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WASHINGTON — On a day they wel-comed their newest colleague, senators alsopaused to remember Sen. Edward Ken-nedy’s nearly five decades in Congress andhis passionate commitment to health carereform.

“The impact he etched into our historywill long endure,” Senate Majority LeaderHarry Reid of Nevada said Thursday. Reidadded: “His dream shall never die.”

A frail Sen. Robert Byrd addressed theSenate for the first time in months to paytribute to Kennedy, his one-time rival andlongtime dear friend.

In a strong voice that has not been heardon the Senate floor since February, the

91-year-old West Virginia Democrat — whospent several weeks in the hospital fightinglife-threatening infections this spring andsummer — reminisced about Kennedy’spersonal gestures, love of life and accom-plishments.

“He believed that life was a contact sportbut that it should never be played withoutjoy,” Byrd said, speaking from his now-familiar wheelchair and dabbing his eyes.“And that is how he saw politics as well.”

Byrd is the longest-serving senator, hav-ing won a record ninth term three yearsago. In the early 1970s, Byrd defeatedKennedy in a race for the post of Democraticwhip.

Kennedy died Aug. 25 at 77, succumbingto brain cancer after a 15-month fight. Hewas buried at Arlington National Ceme-tery.

Later Thursday, George LeMieux, R-Fla.,was sworn in by Vice President Joe Biden,replacing Republican Sen. Mel Martinez.

LeMieux took the office one day afterwatching Martinez give his farewell speechto the chamber.

LeMieux was appointed by Florida Gov.Charlie Crist, his former boss, and will holdthe job only 16 months while Crist andothers seek the same seat.

—Associated Press

Republican George LeMieux (left), appointed byFlorida Gov. Charlie Crist (right), was sworn into theSenate on Thursday. He replaces Mel Martinez.

JOE BURBANK/ORLANDO SENTINEL PHOTO 2006

SPOTLIGHT THE U.S. SENATE

A fresh arrival follows a fond farewell

WASHINGTON — In his health care ad-dress Wednesday night, President BarackObama proposed a new element in hisoverhaul plan, a “trigger” to prevent highermedical costs from pushing the budget deficithigher.

Here is a snapshot of the proposal.

Q What is a “trigger?”

A As applied to government programs, it’sa provision for making something hap-

pen if something else happens first. SocialSecurity, for instance, has a cost-of-livingtrigger: If food, clothing and other prices goup, benefit checks are raised automatically.

Q How would that work to hold downgovernment spending?

A The idea is that if spending on healthcare were to get out of control, cutbacks

in government outlays would be made. Specif-ically, the trigger — also referred to as a “failsafe” — would fire if savings that Obama sayshis plan would create failed to materialize.

Proponents of the health care overhaul arecounting on those projected savings to play abig role in financing the extension of insur-ance coverage to more Americans. TheWhite House, backed by such economists asDavid Cutler of Harvard University, main-tains that making the system more efficientand productive could save hundreds ofbillions of dollars.

Republicans, as well as some moderate and

conservative Democrats, have expressed con-cern that if Congress approves the broadoverhaul and it fails to yield the promisedsavings, neither the president nor Congresswould step in and prevent the deficit fromsoaring.

Q Would the trigger apply to all health carespending?

A No. The idea is to apply it to Medicare’spayments to doctors and others who

provide services to the elderly. Reimbursingthem is a major chunk of federal health carespending, and readjusting the payment sched-ule could be relatively simple to do.

Under Obama’s proposal, providers whofailed to make sufficient progress in control-ling costs would see their Medicare paymentsreduced.

Q Would that only act as a curb onMedicare costs?

A The hope is that the threat of reducedfederal spending could also persuade

providers who aren’t greatly dependent onMedicare to restructure, too, because a reduc-tion in government services can transfermore risk — that is, more potential liability —to the private sector and drive up its costs.

Q Would the trigger be automatic?

A No, a special board would decide when topull it.

Q Is this the same trigger that could launchthe “public option?”

A No, the fiscal trigger is entirely differentfrom the concept being floated by Maine

Republican Sen. Olympia Snowe. Under

Snowe’s proposal, a public option would notbe established unless the government deter-mined that private insurers in a particularregion had failed to revamp their polices toprovide more people with coverage that they

can afford.Snowe’s trigger is viewed as a possible

legislative compromise between supportersof a public option in Congress and those whooppose it.

