It was a defining moment in Edward Kennedy's career.
As the U.S. Senate was casting a decisive vote on key Medicare legislation on a hot July day in 2008, a hush fell over the chamber as a familiar white cloud of hair entered the premises.
The silence exploded into thunderous applause as an ailing Kennedy, struck down by a brain tumor, cast a crucial vote to ensure a veto-proof margin and passage of the Medicare Improvements for Patients and Providers Act of 2008, which made significant changes to the Medicare Advantage program, while stopping a 6% payment cut to doctors.
“Sen. Kennedy has always been a warrior for healthcare, and when he came to Washington that day, tens of millions of Americans were reminded that they've always had a champion in Ted Kennedy,” Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said after the historic vote. “Ted made all the difference.”
Even the Republicans rose to applaud the senator whom they hadn't seen since he had started intensive treatments to ward off cancer.
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View the Hall of Fame photo galleryKennedy succumbed to his illness last August at age 77, but in his 47 years as a senator, Kennedy became Congress' chief healthcare activist.
“Nobody in the history of the country was more effective in moving the nation closer to achieving meaningful healthcare reform,” says Ron Pollack, executive director of advocacy group Families USA. Pollack worked closely with Kennedy on healthcare issues for at least three decades.
The hospital industry also lost an important ally on Capitol Hill with Kennedy's death.
“Nowhere has he had more of an impact than on efforts to improve our nation's healthcare system,” says Richard Umbdenstock, president and CEO of the American Hospital Association. “A friend to hospitals, patients and communities in Massachusetts and across the country, Sen. Kennedy fought to improve healthcare and expand access and coverage for all. … Despite a devastating illness, Sen. Kennedy continued to fight for healthcare reform. His extensive knowledge of the healthcare system and the inner workings of Congress, and his ability to build consensus will be greatly missed as discussions continue on how to best improve healthcare.”
Known as the “Lion of the Senate,” the Massachusetts Democrat was dubbed with many other labels over the years. The ultimate liberal. A pragmatic and dogged worker. But Kennedy may be best known for his ability to buck convention, to reach across partisan lines to find consensus on issues.
“Many consider him to be the finest legislator in the last 50 years. He was respected across the aisles and could work with people opposed to him and try to find middle ground, which is what we so badly need” today, says Stuart Altman, a professor of healthcare policy at Brandeis University. Altman worked with Kennedy when Altman was a young health policy aide in President Richard Nixon's administration.
Altman met Kennedy during a pivotal point in the senator's career: when he became chairman of the Senate Health subcommittee and filed his first bill to promote universal coverage in 1971.
“I was part of the Nixon administration, therefore I looked like I was the enemy” to congressional Democrats, Altman says. Kennedy may have been suspicious of Altman when they first met, but perhaps it was the desire of each of these men to reach across the aisles that sealed their ability to work together.
“I really didn't fit the mold of what was expected out of a Nixon employee,” Altman says. In turn, Kennedy seemed to be “a pragmatic guy that wanted to do the right thing.” He and Kennedy worked together in the early 1970s to create a financing mechanism for medical schools to reward them for increasing the number of new physicians.
Kennedy was often accused by political opponents of being the ultimate liberal, but when trying to craft a bipartisan compromise he was the ultimate pragmatist, Altman says. When Nixon offered up his own reform bill, the National Health Insurance Partnership Act, “Kennedy was willing to work with us on a compromise we could all support,” despite the fact he thought the plan was more of a partnership between the administration and insurance companies than a partnership between patients and physicians, Altman says.
“He broke with advocates to support or try to come up with a truly bipartisan approach,” according to Altman.
His son Rep. Patrick Kennedy (D-R.I.) says Edward Kennedy's ability to broker deals, with the left and right, was his greatest accomplishment. “The lesson of his life and the lesson of his politics was perseverance,” he says.
“His greatest testaments to the legislative process was how much he did during the lean years for Democrats, the years when they didn't have the majority, when the political winds weren't blowing in their direction,” including the Reagan years, Patrick Kennedy adds.
At the same time Edward Kennedy was pushing for broader reform needs, he would look for opportunities to make incremental improvements and did so in a way that secured bipartisan support no other member of Congress was successful in achieving, says Pollack, who collaborated with Kennedy on a number of bills that were successfully enacted into law, including the Health Insurance Portability and Accountability Act, State Children's Health Insurance Program and the Medicare Modernization Act of 2003.
President Barack Obama last year called Kennedy “the greatest partisan in Congress,” Patrick Kennedy recalls. Edward Kennedy's liberal views, however, “didn't keep him from being so ideological that he wasn't willing to work with” GOP senators, such as Orrin Hatch of Utah on SCHIP, or Lincoln Chafee of Rhode Island to pass community health center legislation in the 1970s, or Nancy Kassebaum of Kansas on HIPAA, or John McCain of Arizona on the patients' bill of rights, Patrick Kennedy says.
Some reports claim Edward Kennedy became interested in healthcare when he was laid up with a back injury after a near fatal plane crash, and had to deal with a host of caregivers in the healthcare industry. According to his son, the explanation had more to do with the medical crises that struck Kennedy's family, rather than his own experiences.
“It was a whole host of things, watching his father need round-the-clock care, convalescing from a stroke, watching his brother (President John F. Kennedy) need surgeries for back ailments, watching his son deal with cancer, knowing the other kids in the pediatric wing at the children's hospital were struggling with illness and their parents were dealing with the cost of paying for that medical care,” Patrick Kennedy says. “The notion that these children wouldn't survive because their parents couldn't afford treatment, put it over the top for him.”
Patrick Kennedy, who had childhood asthma and later battled a prescription drug addiction, says his father also had to deal with his mother's alcoholism treatments. “I think there was a very strong consciousness that we had the financial wherewithal to deal with these crises and come through them.” The fact that some people were lacking that ability “is something he really felt powerfully about.”
During his Senate career, Kennedy was never able to pass his signature bill on national health insurance. In the early 1970s, more pressing domestic and foreign issues ended up waylaying Kennedy's efforts. Several years later, the Carter administration contended that Kennedy's national health insurance proposal was too expensive.
Reviews of the healthcare bills he did pass into law have been mixed. The SCHIP law, first enacted in 1997 and recently reauthorized in 2009, to date has enrolled 7.7 million children, and has enjoyed bipartisan support.
HIPAA, an attempt to protect health coverage for workers and their families when they change or lose their jobs, has yielded only modest results, some health analysts claim.
On the cusp of approving what Kennedy set out to do decades ago, a comprehensive healthcare overhaul, congressional Democrats watched that opportunity slip away on Jan. 19, when Republican Scott Brown defeated Democrat Martha Coakley in the race to fill Kennedy's seat. Brown's win hobbled the reform effort, knocking the Senate Democratic Caucus down to 59—one shy of the 60 needed to break a Republican filibuster.
If he had lived, “he could have brought about a compromise between Democrats and Republicans,” Altman contends. He conceded that previous attempts didn't work when Kennedy was alive. But if anyone could broker a deal in the intensely partisan healthcare battle in 2010, it was Kennedy, he says.
Patrick Kennedy adds, people “should look at the fact while he never was able to pass his signature bill on national health insurance, he's gone down as the biggest champion for increasing access to healthcare of any legislator in the history of Congress.”
