- The Washington Times - Wednesday, June 18, 2003

Someone once said that when it comes to shaping public policy, getting a foot in the door can lead to a seat at the table, allowing you to eat your opponent’s lunch — or at least share it. Recently, Sen. Edward Kennedy, Massachusetts Democrat, has maneuvered his tasseled loafers into the legislative doorway on a number of important health issues — ensuring him a seat at the table and maybe some of the spoils going forward.

After 40 years in the Senate, some in the majority, some in the minority, Mr. Kennedy knows the rules and precedents as well as anyone. Playing a pivotal role on three recent health care issues, he served as facilitator, validator and (in a move worthy of his famous nephew-in-law)terminator, helping shape the outcome on each. He demonstrated why mastery of the body’s often arcane rules, coupled with hard work, makes a huge difference in the Senate, an institution designed to cater to the rights of individual lawmakers and the parochial causes they promote.

The first issue is generic drugs. Mr. Kennedy, along with Sens. Judd Gregg, New Hampshire Republican, John McCain, Arizona Republican and Charles Schumer, New York Democrat, facilitated a bipartisan compromise passed by the Senate Health Committee last week that will speed the pace at which generic drugs become available to consumers. The White House supports the measure; sources say the Senate will include the legislation in the Medicare reform bill currently under consideration. Similar legislation stalled last year, but Mr. Kennedy’s willingness to compromise is part of the reason the measure will now likely move forward. His pragmatism emerged this year because he realized this was his best chance to pass the legislation, according to people who have worked closely with him over the years.

Last year, when Mr. Kennedy was chairman of the Health Committee, the legislation stalled. Yet, now that his party no longer controlled the Senate, his chances of passing legislation were dwindling even further. He made the strategic decision to serve as a facilitator of the compromise. It worked.

On Medicare reform, however, Mr. Kennedy served as validator. He was not directly involved in the negotiations that developed the bipartisan legislation under consideration in the Senate this week. Nonetheless, his early support for the bill — calling it a “major breakthrough” — provided significant momentum and probably guarantees it will get more than the 60 votes required to overcome a possible filibuster next week. As Sen. John Breaux, Louisianna Democrat, told The Washington Post, Mr. Kennedy’s support, “took the wind out of the sails” of liberal opponents of the Medicare bill.

Why did he do it? “To put points on the board,” one longtime Kennedy watcher said. “He saw this as the best opportunity to create a $400 billion new federal health care program that the president would sign.” Mr. Kennedy doubtless believes that once the program is established, he and his liberal companions can fight to expand it. This is why reform options touted by the White House and Republicans in Congress, aimed at controlling costs, expanding choice and promoting competition, are essential to include in the final Medicare package. A prescription drug benefit without reform is a reckless option that might bankrupt the program in the future.

Finally, Mr. Kennedy played terminator on another key health policy issue this past week — Medicaid reform — scuttling the prospects for much-needed reform legislation. The Bush administration and many Republicans recognize that Medicaid — the joint federal-state health care program for the poor — is growing out of control. The administration wants to expand state flexibility by providing the federal share of the program in block grants. Mr. Kennedy and other Democrats vehemently object to this approach because they want to protect Medicaid’s entitlement status. The senator reportedly lobbied Democratic governors, telling them to terminate a bipartisan compromise. Administration officials believe the lack of a bipartisan agreement effectively kills any chance Congress will pass Medicaid reform this year.

While his role was a little different on each, Mr. Kennedy demonstrated how his philosophical approach to health-care policy can survive in a Republican-dominated government. He may not have gotten everything he wanted on generic drugs and Medicare, but he laid the foundation to come back for more in the future. And on Medicaid, he ended any chance for broad reform, maintaining the program’s strict entitlement status. A good couple of week’s work for someone who’s party is not supposed to be dining at the policy-making table.

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