A Timeline of Kennedy's Health Care Achievements and Disappointments

by Jennifer Evans and Jaclyn Schiff for Kaiser Health News

Sen. Edward Kennedy never had to worry about getting quality healthcare, but he spent much of his career seeking to guarantee that all Americans had that same access to health services he had. "Every American should be able to get the same treatment that U.S. senators are entitled to," he wrote in Newsweek last month. "This is the cause of my life."

Here are highlights of his health policy milestones:

 --1962: Edward M. Kennedy is elected to the Senate from Massachusetts to fill the seat left by his brother, John, who had been elected president in 1960.

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  --1966: After a trip to the Columbia Point Health Center in Boston, which provided health care to low-income residents, the first-term senator introduces and helps pass legislation that adds $51 million to the Economic Opportunity Act for a national system of community health centers.

--1971: Kennedy becomes chairman of the Senate Health subcommittee and begins his long campaign for national health insurance.

-- 1971: On Jan. 5, Kennedy co-sponsors a bill calling for a significant increase in funding for cancer research – providing a total of $1.2 billion over three years to the National Cancer Institute, more than what was proposed by the Nixon administration. A modified version of the bill is enacted Dec. 23, 1971.

--1971: Kennedy offers his national health-insurance plan. The "Health Security Act" calls for a universal single-payer plan financed through payroll taxes.

With support from organized labor and senior citizens, Kennedy holds hearings around the country and releases his report, "The Health Care Crisis in America," which aims to garner support for his national insurance plan. President Richard M. Nixon, concerned about Democrats gaining advantages from the issue and a possible Kennedy campaign for president, later offers his own version of a bill, the National Health Insurance Partnership Act. It preserves private insurance but requires businesses to provide coverage to employees or make payments to a government-run fund. It also endorses the concept of health maintenance organizations.

"It's really a partnership between the administration and insurance companies," Kennedy says of the Nixon health plan. "It's not a partnership between patients and doctors of this nation." But Kennedy’s efforts on health insurance were pushed to the backburner by public concerns about the Vietnam War and later the Watergate scandal.

--1972: Working with other members of the Senate Select Committee on Nutrition and Human Needs, Kennedy helps secure authorization for a two-year pilot project for the Special Supplemental Nutrition Program for Women, Infants and Children, which provides food and health benefits to poor women who are pregnant and their children up to five years of age. In 1974 Kennedy fights to expand the program, and it is permanently authorized by the legislation.

--1973: Under pressure from doctors and other groups, the Nixon administration backs away from its proposal to expand HMO services, but Kennedy moves ahead on the issue. He sponsors the HMO Act of 1973, which is revised several times before it is eventually signed into law Dec. 29, 1973. The bill authorizes the spending of $375 million over five years to evaluate HMOs and requires employers with more than 25 employees to provide them with the option of a federally certified HMO where available. It also prevents states from restricting doctors who want to join HMOs.

--1973: Kennedy puts up "intense opposition" to the appointment of Caspar Weinberger as secretary of health education and welfare, according to a biography by Adam Clymer, a former New York Times reporter. Kennedy and other senators voice doubts about whether Weinberger can serve the interests of the poor, older Americans and uneducated people, but Weinberger is confirmed.

--1974: Kennedy teams up with Rep. Wilbur Mills, D-Ark., the head of the House Ways and Means Committee, to propose a compulsory national health insurance plan to be paid for by payroll taxes and general revenues. Kennedy’s aides secretly meet with Nixon administration officials but Kennedy and Nixon never agreed on a compromise. The Democrats’ plan is opposed by the American Medical Association and other groups. Kennedy tries unsuccessfully to revive the effort after Nixon resigns. Years later, Kennedy tells the Boston Globe that he may have missed an opportunity by not working closer with Nixon to find a consensus. Perhaps, he says, "We should have jumped on that."

--1976: Although Democratic presidential candidate Jimmy Carter campaigns on the promise of a national health insurance program, Kennedy criticizes him for "intentionally [having] made his position on some issues indefinite and imprecise."

