Kennedy’s voice missed in health debate

It was a week when lawmakers said they keenly felt the absence of Edward M. Kennedy, whose battle with brain cancer has made it increasingly difficult for him to participate in a momentous debate on what has been his signature issue over 46 years in the Senate.

“Obviously, if Kennedy were here, the whole process would be further along,’’ said Senator Tom Harkin, a Democrat from Iowa and a senior member of Kennedy’s Committee on Health, Education, Labor and Pensions. “He’d be working his magic. He has a way of getting everybody on board.’’

Kennedy still holds weekly conference calls with the health committee. He speaks by phone from his home in Hyan nis Port to his staff in Washington, to Democratic leaders, and to the White House, his colleagues say. His office is a hive of activity, and his top aides have been working almost nonstop for months on the health committee’s bill, now nearly finished.

But Kennedy has not been in the Capitol since late April, and it is not clear when he will return. His booming voice and hearty laugh are missing from the corridors. Aides to Kennedy would not say who he has personally spoken to in the healthcare debate, or when, and they would not discuss his health status. Friends say he remains involved, despite his disease.

“He’s trying to work about an hour in the morning and an hour in the afternoon on the health bill, and he does it mostly by phone,’’ said Gerry Doherty, a longtime friend. “It goes without saying how committed he is to the health bill.’’

Even if Kennedy were in perfect health, the battle over the healthcare initiative, and the trillions of dollars at stake in the medical economy, would rage on. But as a Democrat-led Congress races the political clock, Kennedy’s colleagues sorely miss his negotiating skill, his knowledge of the policy details, and his talent for compromising with Republicans and disparate elements of his party.

“It’s like not having your dad here to make you toe the line,’’ said Senator Patty Murra, a Democrat from Washington who is on Kennedy’s committee.

For decades, Kennedy has been the Senate’s great compromiser, known for overseeing hours-long negotiating sessions with senators of all stripes. On a major immigration bill several years ago, Kennedy helped his colleagues bond by asking each to tell how his or her family came to America.

“He has the great ability to get people together, and negotiate to get a consensus,’’ said Senator John McCain, Republican of Arizona.

But Kennedy has not spoken about healthcare lately with the Republicans he would normally be pestering.

Now the center of power in formulating a bipartisan compromise is Senator Max Baucus, the chairman of the Finance Committee and the most important force in Congress in shaping legislation that could get some Republican support.

The even-tempered Montanan is conducting painstaking, closed-door negotiations with a group that has become known as the “coalition of the willing’’ - four Republicans (Senators Michael B. Enzi of Wyoming, Orrin G. Hatch of Utah, Charles E. Grassley of Iowa, Olympia J. Snowe of Maine) and two other Democrats (Senator Jeff Bingaman of New Mexico and Budget Committee chairman Kent Conrad of North Dakota). On the House side, leaders are ignoring Republicans but have a coalition of moderate “Blue Dog’’ Democrats to contend with.

There were heavy skirmishes last week on several fronts. One was the public insurance option: Liberals desperately want a strong government insurance option consumers could choose to buy into instead of private coverage, forcing private insurers to compete by lowering premiums. But opponents of that approach say it could fatally wound the private insurance industry.

Congress is also divided on how to pay for the healthcare bill, which is expected to cost a trillion dollars or more. Baucus’s group wanted to start levying taxes on the most expensive health benefits offered by employers, but that idea has proved unpopular with unions and middle-class voters. The House, meanwhile, is entertaining a tax surcharge on the wealthiest Americans.

It is increasingly clear that Democrats cannot afford to ignore all Republicans in the Senate. There are 60 Democrats, exactly enough to prevent a filibuster, but two of them - Kennedy and Robert Byrd of West Virginia - are ailing. Under special Senate rules, the bill could be approved by a simple majority after Oct. 15, but parliamentary complications of using those rules for healthcare could make that difficult.

The day-to-day handling of the healthcare bill on Kennedy’s health committee has been handed to his good friend, Senator Chris Dodd of Connecticut, who remains in close contact with the Massachusetts senator. But Dodd has major distractions. He is also running the Senate Banking Committee, which is undertaking an overhaul of financial regulations; he faces a tough reelection fight at home amid dismal poll numbers and accusations that he received preferential treatment on two mortgages. Last week, he also suffered a personal tragedy when his sister died from a sudden recurrence of cancer.

Enzi, the ranking Republican on the health committee who is working with Baucus’s coalition, has sent out a regular stream of scathing press releases picking apart the health committee bill.

Hatch, who has collaborated with Kennedy on major healthcare bills such as the Children’s Health Insurance Program, said that a month ago he had an “extensive, hour-long conversation’’ by phone with Kennedy. The Massachusetts senator promised to work with him on healthcare, he said, but instead the committee came out with a partisan bill that had “done away with bipartisanship.’’

“If Kennedy had been here,’’ said Hatch, “the first thing he would have done is pick up the phone and call people like me and say, ‘Let’s see what we can do.’ ’’