plans for injuries caused by the denial of care. The only limits on suits in the Senate bill are those provided under current state laws.

Mr. Bush threatened to veto the Senate measure, saying it would permit a flood of lawsuits that would drive up insurance costs and increase the number of people without coverage.

Negotiations between the House and the Senate will probably be difficult.

"We are not going to give up or give in," said Senator Edward M. Kennedy, Democrat of Massachusetts.

Senate Democrats want higher limits on damages than the House bill provides.

Democrats, believing that voters tend to trust them on health care issues, say they can hold out for concessions. Republicans may feel more pressure to make such concessions as the campaign season heats up next year. But Democrats also run a risk. Republicans could portray them as obstructing progress on the issue if the conference committee reaches an impasse, as similar negotiations did last year.

Negotiators from the House and Senate will come under immense pressure from consumer advocates, doctors, insurers and employers lobbying for or against the bill or some of its specific provisions.

The Bush-Norwood compromise is embodied in an amendment to the original patients' bill of rights. Critics said the compromise would override many state laws and state court decisions that provided greater protection to patients.

Representative John D. Dingell of Michigan, the chief Democratic sponsor of Mr. Norwood's original bill, said: "The president and Mr. Norwood propose creating a new federal law that applies to state courts just for H.M.O.'s. Under this proposal, H.M.O.'s retain a very special status and cannot be held accountable for their negligent and harmful actions in the same way your doctor or hospital is."

Representative Greg Ganske, the Iowa Republican who was chief House sponsor of the Norwood bill this year, said: "Charlie was freelancing. He did not have our authorization. This was Charlie's own deal with the White House."

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