--1977: Carter, concerned about the strength of the economy, moves away from national health insurance and proposes measures to contain expenses, such as hospital cost control. This prompts Kennedy in May at a United Auto Workers conference to lambast Carter for not setting a timetable to establish his health insurance program – a promise Carter made on the campaign trail. "Health reform is in danger of becoming the missing promise in the administration’s plans," Kennedy says.

--1979: In March, Carter proposes phasing in a national health program, which he says will cost $10 billion to $15 billion, beginning in 1983. Kennedy quickly opposes the plan, calling Carter’s approach to health reform "piecemeal." The administration shoots back that Kennedy's proposal for a complete national health plan is too expensive. Kennedy later credits this disagreement as one of the influences on his decision to challenge Carter for the Democratic nomination for the president in 1980.

--1986: As part of what Kennedy calls "a fairly small step" to extend coverage to the country's uninsured, he introduces legislation requiring employers to allow employees and others who lose group health coverage to purchase their employer-based insurance at their own expense for a fixed time period. It passes as part of the 1985 budget reconciliation bill. On April 7, President Ronald Reagan signs the Consolidated Omnibus Budget Reconciliation Act or COBRA, which was adopted as the name for Kennedy's program.

--1987: Kennedy becomes the chairman of the Senate’s Labor and Human Resources Committee (later known as the Health, Education, Labor and Pensions Committee).

--1990: As chief co-sponsor, Kennedy joins forces with with Sen. Tom Harkin, D-Iowa, to drive the passage of the Americans with Disabilities Act, prohibiting discrimination based on disability.

 

--1990: Joined by Elizabeth Taylor, Kennedy and Sen. Orrin Hatch, R-Utah, hold a press conference on March 6 introducing a bill that eventually would be known as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to provide federal grants to improve care for individuals and families hit by HIV and AIDS. The measure passes later in the year and is signed by President George H.W. Bush on Aug. 18.

--1992: Kennedy co-sponsors the Mammography Quality Standards Act, which seeks to ensure that all women have access to quality mammography by dealing with issues at screening facilities, including lack of oversight, inferior equipment and poorly trained staff. The law, which has been reauthorized several times, requires all facilities to be inspected, accredited by an FDA-approved group and certified by the FDA or the state.

--1996: Together with Sen. Nancy Landon Kassebaum, R-Kan., Kennedy co-sponsors the Health Insurance Portability and Accountability Act (HIPAA) to protect workers and their families who change jobs or lose employer-based health insurance from being locked out of health coverage or forced to wait for coverage due to pre-existing medical conditions. It also prohibits insurance from being cancelled because of illness. Also, for what the bill is now most well-known, HIPAA establishes provisions on medical confidentiality. President Bill Clinton signs the bill into law on Aug. 21, 1996.

--1997: Kennedy and Hatch announce plans to provide health insurance for millions of uninsured children through the State Children’s Health Insurance Program (SCHIP) and fund the program through an increase in cigarette taxes. Hatch says, "Some have referred to us as the odd couple of the United States Senate. I like to think of us as the dynamic duo."

The legislation, although initially a victim to budget rules, passes and is signed by Clinton in August as part of the Balanced Budget Act. It provides money to the states to pay for health coverage for children who do not qualify for Medicaid but whose families cannot afford private insurance. Kennedy calls it "the most far-reaching step that Congress has ever taken to help the nation's children, and the most far-reaching advance in health care since the enactment of Medicare and Medicaid a generation ago."

--1998: Kennedy is one of 31 co-sponsors for the Patient Bill of Rights. Although this measure is not the first such bill to be introduced, it becomes the leading vehicle to address public anger toward managed care practices. The legislation aims to protect patients who are members of managed care plans from, among other things, being denied care for the purposes of cost-containment. It also opens the door for patients who are injured as the result of being denied care to sue health plans in state courts.

Later, a more sweeping measure advanced by Rep. Charles Norwood, R-Ga., a retired dentist, passes the House, but Senate GOP leaders hold off Democratic efforts to bring up the bill in that chamber before the close of the 105th Congress. In 1999, the Republican-controlled Senate approves a scaled-back measure while the House, in November, approves a Democratic-backed version. In 2000, after six months of House-Senate negotiations, the conference committee is unable to reach a final agreement.

