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Consumers Union, publishers of Consumers Reports, says that the House version of the patient protection act fails to protect patients and in some instances actually restricts patients’ rights in states that currently have tougher patient rights laws in effect. Moreover, the group claims that the bill, which has received President Bush’s support, gives HMOs advance warnings as to the costs of violating certain terms of the act. The House version, says Consumers Union, contains "hidden hurdles" that prevent patients from exercising their full rights under the law. As an example, the group points to the fact that currently 40 states have tougher external review laws than the proposed federal measure. Federal law would pre-empt state regulations, the group notes, and in effect would further limit patients’ rights. Another fault with the proposed legislation, says the group, is that it places the burden of proof on patients and also limits the amount a patient can collect in damages from a lawsuit.