The Next Steps for Kennedy's Cause: Healthcare Reform

Sen. Ted Kennedy was out of sight this summer, fighting the brain cancer that finally claimed his life lastweek, but up until his last days he was still at work, following C-SPAN's healthcare reform coverage and calling his Washington colleagues. Earlier this month, he phoned Connecticut Sen. Chris Dodd, a close friend, to offer advice. "He was just as courageous as he could be," Dodd said last Wednesday, the morning after Kennedy's death. "Less than two weeks ago, when he called, it was like he had never been sick. He was down with the details on how to deal with costs—literally, two weeks ago."

Though Kennedy is gone, the cause of his career—universal health coverage—is simmering at the forefront of national politics, much as it was in the early 1970s and again in the 1990s. Congress won't return from its recess until September 8, yet much of what has gone on this year, and much of what is still to come, reflect the shifting nature of the reins of power that Kennedy held for so long.

Kennedy was the country's dominant healthcare figure for much of his career. Even after his cancer diagnosis forced him to leave Washington last year, he ranked as the sixth-most-powerful healthcare player in the country, according to a survey by the trade magazine Modern Healthcare. This year, because of his deteriorating health, he didn't crack the top 100, but senators like Dodd say he still held a powerful place in the debate. He was replaced on the list by two colleagues, Montana Sen. Max Baucus, a Democrat, and Iowa Sen. Chuck Grassley, a Republican. They now lead the Senate Finance Committee's "Gang of Six," which has positioned itself at the center of the reform debate in Kennedy's absence.

Baucus says the Gang of Six is working on a healthcare bill that will win bipartisan support. But amid August's wild town halls and the new concerns among liberals that a public health insurance option will be dropped from the bill, many Democrats have grown restless with its promises.

Some, like New York Sen. Chuck Schumer, say that if Democrats want to get something done, they are going to have to do it alone. But Kennedy's death may make that more difficult. Democrats have only 59 votes in the Senate now, one short of the 60 needed to block a filibuster. (Unless Massachusetts law is changed, the state won't hold a special election to replace Kennedy until at least January.) One option that's sure to make news in coming weeks will be a legislative maneuver known as reconciliation, which would allow Democrats to pass a healthcare bill with only 51 votes. But some on Capitol Hill say that would be unwise.

Had Kennedy been present, experts say, this summer's debate might have been more civil and reasoned, not just because of the deep respect he commanded from members of both parties but also because of his ability to talk in compelling and clear terms about healthcare. "We have been lacking articulation," says Yale University's Ted Marmor, a health policy expert and former senior policy adviser to Walter Mondale. "Kennedy would have been early and earnest in attending to the justification for why we are going about things in a certain way."

Yet Marmor and others also say that Kennedy, who remained a life-long idealist on large issues like national healthcare insurance, could only have done so much, given the partisan nature of the debate. "There is no doubt he would have been the most eloquent voice there could be for the cause of universal health insurance," says Jonathan Oberlander, a health policy expert and professor at the University of North Carolina. "But John McCain wasn't going to vote for this if Kennedy was there. Orrin Hatch wasn't going to vote for this if Kennedy was there. There is an ideological divide."

Perhaps the biggest impact of Kennedy's absence has yet to be felt. Assuming that a bill does pass the Senate, members of both chambers will have to get together in a conference committee to merge their competing versions. Those negotiations may prove just as difficult as what has happened this summer. "Had he been well, Kennedy might have been the figure in the conference committee who held on to some principles more vigorously" than other Democrats, says Marmor. That duty will now most likely be split between Baucus and whoever fills Kennedy's giant shoes on the Senate Health Committee.

• See photos of town hall protests.
• See photos of Ted Kennedy throughout his life.
• Read Democrats Avoid Tort Reform in Healthcare Debate.