--2001: Kennedy together with Sens. John McCain, R-Ariz., and John Edwards, D-N.C., introduce the Bipartisan Patient Protection Act, giving patients the right to sue health plans in state courts based on denied care. Although President George W. Bush vows to veto the bill, it passes the Senate 59-36 in June.

The House passes a modified GOP-backed measure that allows employers to protect themselves from liability, the result of a closed-door compromise made between Bush and Norwood, a long-time patients' bill of rights leader. The compromise, Kennedy said, ''makes [the patients' bill of] rights unenforceable.'' Adding ''a right without a remedy is not an effective right." A Senate-House conference never convenes to work out differences between the two chambers. Kennedy and the bill’s other primary sponsors continue attempts to reach agreement with the administration, but abandon these negotiations in 2002.

--August 2001: Kennedy and Hatch introduce the Rare Diseases Act. The legislation increases funding for the NIH Office of Rare Diseases and expands its work. It later splits into two different acts--the Rare Diseases Act and the Rare Diseases Orphan Product Development Act--which are signed into law by Bush in November 2002.

--2003: Kennedy backs Bush's 2003 plan to add a prescription benefit to Medicare that came with a $400 billion price tag spread out over 10 years. But when Kennedy learns that the Medicare Prescription Drug and Modernization Act of 2003 would, for the first time, allow private HMOs to compete with Medicare for patients, Kennedy works to amend the bill, criticizing the proposal for Medicare competition as "an untried, untested, unworkable program.'' His efforts ultimately prove futile and he opposes the final bill. The Medicare Prescription Drug and Modernization Act of 2003 passes Congress and is signed into law by Bush on Dec. 8, 2003.

Later, in an interview with the Boston Globe, Bill Novelli, chief executive of the AARP, which broke with Kennedy, a longtime ally, to endorse the Republican-backed bill, credits the prescription drug benefit to Kennedy. "I think the lesson he learned from the Nixon era is a lesson that history teaches us: You should not let the perfect be the enemy of the good," he says. "The Medicare Modernization Act was certainly not perfect, but the idea was, get it done and improve it over the coming years."

--2006: Kennedy and Sen. Charles Grassley, R-Iowa, secure passage of the Family Opportunity Act, which expands Medicaid coverage for children with special needs even if their parents earn more than the usual limit.

--2006: Kennedy, and Sen. Pete Domenici, R-N.M., work with mental health advocates, private insurers and industry on legislation to require private insurers to offer mental health benefits equivalent to traditional health benefits. The bill builds on 1996 legislation seeking to end restrictions on mental health coverage. The Senate approves the bill in September 2007 and the House in March 2008. After negotiations between the Senate and House, language supporting the combined plan is written into law as part of the economic stimulus bill. The effective date for most health plans to make the change is Jan. 1, 2010.

--May 20, 2008: Kennedy is diagnosed with a malignant glioma, a common, highly lethal form of brain tumor. He undergoes surgery and other treatments.

--July 9, 2008: Just a month after undergoing surgery for brain cancer, Kennedy makes a surprise appearance in the Senate, which gives Democrats enough votes to prevent a Republican filibuster that would have cut Medicare fees to doctors. "We got this victory because of Ted," Sen. Max Baucus, D-Mont., tells the Los Angeles Times. The bill passes later that month after the Senate overrides President Bush’s veto.

 -- 2008: Kennedy, weakened by cancer treatment, addresses the Democratic National Convention in Denver Aug. 25, pushing the party to continue his efforts on reform. "For me this is a season of hope -- new hope for a justice and fair prosperity for the many, and not just for the few -- new hope," he says. "And this is the cause of my life -- new hope that we will break the old gridlock and guarantee that every American -- north, south, east, west, young, old -- will have decent, quality health care as a fundamental right and not a privilege."

--2009: On June 9, Kennedy submits the Affordable Health Choices Act, and although Kennedy is sidelined fighting his cancer and not able to participate, the measure passes in his Senate Health, Education, Labor and Pensions Committee as part of the larger Capitol Hill effort on health reform. However, the Senate Finance Committee is expected to significantly alter the bill. In July, Kennedy, along with long-time speechwriter and friend Robert Shrum, published an article in Newsweek outlining his personal and political experiences with health issues over the years and describing his vision for reform.  He wrote: "For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society."