If you think your medical HMO has denied treatment you need, you might not get much help from state courts. The US Supreme Court today ruled against a lawsuit by two patients in Texas. They were seeking large malpractice or negligence awards from their insurance companies, under a patient protection law that's on the books in Texas. The ruling could weaken similar laws in other states. The insurance companies successfully argued that those battles should be waged in federal courts -- where awards are traditionally lower than in the state courts. The case highlights some of the issues that have scuttled congressional efforts to pass some type of blanket protection for HMO patients.