Kennedy’s Absent Voice on Health Bill Resonates

“He would lend a gravitas to the issue that we’re kind of missing right now,” said Senator Tom Harkin, Democrat of Iowa and a member of the Health, Education, Labor and Pensions Committee.

Mr. Harkin’s Republican counterparts similarly invoked Mr. Kennedy in criticizing a health care measure the committee approved Wednesday with only Democratic support. “It is a very one-sided, very liberal bill,” said Senator Orrin G. Hatch of Utah. “I know that Ted would not have done that had he been able to be here.”

Senator Edward M. Kennedy, who is battling brain cancer, has not been on Capitol Hill since April. Colleagues routinely lament his absence, which has been especially painful to Mr. Kennedy, the committee chairman, who has spent much of his career trying to expand health coverage.

People close to Mr. Kennedy marvel at how his fight for his life could coincide so dramatically with what may be the culminating summer of his life’s cause. “It’s been a miraculous story,” said Senator Christopher J. Dodd, Democrat of Connecticut.

The 77-year-old Mr. Kennedy is at his home on Cape Cod, undergoing new chemotherapy treatments that have left him depleted and frustrated in recent weeks, friends say. “He has moments that are tremendous,” Mr. Dodd said. “And others that are really tough.”

Ever since Mr. Kennedy’s diagnosis in May 2008, friends and others have tried to honor an unspoken code not to talk about his health except to say that he is doing well, engaged in his work from afar and looking forward to returning to the Senate.

Colleagues and public officials have also been wary of appearing to be planning for life after Mr. Kennedy — a particularly verboten topic in Massachusetts, where several Democratic members of Congress and possibly members of the Kennedy family could vie for the first Senate seat to come open in that state since John Kerry, the junior senator, was elected in 1984.

Mr. Kennedy’s office says the senator is in touch with his staff and monitoring the progress of health care legislation by phone and C-Span. “He’s doing well, continuing to balance his treatment with his work,” said Mr. Kennedy’s spokeswoman, Melissa Wagoner.

But conversations with friends and colleagues about Mr. Kennedy’s condition now typically include a weary acceptance of the inevitable: that his cancer — whose survival time for people similarly afflicted is typically measured in months, not years, from diagnosis — is taking a mounting toll.

The “constant phone calls” that his staff and fellow senators reported over the winter have fallen off; people who have seen him say Mr. Kennedy comprehends things well but struggles to speak at times.

Vicki Kennedy, Mr. Kennedy’s wife, has limited visitors on Cape Cod to a few friends and family members. She does not want her husband to be seen in his weakened state, friends say; nor does she want him to expend limited energy.

On days when he feels strong enough, Mr. Kennedy will go out on his sailboat (a video clip last week showed him bundled up in a red parka as he arrived at the pier) or take a golf cart drive to visit his older sister, Eunice Shriver, who lives up the street in Hyannis Port. Last week, a family member said, Mr. Kennedy and his sister toasted her 88th birthday together while overlooking the ocean.

When President Obama met with Pope Benedict XVI at the Vatican last Friday, he asked the pontiff to pray for Mr. Kennedy, said Robert Gibbs, the White House spokesman. Mr. Obama also delivered a private letter from the senator to the pope

As his health has declined, Mr. Kennedy has become more of an inspirational leader than a tangible one. He turned over his day-to-day committee duties to Mr. Dodd in the spring. Mr. Dodd called him Tuesday night to tell him the health committee, known as HELP, would pass the health bill — whose centerpiece is a government-run insurance plan — the next day. “I called about 8:15, and he was already asleep,” Mr. Dodd said. Mr. Kennedy called back at 7 a.m. Wednesday sounding thrilled.

“Just bellowing with joy,” Mr. Dodd said, “as excited as I’ve heard him in a long time.”

Mr. Dodd takes exception to Republican criticism that the committee’s bill would have been less partisan under Mr. Kennedy, saying Mr. Kennedy would have fought for its major components. But he also said the Republicans might drop their opposition as the legislation evolved.

“I don’t take that as a permanent problem,” he said, “and Teddy wouldn’t either.”

Senators of both parties say the health care debate is entering its most acute phase — with multiple committees in the House and Senate trying to forge compromises — a period Mr. Harkin called “Kennedy time.”

No one, he said, is better suited than Mr. Kennedy to navigating the obstacles that could derail, or delay, the passage of a health care bill.

“Let me say something that’s very obvious,” said Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee. “If Kennedy were here, it would make melding the Finance Committee bill and the HELP Committee bill much easier.”

Similarly, members of the health committee, particularly Democrats, often speak in terms of “What would Teddy do?” Senator Patty Murray, Democrat of Washington, said. “We’re all working to do what we think he’d want us to do.”

Aside from Mr. Obama’s determination to deliver comprehensive health care legislation, Mr. Kennedy’s precarious health has created an unspoken urgency.

“We are conscious that it would be appropriate that he should be chairman of this committee when the bill is passed,” said Senator Jack Reed, Democrat of Rhode Island and a member of the health committee.

Some hold out hope that Mr. Kennedy can make a last-ditch appeal to his Republican friends — a kind of dying wish — to support the legislation so he can complete his life’s work.

It is not clear, though, that such a request would have the desired effect. Mr. Hatch, a close friend of Mr. Kennedy, said, “I would like to work with him on it and have a legacy issue for him.” But he said that that would have been more likely if Mr. Kennedy had been more involved in shaping the bill.

Mr. Hatch said he had not spoken with Mr. Kennedy in several weeks.

“I’m a believer in miracles,” Mr. Hatch said. “I’m praying that somehow or other he’ll come through. But it’s very dramatically against him.”