Kennedy's death leaves gap in health reform leadership

Washington -- As lawmakers prepare to revisit the health system reform debate without the late Sen. Edward Kennedy (D, Mass), former staff and colleagues said the Senate sorely will miss both his negotiating skills and his steadfast adherence to principles.

Kennedy, who died of brain cancer Aug. 25, was involved in all of the major health bills of the last 30 years, Sen. Orrin Hatch (R, Utah) said Aug. 30 on ABC's "This Week with George Stephanopoulos." In every case, Kennedy fought as hard as he could for what he wanted, but when he recognized he could get a good bill that accomplished most of his goals, he compromised. "If he was here, I don't think we would be in the mess we are in right now," Hatch said.

Kennedy was always willing to sit down and talk to see if a compromise could be reached on legislation, said Craig Orfield, spokesman for Sen. Mike Enzi (Wyo.), the highest-ranking Republican on the Senate Health, Education, Labor and Pensions Committee, which Kennedy chaired.

Enzi, delivering the weekly GOP radio address on Aug. 29, asked Democrats to embrace that tactic with health reform. "I hope the president and the Democratic-controlled Congress will reject the go-it-alone path that they are currently on."

Sen. Chris Dodd (D, Conn.) has been the interim HELP Committee chair, but Democratic leaders have not issued a plan to name a permanent replacement. The HELP panel on July 15 approved along party lines a partial health reform bill. It awaits complementary language by the Senate Finance Committee.

Meanwhile, Massachusetts Gov. Deval Patrick on Aug. 31 announced that a special election for Kennedy's seat will be held on Jan. 19, 2010. Massachusetts law requires an election between 145 and 160 days after the seat becomes vacant. Patrick also promised to work with state legislators on a bill allowing him to appoint an interim senator.

Former Kennedy staffers and others soon began to call for health reform to honor the late senator.

Ellen-Marie Whelan, PhD, said the senator's death may inspire Democrats to work even harder. She was staff director for a HELP subcommittee from 2003 to 2008. "We have got to carry it across the finish line."

American Academy of Pediatrics President David Tayloe Jr., MD, agreed. "Let us now come together and honor him by finishing what he started."

Ron Pollack, executive director of health consumers group Families USA, said the senator's influence has not ended. "Do not underestimate the role that Sen. Kennedy will play even after his death. The inspiration of [his] lifetime, his friendships and his commitment to this issue will be a significant factor in the final votes for health care reform this year."

American Medical Association President J. James Rohack, MD, also cited the potential lasting effect. "No doubt Sen. Kennedy's legacy will be burnished by his many contributions to improving America's health system over the years -- including his work that helped pave the way for this year's effort to provide affordable, quality health insurance coverage to all Americans."

But one former Republican staffer said Democrats who invoke Kennedy's name to pass a bill risk a backlash. Naming a building after a late senator is appropriate, but renaming a bill that could affect 16% of the national economy is too much, said Michael Franc, communications director for former House Majority Leader Dick Armey (R, Texas) and now a lobbyist for the Heritage Foundation, a conservative think tank.

Tactical considerations

Until the empty seat can be filled, Kennedy's death officially leaves the Democratic caucus with 59 votes in the Senate, one short of the 60 usually needed to end debate on a measure and move to final consideration. But with the senator absent from the chamber for most of the time since his cancer diagnosis -- and with Sen. Robert Byrd (D, W.Va.) also ailing -- Democratic leaders might not have been able to count on having those votes for health care in the first place.

Talk about the Democratic strategy in the days leading up to Kennedy's death and immediately afterward increasingly gravitated toward whether leaders will attempt to use a parliamentary procedure called reconciliation to force a reform bill through the upper chamber with only 51 votes instead of the usual 60. Party leaders said they have reserved that option if bipartisan negotiations break down, but some Senate Republicans have vowed aggressively to fight such a move.

More cracks were starting to form in relations between Democratic and Republican health reform negotiators in recent days. Enzi and other HELP Committee Republicans, for instance, on July 30 said they were growing impatient in their wait for a copy of the committee-approved version of the Affordable Health Choices Act.

Some shared Hatch's contention that such a breakdown might not be occurring if Kennedy were still around to lead the talks.

"In many ways the senator is irreplaceable," said Jay Himmelstein, MD, a professor of family and community medicine at the University of Massachusetts who served as a fellow on the Senate HELP Committee in the early 1990s. He said Kennedy was able to negotiate effectively because he understood the impact the legislation would have.

At least one former Kennedy staffer worried that President Obama and congressional Democrats would compromise too much in the pursuit of a bipartisan bill.

"The Congress will pass something called health reform. Whether it's meaningful or not is something else entirely," said Philip Caper, MD, who served in the early 1970s on a health subcommittee on which Kennedy served as chair.

He noted that Congress is having some of the same fights it had in the 1970s when the debate first began. "We're still arguing about whether health care should be a right in the U.S. That's the fundamental question that hasn't been answered."