Health bill highlighted as vehicle for long-term care

The Caucus Room of the Russell Senate Office Building, with its carved marble walls and heavy chandeliers, is where historic things happen, an aide to Senator Edward M. Kennedy explained to some 250 people. That, she said, is why his health committee decided to host a briefing there yesterday on how its health-reform bill could transform life for people with disabilities and create a new national long-term care insurance plan.

But the 77-year-old Kennedy, who is battling brain cancer, did not attend the briefing. He wasn't on Capitol Hill last week, either, when Democrats on his committee began preparing to unveil their draft healthcare legislation. Senator Chris Dodd, a Connecticut Democrat and Kennedy's top deputy, has been filling in.

Kennedy spokesman Anthony Coley said Kennedy has been working on the healthcare bill while receiving his cancer treatments, but he did not expect him back in Washington this week.

"As Senator Kennedy has said many times, guaranteeing that all Americans have access to affordable and quality healthcare is the cause of his life," Coley said in an e-mail, noting that Kennedy had "a very productive meeting" over the weekend with Dodd.

"He's been a leader on this issue for 40 years, and he continues to lead," Coley wrote. "That doesn't depend on location."

Last week, Dodd had choked up when he was asked how Kennedy was doing.

"I'm getting indications every day that the senator will get back here as quickly as he can," Dodd said last Wednesday. "He's fighting hard. . . . He's doing OK. Look, this is tough."

Senator Orrin Hatch, a Utah Republican who has sometimes worked closely with Kennedy over the years but has expressed disappointment about the extent of government spending and regulation in Kennedy's draft healthcare bill, said yesterday he has not spoken directly with Kennedy about his concerns.

"If he wants to chat with me, I'll chat with him anytime, but I want to see him get through this as much as he can," he said.

Still, committee Democrats yesterday highlighted two more potential components of the healthcare bill.

Senator Tom Harkin said he is going to push to wrap into the healthcare package a bill known as the Community Choice Act, which would let people who qualify for long-term care services - either medical or personal assistance - decide whether to receive them at home or in an institutional setting.

Harkin said the legislation would cost billions, but in a healthcare bill that will cost $1 trillion to $1.5 trillion over a decade, "I'm here to tell you that $2 billion, $3 billion, $4 billion is not much to ask."

The committee hopes to include a new national long-term insurance program that would provide basic help for people as they age or if they become disabled. Under current law, people who want long-term home or community-based care find it difficult to get into the popular Medicaid "waiver" programs offering home health services. Many elders who need assistance wind up spending their savings in order to be poor enough to qualify for Medicaid, so they can enter a nursing home, when they might just need regular help around the house and regular home nurse visits.

All working Americans would automatically be enrolled in the plan unless they choose to opt out. Students and poor people would pay only $5 a month, others would pay not more than an average of $65 a month. After being enrolled for five years, members could receive limited home services once they need them.

Republicans have expressed distaste at the cost of the Democratic proposals being floated so far - particularly those from Kennedy's committee. Yesterday a Republican aide who was not authorized to speak for the record said the long-term care proposals could be very expensive, though the Congressional Budget Office has not finished reviewing the proposals yet.

"If they are aiming very high and willing to negotiate, that's our hope," the GOP aide said. "If that's not the case, and this is just a hard-and-fast marker, take it or leave it, there's going to be a real problem from our side."

Susan Milligan of the Globe staff contributed to this report.