John McCain Better known for hiswork on campaign finance reform and the military, McCain did have ahand in one landmark health bill — the Americans with DisabilitiesAct of 1990. (Photo: ALM File)

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There are many lawmakers who made their names in health care, seeking tousher through historic changes to a broken system.

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John McCain was not one of them.

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And yet, the six-term senator from Arizona and decoratedmilitary veteran leaves behind his own health care legacy,seemingly driven less by his interest in health care policy thanhis disdain for bullies trampling the “little guy.”

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Related: 12 biggest names in health caredisruption

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He was not always successful. While McCain was instrumental inthe passage of the Americans with Disabilities Act in 1990, mostof the health initiatives he undertook failed after running afoulof traditional Republican priorities. His prescriptions ofteninvolved more government regulation and increased taxes.

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In 2008, as the Republican nominee for president, he ran on ahealth care platform that dumbfounded many in his party whoworried it would raise taxes on top of overhauling the U.S.tradition of workplace insurance.

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Many will remember McCain as the incidental savior of theAffordable Care Act, whose late-night thumbs-down vote halted hisparty's most promising effort to overturn a major Democraticachievement — the signature achievement, in fact, of the Democratwho beat him to become president. It was a vote that earned himregular — and biting — admonishments from President DonaldTrump.

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McCain died Saturday, following a battle with brain cancer. Hewas 81. Coincidentally, his Senate colleague and good friend TedKennedy died on the same date, Aug. 25, nine years ago, succumbingto the same type of rare brain tumor.

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Whether indulging in conspiracy theories or wishful thinking,some have attributed McCain's vote on the ACA in July 2017 to achange of heart shortly after his terminal cancer diagnosis.

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But McCain spent much of his 35 years in Congress fighting anever-ending supply of goliaths, among them health insurancecompanies, the tobacco industry and, in his estimation, theAffordable Care Act, a law that extended insurance coverage tomillions of Americans but did not solve the system's ballooningcosts.

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His prey were the sort of boogeymen that made for compellingcampaign ads in a career stacked with campaigns. But McCain was“always for the little guy,” said Douglas Holtz-Eakin, the chiefdomestic policy adviser on McCain's 2008 presidential campaign.

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“John's idea of empathy is saying to you, 'I'll punch the bullyfor you,'” he said in an interview before McCain's death.

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McCain's distaste for President Barack Obama's health care lawwas no secret. While he agreed that the health care system wasbroken, he did not think more government involvement would fix it.Like most Republicans, he campaigned in his last Senate race on apromise to repeal and replace the law with something better.

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After Republicans spent months bickering amongst themselvesabout what was better, McCain was disappointed in the optionpresented to senators hours before their vote: hobble the ACA andtrust that a handful of lawmakers would be able to craft analternative behind closed doors, despite failing to accomplish thatvery thing after years of trying.

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What bothered McCain more, though, was his party's strategy topass their so-called skinny repeal measure, skipping committeeconsideration and delivering it straight to the floor. They alsorejected any input from the opposing party, a tactic for which hehad slammed Democrats when the ACA passed in 2010 without a singleGOP vote. He lamented that Republican leaders had cast asidecompromise-nurturing Senate procedures in pursuit of politicalvictory.

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In his 2018 memoirs, “The Restless Wave,” McCain said even Obamacalled to express gratitude for McCain's vote against theRepublican repeal bill.

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“I was thanked for my vote by Democratic friends more profuselythan I should have been for helping save Obamacare,” McCain wrote.“That had not been my goal.”

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Better known for his work on campaign finance reform and themilitary, McCain did have a hand in one landmark health bill — theAmericans with Disabilities Act of 1990, the country's firstcomprehensive civil rights law that addressed the needs of thosewith disabilities. An early co-sponsor of the legislation, hechampioned the rights of the disabled, speaking of the servicemembers and civilians he met in his travels who had become disabledduring military conflict.

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McCain himself had limited use of his arms due to injuriesinflicted while he was a prisoner of war in Vietnam, though he wasquicker to talk about the troubles of others than his own whenadvocating policy.

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Yet two of his biggest bills on health care ended in defeat.

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In 1998, McCain introduced a sweeping bill that would regulate the tobacco industry andincrease taxes on cigarettes, hoping to discourage teenagers fromsmoking and raise money for research and related health care costs.It faltered under opposition from his fellow Republicans.

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McCain also joined an effort with two Democratic senators,Kennedy of Massachusetts and John Edwards of North Carolina, topass a patients' bill of rights in 2001. He resisted at first,concerned in particular about the right it gave patients to suehealth care companies, said Sonya Elling, who served as a healthcare aide in McCain's office for about a decade. But he camearound.

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“It was the human, the personal aspect of it, basically,” saidElling, now senior director of federal affairs at Eli Lilly. “Itwas providing him some of the real stories about how people werebeing hurt and some of the barriers that existed for people in thecurrent system.”

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The legislation would have granted patients with privateinsurance the right to emergency and specialist care in addition tothe right to seek redress for being wrongly denied care. ButPresident George W. Bush threatened to veto the measure, claimingit would fuel frivolous lawsuits. The bill failed.

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McCain's health care efforts bolstered his reputation as alawmaker willing to work across the aisle. Sen. Chuck Schumer ofNew York, now the Senate's Democratic leader, sought his help onlegislation in 2001 to expand access to generic drugs. In 2015, McCain led abipartisan coalition to pass a law that would strengthen mentalhealth and suicide prevention programs for veterans, among otherveterans' care measures he undertook.

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It was McCain's relationship with Kennedy that stood out,inspiring eerie comparisons when McCain was diagnosed last yearwith glioblastoma — a form of brain cancer — shortly before hisvote saved the Affordable Care Act.

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That same aggressive brain cancer killed Kennedy in 2009, monthsbefore the passage of the law that helped realize his work tosecure better access for Americans to health care.

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“I had strenuously opposed it, but I was very sorry that Ted hadnot lived to see his long crusade come to a successful end,” McCainwrote in his 2018 book.

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While some of his biggest health care measures failed, theexperiences helped burnish McCain's résumé for his 2000 and 2008presidential campaigns.

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In 2007, trailing other favored Republicans, such as former NewYork City mayor Rudy Giuliani in early polling and fundraising,McCain asked his advisers to craft a health care proposal, saidHoltz-Eakin. It was an unusual move for a Republican presidentialprimary.

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The result was a remarkable plan that would eliminate the tax break employersget for providing health benefits to workers, known as the employerexclusion, and replace it with refundable tax credits to helppeople — not just those working in firms that supplied coverage —buy insurance individually. He argued employer-provided plans weredriving up costs, as well as keeping salaries lower.

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The plan was controversial, triggering “a total freakout” whenMcCain gained more prominence and scrutiny, Holtz-Eakin said. ButMcCain stood by it.

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“He might not have been a health guy, but he knew how importantthat was,” he said. “And he was relentless about getting itdone.”

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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