http://www.nytimes.com/2008/07/10/wa...dicare.html?hp

Kennedy Returns to Help Pass Medicare Bill

By CARL HULSE and ROBERT PEAR
Published: July 10, 2008

WASHINGTON — Senator Edward M. Kennedy made an extraordinary return to the Senate on Wednesday to deliver Democrats a decisive victory on a signature health care issue despite his own treatment for brain cancer.

Lauren Victoria Burke/Associated Press


Senator Edward M. Kennedy, with his niece, Caroline Kennedy, entered the Capitol on Wednesday for the first time since his brain surgery.

Mr. Kennedy, Democrat of Massachusetts, flown in virtual secrecy to Washington, stirred the normally staid chamber to a rousing ovation and moved many colleagues to tears when he made a surprise appearance in the Senate in the late afternoon to break a Republican filibuster on a Medicare bill.

Looking steady but flushed in his first visit to the Capitol since his cancer was discovered in late May, Mr. Kennedy was quickly surrounded by senators who could barely keep from overwhelming him despite cautions to keep their distance because his treatments have weakened his immune system.

Democrats were overjoyed and Republicans stood, smiled and applauded as well, though some looked uneasy as it dawned on them that once again Mr. Kennedy was about to hand them a stinging defeat on health care policy. The defeat was sealed once Mr. Kennedy delivered a clear “aye” in his familiar but recently absent baritone accompanied by twin thumbs-up.

“I didn’t want to miss the opportunity to be able to express my voice and my vote,” Mr. Kennedy told reporters as he left the Capitol to return to Massachusetts and resume his treatments.

Mr. Kennedy’s appearance was the product of a covert operation coordinated with Senator Harry Reid of Nevada, the majority leader, after the bill to block a cut in doctor fees paid by Medicare fell one vote short two weeks ago. Few Democrats were made aware of the plan until minutes before the vote, and Republicans were blindsided, giving them no time to plot a counterstrategy.

Mr. Reid escorted Mr. Kennedy into the chamber along with Senator Barack Obama of Illinois, the Democratic presidential contender who was in the Senate for the Medicare vote as well as an earlier terror surveillance vote. Also serving as informal bodyguards were Senators John Kerry of Massachusetts and Christopher J. Dodd of Connecticut and Representative Patrick J. Kennedy of Rhode Island, Mr. Kennedy’s son.

Mr. Dodd said that Mr. Kennedy’s medical team had cautioned against the visit but that Mr. Kennedy would not be deterred.

“This is an act of courage,” said Mr. Dodd, a close friend.

Many of Mr. Kennedy’s staff members watched from the Senate gallery along with his wife, Victoria, and his niece Caroline Kennedy.

Once it became clear that Democrats had the votes to push the bill through, Republican resistance collapsed and the procedural obstacle was cleared on a vote of 69 to 30. The measure now goes to the White House, which has threatened a veto.

Tony Fratto, a White House spokesman, said there was “nothing to indicate” a change in the veto threat, but “it’s always the president’s decision.”

Nine Republicans switched their votes, providing enough for a veto override if the White House makes good on its threat and all senators stick with their position.

“Without Ted Kennedy, we wouldn’t have gotten the extra nine votes,” said Mr. Reid, who aides said was laughing uproariously in the cloak room after they pulled off the victory. “They knew the die had been cast, so they gave up.”

Senate officials said Mr. Kennedy had been unhappy that his absence had hurt efforts to block the cuts, which some fear could make some doctors less willing to treat patients on Medicare, a program Mr. Kennedy has championed since he voted for its creation in 1965. They said he contacted Mr. Reid about the possibility of traveling to Washington, and the two senators and their staffs hatched the plan that was cemented Tuesday night.

The bill would reverse a 10.6 percent cut in Medicare payments to doctors who care for millions of older Americans. The cut, required by a formula in the Medicare law, took effect on July 1, though the Bush administration has delayed processing new claims for two weeks, to give Congress time to come up with a compromise.

The bill had overwhelming bipartisan support in the House, where it was passed by a vote of 355 to 59 on June 24.

President Bush and many Republican senators have opposed the measure, in part because it would finance a small increase in Medicare payments to doctors by cutting federal payments to insurance companies that offer private Medicare Advantage plans, as an alternative to the traditional government-run program.

“It has to be done in a bipartisan way, in a way that keeps alternatives for seniors in the private sector,” said Senator John Cornyn, Republican of Texas, who was one of the original holdouts against the measure. But Mr. Cornyn ended up supporting it Wednesday, along with eight others who voted to block consideration of the measure just two weeks ago.

Others who switched their votes at the last minute on Wednesday, just before the roll call ended, were Saxby Chambliss and Johnny Isakson of Georgia, Lamar Alexander and Bob Corker of Tennessee, Kay Bailey Hutchison of Texas, Mel Martinez of Florida, Arlen Specter of Pennsylvania and John W. Warner of Virginia.

In the last week, the American Medical Association has run radio and television advertisements putting pressure on 10 Republican senators, including five of those who changed their votes. Two senators singled out for criticism by the A.M.A., John E. Sununu of New Hampshire and Roger Wicker of Mississippi, are in competitive races, but stood firm in opposition to the bill.

Jubilant Democratic political operatives quickly unleashed attacks, hammering Republican senators whether they had held firm in opposing the measure or switched sides to support.

Senator John McCain, who was absent, addressed the Medicare vote on the campaign trail on Wednesday. He said Democrats were playing political games rather than addressing an important issue. He said he would have voted against the measure.

Mr. Kennedy’s appearance is not the first by an ailing senator at a critical moment. In May 1985, Senator Pete Wilson, Republican of California, was taken by ambulance to the Capitol from Bethesda Naval Hospital where he had undergone an appendectomy and pushed into the chamber in a wheelchair, wearing a bathrobe and pajamas, to cast a critical vote in favor of President Ronald Reagan’s budget in May 1985.

In June 1964, Senator Clair Engle, Democrat of California, dying of a brain tumor, was wheeled into the Senate chamber for two crucial votes on the Civil Rights Act.

David M. Herszenhorn contributed reporting.