"Our nation is galloping toward a health care crisis of dimensions we have never faced before," said Rep. Nancy Johnson ( news, bio, voting record), R-Conn. "There are whole states where a woman cannot find an obstetrician that will take a high-risk pregnancy."

"Very quietly, access to sophisticated high-risk care is declining in America," she added.

Democrats questioned whether the bill would simply be a cash cow for insurers after Republicans rejected Democratic attempts to require that savings be used to lower malpractice insurance premiums.

"They are going to allow the insurance industry to pocket this money," said Rep. Edward Markey ( news, bio, voting record), D-Mass. "That's what it's all about. It's about the insurance companies, not about physicians."

But Republicans were buoyed by support from the White House, business groups, insurers and hundreds of physicians.

"This is the moment of truth," said Dr. Donald Palmisano, president-elect of the American Medical Association. "Without reforms, patients, trauma centers, maternity wards and physicians are all at the mercy of an out-of-control liability system."

The House legislation would limit noneconomic damages, such as pain and suffering, to $250,000. Punitive damages would be limited to twice the amount of economic damages awarded or $250,000, whichever is greater.

Patients' ability to file lawsuits over old cases would be limited under the legislation, which would also curtail lawyers' fees.

In tackling the issue, the House waded into a debate that is already taking place in dozens of states. Nevada Gov. Kenny Guinn, a Republican, recently signed into law a bill that caps pain-and-suffering awards, and Mississippi legislators have been in a special session for weeks trying to craft a bill.

For doctors, the relief is sorely needed, supporters said.

"There definitely has to be a cap," said Dr. Khadra Osman, a gynecologist in Ft. Lauderdale, Fla. who recently had to drop her obstetrics practice after seeing her yearly malpractice insurance rate go from $32,000 in 2000 to $74,000 in 2002. "I cried with every single patient of mine who was pregnant."

Dr. Robert Comeau, a Las Vegas obstetrician, understands. He recently began scaling back his practice because his insurer is going out of business and he envisions trouble getting affordable insurance. Already, he has gotten estimates of up to $100,000 for malpractice insurance.

"If I have a lot of deliveries, if I'm in the emergency room, I won't be as marketable," said Comeau, who has scaled back to only 125 deliveries a year. He now works in only one emergency room instead of four. "It is very frustrating. My wife wants me to move. Some of my friends have their houses up for sale. Others are getting new licenses in other states."

"I'm going to seriously look at leaving if something doesn't happen," Comeau said.

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The bill is H.R. 4600.

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