Air of uncertainty as Kennedy fights for healthcare overhaul
WASHINGTON - Senator Edward M. Kennedy made a decision last year, as he confronted his brain cancer diagnosis. Overhauling the nation's healthcare system would be his top priority, the capstone of his legacy. His staff worked relentlessly to lay the groundwork for a bill, and Kennedy quit the Judiciary Committee in December to focus exclusively on his goal.
Now that Congress has concluded work on the stimulus package, enabling members to concentrate on other priorities, people working with Kennedy on healthcare profess cautious optimism about his chances of winning what could be his final legislative battle, despite enormous political odds.
Kennedy continues to work doggedly on healthcare behind the scenes, they say, adding that other senators' affection for Kennedy and his passion for the subject might help lead them to a compromise.
But an air of uncertainty hangs over the issue. Kennedy, who chairs the Committee on Health, Education, Labor and Pensions, and who has played a leading role in virtually every piece of health legislation in the last 40 years, has been mostly absent from his office since Inauguration Day, and it is unclear whether he will be strong enough to lead the debate.
His staff strives to give Kennedy's unseen work on the issue a public face, but Kennedy has done no public interviews since his diagnosis, and he has hardly been in the Senate.
"He's very engaged with the subject matter, and he would love to be back here," said Senator Chris Dodd, one of Kennedy's closest friends. He said Kennedy plans to return on a more full-time basis to help lead the healthcare fight next month.
Kennedy's collapse at a luncheon after President Obama's inauguration, which doctors attributed to exhaustion, underscored the fragility of his health. When he appeared last week to cast an important vote on the president's stimulus package, his hands trembled and he stumbled on his way up the walk to the Capitol. He uttered a few sentences to reporters on his way in, which was as close as he has come to making public remarks in months. Then he returned to Florida, despite the near-certainty of another close vote on the combined House and Senate versions of the stimulus bill later in the week.
A stream of press releases substitutes for Kennedy's presence: The senator commends the president and Congress for expanding the children's health insurance. He is pleased to see that a report on the Massachusetts health reform law is "another strong endorsement" of its efficacy.
Hours after Tom Daschle withdrew his name for the nomination because of tax problems, Kennedy and Senate Finance Committee Chairman Max Baucus issued a joint letter to President Obama, declaring their determination to pass a healthcare bill in spite of Daschle's absence.
Kennedy appears to spend hours a day burning up the phone lines with calls to his staff and other senators. He had a long talk with Daschle last weekend, after the implosion of Daschle's nomination, Dodd said. Dodd was trying to give his 3- and 7-year-old children a bath the other night when the phone rang - it was Kennedy, wanting to talk about Daschle's replacement, again.
"At least so far, Kennedy gives every indication of being focused and engaged, even if it's done mostly by telephone," said John Rother, a lobbyist for AARP. "He's conserving his strength."
An Obama administration official said the to-do lists Kennedy always brings to White House meetings have not stopped coming; the senator calls regularly with input on personnel, budget priorities, and his thoughts on the strategy for pushing a major health bill, not to mention day-to-day concerns.
"I get a lot of my information about other parts of the administration from Senator Kennedy," said the official, who was not authorized to speak for the record.
Kennedy's policy apparatus also functions without him physically present, perhaps by design. Since last summer, his policy staffers have been testing ideas on different healthcare constituencies that have been meeting secretly multiple times a week, hashing out disagreements over policy issues. He also set up four subcommittees to hold hearings on different aspects of health reform - a way of bringing in new ideas and trying them out in public and among committee members. It allows the committee to work without him presiding.
"He knows everything I'm doing in my hearings, and he gives guidance," said Senator Barbara Mikulski of Maryland, who chairs the subcommittee on insurance, who said Kennedy speaks with her weekly to discuss her progress.
Kennedy's healthcare policy aides have been working with aides to Baucus, who produced a significant white paper on healthcare late last year, to produce a plan. It is not done yet; the stimulus package has consumed the Senate in recent weeks, and the senators are trying to coordinate with the Obama administration, which is still scrambling for a point-person on healthcare.
Everyone who wants sweeping changes in healthcare is keenly aware of the pressure to get a bill signed into law before the end of the year, when campaigning for the midterm elections begins.
Kennedy's poor health compounds that sense of urgency for his staff. "They talk about how important this is to the senator, and they're carrying out on his behalf in a remarkable way," said Ron Pollack of Families USA, the healthcare consumer group.
With the stimulus eclipsing all else until now, Kennedy's physical absence has not mattered so much. But when the time comes to make deals, there may be no substitute for Kennedy being in the room.
"He has an uncanny ability to always know when he's got to physically be in a room," the administration official said. "I'm confident that's what's going to happen." 