By Marcia Clemmitt, Staff Writer, CQ Researcher, Aug. 26, 2009.
This morning, as I put the finishing touches on a long piece on health reform (to be published on Aug. 28), the death of Sen. Edward M. Kennedy, D-Mass, calls up many memories of watching “the lion of the Senate” in action.
As a newbie health-care reporter in the mid-1990s, I quickly learned that there was virtually no such thing as a health-related bill that Kennedy and his staff were not closely involved with, whether or not the Democrats controlled the Senate. Over the years, I’ve spent countless hours in committee hearings and back-office briefings led by Kennedy and his impressive staff, on health-related issues ranging from AIDS and the Food and Drug Administration to Medicaid for children with disabilities.
I’m especially struck by Kennedy’s dogged perseverance in the cause of universal coverage. His long career in the Senate – Kennedy served since November 1962 – was marked by an unrelenting focus on, someday, somehow, ensuring that all Americans would have reliable, affordable health insurance.
Just as striking, though, has been his willingness to develop new, ingenious legislative proposals and work across the aisle with various Republican colleagues in pairings that invariably were referred to as “strange bedfellows.” Why the willingness to compromise? Kennedy realized the health-care industry, Congress and, perhaps, much of the public had little stomach for sweeping change.
In the 1960s and early ’70s, Kennedy actively championed universal coverage through a single-payer health-care system. He held hearings around the country and issued a report on “The Health Care Crisis in America,” ultimately proposing his “Health Security Act,” – a universal single-payer plan with a national health budget and no consumer cost-sharing, paid for through a payroll tax.
With Republican President Richard M. Nixon in the White House, however, the times weren't ripe for a European-style single-payer proposal. Nevertheless, Nixon, too, was worried about the number of uninsured Americans, as well as the rapidly rising health-care costs that threatened the coverage of many more. He proposed his own coverage and cost-trimming measures.
Heartened by having Republican leader champion major reforms, Kennedy tried to harness the new, surprising bipartisan interest in coverage expansion.
Realizing that his own single-payer proposal was a step too far for most in Congress, he teamed with Rep. Wilbur Mills, D-Ark., on a more centrist bill with a mandate for employers to contribute to coverage and a requirement that consumers share some of the costs. And, for a while, it seemed that the time for health-care reform might have arrived.
In 1974, however, scandals drove both Nixon and Mills from office, and with Kennedy’s chief House ally out of Congress and one of the few strong Republican voices for health-care reform out of the White House, the campaign went to the back burner.
Kennedy didn’t give up his efforts, however.
Beginning in the late 1970s, he developed a new, much more market-oriented proposal, calling for private insurers to compete for customers who would each be issued an insurance card to get doctor and hospital care. Each American would have the card, employers would contribute to the coverage, and the government would subsidize the cost based on income. Insurers would be paid based on the health risk of their enrollees – a system similar to those in Germany, Switzerland and the Netherlands – and providers would get negotiated fees.
Conservatism was on the rise, however, and along with it a growing public distrust of government regulation and taxes of all kinds. In that climate, Kennedy’s major coverage proposal got nowhere. However, he never stopped his efforts to pass legislation to make Americans’ health coverage more secure and affordable, often reaching across the aisle to work with Republican allies on those proposals.
In 1985, he was a key architect of COBRA – the legislative provision that allows workers to buy into an ex-employer’s health coverage for 18 months after leaving the job, to help people avoid gaps in their insurance coverage.
In 1996, he worked with Republican co-sponsor Sen. Nancy Landon Kassebaum of Kansas to pass HIPAA, the Health Insurance Portability and Accountability Act. Among many other things, HIPAA limits some insurers’ ability to decline people coverage on the basis of their having pre-existing medical conditions, a provision Kennedy and Kassebaum hoped would help more people get insurance.
In 1997, he worked closely with Republican Sen. Orrin Hatch of Utah to enact SCHIP, the State Children’s Health Insurance Program, authorizing states to create coverage programs for the many uninsured children living in low-income working families.
In 2005, after a five-year struggle, Kennedy and Republican co-sponsor Sen. Charles Grassley of Iowa finally pushed through legislation help children with disabilities get and retain Medicaid coverage – which provides people with disabilities many specialized services that don’t exist in private health-care plans – even when their parents’ income rises above the Medicaid cut-off level. Before this provision became law, many parents with disabled children in need of special services like speech or physical therapy were forced to turn down overtime, new jobs and raises to keep their incomes within the Medicaid-eligible limits.
Kennedy’s legislative interests and his bipartisan adventures went far beyond health care, of course. He’s garnered plenty of both praise and blame for his work with President George W. Bush on the 2002 No Child Left Behind Act, for example, and made Republican friends, along with staunch opponents, along the way.
Education has been another of Kennedy’s passions over the years. In January 2008, shortly before his cancer diagnosis, I recruited him to write an “At Issue” essay for a CQ Researcher report on student financial aid. He argued on the need for government to keep up pressure on the student-loan industry to ensure that aid programs provide maximum benefit to students. (see "Student Aid" January 25, 2008)
“Millions of students face staggering tuition bills, and recent graduates juggle an average of about $20,000 in student debt. Congress should do more — not to keep private lenders in the loan business but to help students afford college and deal with debt,” Kennedy wrote. “We should reduce unnecessary subsidies to private lenders and use the savings to increase aid to the neediest students… Each year, 400,000 qualified students are still unable to attend a four-year college because of cost.”In the piece, Kennedy pledged to continue pushing for improvements in aid programs. “Most important, we'll keep the focus on students, so more can afford college and have a genuine chance at the American dream,” he wrote.
“He Always Seemed to Be Moving Fast”
He generally walked fast, with a bit of a side-to-side shuffle in recent years. In the Senate’s endless marble halls – which look as if they were designed for giants -- or, at least, egos of giant size – he always seemed to be moving as fast as he could to the next place he had to be. You seldom saw him on the Hill without someone – an aide, a reporter, a fellow senator – talking urgently in his ear. Even entering a room, he was usually deep in conversation. He often looked over his glasses or took them off to peer closely at a hearing witness, and his questions were incisive and informed.
Once, at a Medicare hearing, I heard him make a small misstatement of fact, a rare occurrence for Kennedy during an important public deliberation. David Nexon, one of his top health-care staffers for many years, leaned forward from the back row of staff chairs and hissed a correction, and Kennedy quickly amended himself. At the reporters’ table, we exchanged amused, slightly shocked glances, realizing that, yes, a bit of a royal bubble did always seem to surround him, and that we were kind of amazed that Nexon would so easily pierce it.
The Senate is a gentlemen’s – or perhaps, today, a gentlepersons’ – club. Many senators really do have friendly lunches together after hurling bruising indictments at one another across the floor. It seems strange and makes you wonder whether most of the beliefs so passionately espoused are a bit phony. But sometimes the camaraderie leads to alliances that make things happen.
This was never clearer than in 1997, when Kennedy linked up with Republican Sen. Orrin Hatch of Utah to pass the State Children’s Health Insurance Program.
Few legislators could be farther apart philosophically than conservative Hatch and liberal Kennedy. But Kennedy tapped into their friendship and, apparently, Hatch’s memories of growing up without much money and with some serious needs -- including for health care -- and forged the pair into a well-nigh unbeatable lawmaking team that pushed the SCHIP legislation through.
It’s watching that seemingly improbable series of events unfold that I remember most about covering Sen. Kennedy.