It's been a decade and a half since anyone in Congress has attempted to put together a major overhaul of the health-care system, and no one on Capitol Hill or in the White House these days is under any illusions that it will come easy. But as the Senate Health, Education, Labor and Pensions (HELP) Committee on Wednesday becomes the first to begin the process of formally drafting a bill one that members will call the Affordable Health Choices Act it's already clear that the task will be that much tougher because of the absence of the committee's, and the issue's, driving force.
No one in Congress, after all, has put more into the cause of health reform than committee chairman Ted Kennedy, who introduced his first national health-insurance bill all the way back in 1970. But Kennedy, who is struggling with brain cancer, has been away from Washington for most of this year and it shows in the chaos that surrounds the panel as it begins to try to turn his long-held dream of universal health coverage into reality. "As we always say around here, if you want to get a bill through, give it to Kennedy," says Iowa Senator Tom Harkin, a senior member of the panel. "He just knows how to get the deals and get everybody working together."
Those skills would come in handy now. So far, there are few indications that the HELP Committee will come up with a strong bill that sets the tone for the debate that will follow on the Senate floor. On the contrary, it now increasingly looks like the HELP Committee will be playing a subordinate role in the debate to the Senate Finance Committee, whose chairman, Max Baucus of Montana, says he expects to begin the markup (or formal drafting) of his own, likely more centrist, bill next week. Also likely to fall to Baucus and the Finance Committee will be the most difficult question of all about health reform: how to pay for it.
The clearest sign of Kennedy's absence from the committee is what's still missing from the draft legislation. Committee chair members on Capitol Hill generally prefer to go into markup with a version of a bill that is as close as possible to what they expect to see in the finished product. However, the HELP Committee will begin its work with one that is missing many of its central components. Among the contentious items still to be worked out are the shape of a government-run public health plan to compete with private insurance and an expected requirement that nearly every employer provide health coverage for its workers.