Republicans intend to stage another Senate clash this fall over legislation to limit damage awards in medical malpractice (search) cases, undeterred by a congressional report that says rising insurance costs for doctors are not causing widespread denial of care.

While Democrats this year blocked a bill to limit damages across a range of cases, some Republicans say they may sharpen the issue next time by proposing caps only on one type of medical malpractice suit - those involving obstetrical care - or in a limited geographical area.

Even a limited bill could face a Democratic filibuster. Still, Sen. Mitch McConnell, R-Ky., said rising insurance premiums have led to a "national crisis" and he added that the GOP sees political gain in pursuing the issue. "One of the reasons we have votes around here is to put people on the record," he said Wednesday.

President Bush long has supported medical malpractice legislation, arguing it could help reduce unnecessary lawsuits that make it harder for doctors to practice. The GOP-controlled House approved a measure on the issue this year.

In the Senate, McConnell and many Republicans cite American Medical Association (search) claims of widespread problems resulting from rising malpractice insurance premiums. The doctors' organization said in March that 18 states were in a "full-blown medical liability crisis."

But a General Accounting Office (search) study released last week of nine states - five of which are AMA-labeled crisis states - came to a much different conclusion. Congressional investigators cited "localized but not widespread access problems." The report added that these instances "often occurred in rural locations, where maintaining an adequate number of physicians may have been a long-standing problem."

Additionally, investigators found that "some reports of physicians relocating to other states, retiring or closing practices were not accurate or involved relatively few physicians."

The study found that the growth in recent years in premiums and payments by insurance companies was slower in states that have enacted limits on malpractice awards. But it said it could not determine whether the differences were the result of the state-passed laws or other factors.

Ironically, the report was requested by three House Republicans who support limits on malpractice damage awards as one way to attack what are said to be widespread problems with health care.

A spokesman for one of those lawmakers, Rep. James Sensenbrenner, chairman of the House Judiciary Committee, said the study "demonstrates the need for medical liability reform legislation. It confirms cases where access is hindered, where patients are suffering. These are all at least partially a result of unnecessary litigation," spokesman Jeff Lungren said.

But if anything, the report seems likely to stiffen Democratic resistance. The study "lends credence to what many have been arguing all along, which is that Republicans attempts at so-called medical malpractice reform are little more than cover to protect and pay off HMOs and insurance companies," said Jay Carson, a spokesman for Senate Democratic leader Tom Daschle of South Dakota.

Senate Democrats blocked legislation in July that would have would have limited noneconomic damages, commonly known as pain and suffering, to $250,000. Punitive damages would be capped at the greater of $250,000, or twice the amount of economic damages, which cover medical expenses, loss of wages, funeral expenses and similar costs.

Additionally, the measure called for limiting the amount of money that lawyers could take if they work on a case on a contingency fee. The bill would have applied to malpractice suits against doctors, hospitals or health care providers, as well as the manufacturer, distributor or seller of a medical product.

In one respect, the legislation represents a battle of powerful special interests.

The measure had strong support from the AMA, the American Association of Hospitals and American Insurers Association (search), traditional Republican allies and heavy donors to GOP campaigns.

But it draws opposition from The Association of Trial Lawyers of America (search), a reliable ally of Democrats and heavy donor to their campaigns.

McConnell, who is the Senate GOP whip, said in an interview that at a minimum, Republicans would make a fresh attempt to break the Democratic filibuster on the across-the-board limit bill brought to the floor this year.

But he and Sen. Judd Gregg, R-N.H., as well as several GOP aides, said a different approach was possible. Gregg said he would consider offering "targeted amendments" that would apply only to selected groups of doctors, such as emergency room doctors, obstetricians and gynecologists, or perhaps doctors working in underserved areas.

"I'm going to look for the first reasonable opportunity," he said.

David S. Casey Jr., president of the trial lawyers' association, issued a statement saying that the GAO report "has now shown that the medical malpractice `crisis' is a political fabrication created for political ends."

AMA's president, Dr. Donald J. Palmisano, countered with a statement saying that the GAO report "confirms that America's medical liability crisis is causing access to health care problems in high-risk medical specialities."