Senator Edward Kennedy's death comes as a political struggle appears to be chipping away at the Democratic power-broker's vision for what he called the cause of my life, providing affordable healthcare coverage to all Americans.
After decades of laying the groundwork to overhaul the U.S. healthcare system, Kennedy, who died late on Tuesday at age 77, was forced into a limited role in the fight to enact such legislation since being diagnosed in May 2008 with brain cancer.
Yet despite being away from Congress most of the year, Kennedy, one of the most effective lawmakers in U.S. history, managed to help draft a preliminary bill to overhaul the $2.5 trillion U.S. healthcare system.
Between chemotherapy treatments, the ailing liberal lion stayed in contact, the best he could, with colleagues and President Barack Obama, who at Kennedy's urging made healthcare reform his top domestic priority.
But Kennedy's physical absence on Capitol Hill created a void felt by those seeking a deal.
If the country ends up without healthcare reform, I think divine misfortune will be to blame, said Paul Light of New York University's Center for the Study of Congress.
Kennedy was a powerhouse in face-to-face negotiations who was sensitive to the need for bipartisanship, Light said. The debate is now stalled and getting vicious. Kennedy wouldn't have allowed it.
But Kennedy's death, with the extensive news coverage and outpouring of affection for him, could actually jump-start the effort for legislation that would be seen as a tribute to his lifetime of work.
Republican Senator John McCain has called Kennedy the most effective member of the Senate if you want to get results.
In a June interview with Reuters, McCain noted the difficulties in reaching a healthcare deal without him.
The absence of Ted Kennedy is a very big factor, McCain said. What Ted Kennedy usually does ... is that he sits down and negotiates and then you come to some kind of agreement.
Still, because of competing political and economic pressures, many congressional analysts figure a healthcare bill will be signed into law this year. But they say it is certain to fall far short of Kennedy's goal of covering all of the estimated 46 million Americans without health insurance.
Whatever passes, Kennedy deserves credit because he's been the guiding light on this issue for decades, said Ethan Siegal of The Washington Exchange, which tracks Congress for institutional investors.
Born to privilege and wealth, Kennedy became a voice for the young and old, poor and disabled, minorities and labor during his nearly half century in the Senate.
Over the years, he led successful efforts to upgrade schools, bolster civil rights, raise the minimum wage, outlaw discrimination and expand healthcare.
There's a lot to do, Kennedy told Reuters in a 2006 interview when asked to explain what even critics called his relentless efforts on behalf of the downtrodden.
Most of all it's the injustice that I continue to see and the opportunity to have some impact on it, Kennedy added.
Kennedy reached out to Democrats and Republicans, but also took on members of both parties when he saw fit.
After a dispute with Democratic President Jimmy Carter over healthcare, Kennedy challenged Carter for their party's 1980 presidential nomination. Carter won but was damaged and lost in the general election to Republican Ronald Reagan.
Kennedy worked with Republican President George W. Bush in 2001 to pass legislation, No Child Left Behind, to bolster schools and make them more accountable. But Kennedy later accused Bush of inadequately funding the program.
SON BATTLED CANCER
Kennedy got much of his passion to expand health insurance to all Americans in 1973 when his then-12-year-old son, Teddy, battled cancer. He survived, but lost a leg to the illness.
My dad would spend the night in the hospital with my brother, recalled Patrick Kennedy, who now serves in Congress as a member of the House of Representatives.
He met other families and heard their financial struggles, Patrick Kennedy said. He couldn't imagine not being able to pay the bills for my brother. He believed all should have affordable and quality health care.
Over the years there are countless stories of my dad paying for health insurance for people who didn't have the money, Patrick Kennedy said. My dad didn't tell me. Other people told me and thanked me.
Kennedy was a popular yet polarizing figure and frequent target of conservatives.
In recent months, with Kennedy's condition deteriorating, the drive to revamp healthcare ran into increased delays and opposition. Yet Kennedy remained upbeat. At least he tried.
In the July 27th edition of Newsweek magazine, Kennedy wrote: We will end the disgrace of America as the only major industrialized nation in the world that doesn't guarantee health care for all of its people.
On July 30, Obama named Kennedy as a recipient of the 2009 Presidential Medal of Freedom Award, the nation's highest civilian honor for lifetime achievement.
Obama called Kennedy one of the greatest lawmakers -- and leaders -- of our time. and said the senator had dedicated his career to fighting for equal opportunity, fairness and justice for all Americans.