The last thing House Republican leaders wanted in their final hours before recess was a health care defeat on the floor engineered by conservative Charlie Norwood, R-Ga., a dentist who joined forces with Democrats.
During the wee hours Friday, Hastert and fellow bleary-eyed House leaders signed off on an alternative bill sponsored by an even more conservative doctor from Oklahoma - Tom Coburn.
"I've got a commitment signed in blood - from the entire leadership at 1:45 in the morning," said Coburn.
Hastert has a small Republican majority in the House and has had to work hard to keep his troops together on tough spending and tax bills this year. Some of the toughest fights are still to come next month.
If he loses as few as five Republicans on the HMO bill and the Democrats stay unified, the leadership-backed health initiative could be defeated.
The showdown will come in the fall, probably in September. Both the Norwood and Coburn camps are predicting victory, although sources on both sides privately acknowledge it could be a very close vote.
Coburn and his co-author John Shadegg, R-Ariz., said details of their bill are still being finalized. But from the initial summary descriptions, it will go further toward the center than a Republican bill that passed very narrowly in the House last year with virtually no Democratic support.
Most significantly, it will include new rights to sue - the first time that GOP leaders have backed such a provision. "HMOs can be taken to court and held accountable when patients are harmed," Hastert said.
Last year, the House bill died when the Senate failed to act. This year, the Senate has passed a patients' bill of rights, but it had no Democratic support and President Clinton has threatened to veto it saying it covers too few people and gives them too few protections.
The Senate bill covers one segment of the population who have a specific type of health plan - about 48 million people. The main House proposals this year and last cover all Americans with private health insurance - about 161 million people.
Coburn and Shadegg said they will allow greater access to the courts for patients who have been denied medical care by a health plan. But patients will have to go through some type of certification process first to establish that they have been injured.
The Norwood bill does allow expanded lawsuits in state courts.
Coburn-Shadegg also address access to insurance and cost, by among other things creating more Medical Savings Accounts, which let people use tax-free dollars for health care instead of traditional insurance. That would be voted on separately to the patients' rights legislation.
Norwood was unavailable for comment Friday, but in announcing his agreemnt with Michigan Democrat John Dingell late Thursday he predicted he would have several dozen Republicans on his side.
As news of the deal spread, lobbyists for insurance companies and businesses mobilized against the measure.
"This legislation is built on the erroneous premise that trial lawyers are the sole guardians of medical care," said Karen Ignagni, president of the American Association of Health Plans, an HMO trade group.