Obama’s fiscal ‘trigger’ targets Medicare costs Plan would cut federal outlay if savings don’t materialize

By James OliphantTRIBUNE NEWSPAPERS

Obama adviser David Axelrod, right, greets Sen. Lindsey Graham, R-S.C., before the president’sWednesday address on health care, in which he proposed a “trigger” for Medicare spending.

JASON REED/GETTY PHOTO

WASHINGTON — A day afterPresident Barack Obama went toCapitol Hill to renew his call for asweeping health care overhaul,Democrats across the ideologicalspectrum rallied behind him, giv-ing important new momentum tothe push for legislation this year.

Especially important for theWhite House was the reaction ofseveral conservative Democrats,who will be crucial to passing ahealth care bill in the House ofRepresentatives and the Senate andwho cheered the president’s pledgeto ensure that a health overhaulwould not add to the governmentdebt.

“If the details live up to thequality of the speech, then it’s agood plan,” said Tennessee Rep. JimCooper, a conservative Democratwho has been highly critical of theliberal health care bill developed byHouse Democratic leaders.

On the left, liberal lawmakers andinterest groups, who have grownmore anxious about the fate of aproposed government insuranceplan, applauded Obama for force-fully endorsing the idea Wednesdaynight, even though he said he wasopen to alternatives.

“The president last night spoke tothe conscience of America,” saidRep. Barbara Lee, D-Calif., one ofthe chamber’s most liberal mem-bers who also heads the Congres-sional Black Caucus. “He talkedabout this being a moral impera-tive, an issue of social justice. Andbelieve me, that resonated.”

Labor unions, which have bris-tled at proposals to tax high-valuehealth plans such as those providedunder some union contracts, heldtheir fire even as Obama suggested

such an approach in his speech.“I take the president at his word

that he does not want to raise taxeson the middle class,” said AndyStern, head of the influential Serv-ice Employees International Union.

Most Republican leaders Thurs-day continued to lambaste Obama’shealth care plan.

“It sounded very much like theChicago politics that I know he’sfamiliar with,” said Arizona Sen.Jon Kyl, the No. 2 Republican in theSenate. “It appeared as if he wastrying to ram something through.”

Privately, however, some Repub-licans worried that the party’s un-remitting opposition to the Demo-cratic plans could boomerang innext year’s congressional elections,especially if a far-reaching plan isapproved.

To build on Obama’s rhetoric,Democratic leaders must swiftlyshow progress in moving healthcare bills.

Obama’s speech did not settlesome of the most contentious ques-tions bedeviling that effort, includ-ing the public option and the detailsof any new taxes and fees that maybe necessary to pay for a majorexpansion in coverage.

Nor did the president succeed insmoothing out all the divisions inhis party.

Underscoring persistent tensionsbetween House Democrats and

their Senate colleagues, HouseWays and Means Committee Chair-man Charles Rangel, D-N.Y., a keyarchitect of the House health carebill, Thursday derided the Senatelegislative effort.

“I wouldn’t spend a lot of time onwhat the Senate is thinking. Theyare not thinking, quite frankly,”Rangel said.

Richard Simon, Janet Hook andPeter Nicholas contributed to thisreport.

nlevey@tribune.com

Democrats heed leader’s callParty factionsre-energized butmust find waysto bridge gapsBy Noam N. LeveyTRIBUNE NEWSPAPERS

Before a speech to the American Nurses Association on Thursday, President Barack Obama is introduced by group President Beck Patton, left, and ac-companied by nurses Sonia Reich, second left, and Linda Gural. Democrats across the ideological spectrum praised Obama’s health care address.

CHARLES DHARAPAK/AP PHOTO

18 CHICAGO TRIBUNE | SECTION 1 | FRIDAY, SEPTEMBER 11, 2009

NATION &WORLD PAGES 18-27

The White House Web site hasinformation on the Obamaadministration’s health careplan at www.whitehouse.gov/issues/health_care/plan/

Health care goals

President Barack Obama’s make-or-breakcongressional address Wednesday nightdrew nearly 32 million viewers. But the audi-ence was 39 percent smaller than that forObama’s first address to a joint session ofCongress, on Feb. 24, which attracted 52.4million viewers.

The speech drew 8.16 million viewers toNBC, 7.4 million to ABC and 5.63 million toCBS.

Fox didn’t air the speech, choosing in-stead to proceed with the season premiereof “So You Think You Can Dance,” the thirdtime this year the network has not run apresidential appearance in prime time.

Obama remarked Thursday on Fox’s deci-sion, but noted that “So You Think You CanDance” is “a show Michelle likes, by the way.”

—Matea Gold, Tribune Newspapers

32 million watch speech; Obama unfazed by Fox

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