Senator Eliot Shapleigh - El Paso, Texas

WASHINGTON – As the health care debate consumed Congress this month, Sen. Kay Bailey Hutchison emerged as a visible critic – impassioned but powerless.

One day last week, for instance, she took to the Senate floor to rail against a provision allowing for immediate tax hikes to pay for programs that won't roll out for three or four years. That's an outrage, she declared, arguing to send the bill back to committee.

Democrats quickly swatted down the stalling tactic, tabling her motion before Republicans could react. Visibly angry, Hutchison denounced the maneuver moments later.

"We're talking about $100 billion in taxes that will start in three weeks," she said. "I hope the American people are listening."

Despite her sudden intense interest in the debate raging in Washington, Hutchison doesn't have a long record to point to on health care. She was active on the biggest health care debates of her time in the Senate, but no signature legislation on the topic bears her name. She wins credit from some for behind-the-scenes battling for Texas interests, but that can be hard for voters to appreciate.

Critics accuse her of grandstanding. And her role carries some risk. As of last summer, she had promised to quit the Senate by now to focus on unseating Gov. Rick Perry next year. So now that she has stayed in Washington expressly to battle the Democratic plan, she might come off as ineffectual if it passes.

"I certainly couldn't walk out on health care, because it affects so many Texans," she told a San Antonio radio station this month when she put her resignation on hold. "I just had to make the decision – very tough one for me – to stay and fight health care as long as I have breath."

Hutchison is gambling that either way, GOP voters in the March gubernatorial primary will reward her for resisting what they view as a government takeover of health care. To that end, Hutchison has made a flurry of floor speeches in recent weeks, a half-dozen impassioned arguments to slow down and think again.

The exposure – she's turned up often on cable networks, calling the bill a "monstrosity" – easily eclipses anything she's done previously on health care. But advocacy isn't the same as achievement.

The unceremonious defeat of her motion to send the bill back to committee drew scoffs from Perry, whose aides dusted off her recent boasts that she would "call in every favor, twist every arm" and "lead the fight."

"The senator has had zero influence in the health care debate," said Perry spokesman Mark Miner. "The only thing she's fighting to do is get in front of the cameras."

Democrats agree. "To see her try to rise on this issue when there has been no leadership is pretty impressive," said Ricardo Ramirez, aDemocratic National Committee spokesman.

The Hutchison camp rejects the taunts.

"It's unfortunate that the Democrats have chosen to debate amongst themselves and not include Republican input," spokesman Jeff Sadosky said, noting that last summer Hutchison worked on a GOP plan focused on tax credits, medical liability lawsuit limits and letting small businesses band together to buy cheaper insurance. "We've been able to shine a bright light on a 2,000-page government takeover."

Although Hutchison cited the health care fight as the top reason to prolong her Senate career, the issue isn't among the half-dozen highlighted on her campaign Web site. There's nothing to help voters learn about her accomplishments or stances in that area, though aides say that will change as the March primary approaches.

Nor do health care advocates and analysts consider it a signature issue for Hutchison, though she hasn't ignored it, either. Health care was, in fact, the first big issue to confront her when she joined the Senate in 1993.

The day after President Bill Clinton unveiled his plan for universal coverage, Hutchison was on the Senate floor denouncing it as "a cataclysmic change" that would entail "price controls, mandates and ... massive payroll taxes."

"What we are looking at is rationing of health care," she warned.

But for some conservatives, some of her positions show she's in the big-government camp herself. They cite her support for the state Children's Health Insurance Program and for a Medicare prescription drug benefit.

CHIP, which covers children in families with income too high to qualify for Medicaid, was created in 1997 at an initial cost of $24 billion – a pittance compared with the $400 billion initial price tag attached to the Medicare expansion in 2003.

President George W. Bush pushed hard for the drug benefit, which was popular with seniors. At the time, Hutchison called it one of the toughest votes she ever cast, but necessary to modernize a program that – as she said repeatedly – covered a five-day hospital stay for amputating a limb but not the drugs that could have made that surgery unnecessary.

CHIP has taken up far more of her energy through the years, though she hasn't gone out of her way to tout that.

She supported its creation. Two years ago, when Congress was debating its future, Hutchison – by then part of the Senate GOP leadership – was one of 18 Republicans who defied a Bush veto, voting to boost the program to $35 billion and expand coverage to more than 10 million children.

Anne Dunkelberg at the Center for Public Policy Priorities in Austin, which advocates for poor Texans, called the senator "very helpful" on the issue.

"She's paid attention to CHIP, and the fact that it was effective and popular," Dunkelberg said.

This is one element of health policy that has brought Hutchison and Perry into direct conflict. From the outset, Texas didn't manage to spend its allocation within the three years Congress gave states.

By early 2005, Texas had forfeited nearly $772 million in federal matching funds, even though Congress – largely through Hutchison's intervention – provided several extensions. The sum now tops $1 billion.

Hutchison has blamed mismanagement in Austin, at times calling out Perry directly. The governor has accused her of being ineffective at protecting the state's interests.

"Texas has never done a particularly good job using all the funds," said Tom Banning, chief executive of the Texas Academy of Family Physicians, which is neutral in the race. "She and Senator [John] Cornyn were very active at ensuring that the dollars designated for Texas were available for Texas."

Banning said Hutchison's clout shouldn't be measured by her role in the current debate – in which Republicans are largely shut out – nor by looking at health care legislation she has written, of which there isn't much.

Hutchison protected Texas through wonky backroom conversations over funding formulas on a range of federal programs, he said, and that's important. He noted that the senator has paid especially close attention to veterans' health care, and he lauded her for working to ease the nursing shortage and to protect doctors against cuts in Medicare reimbursements.

Hutchison calls herself a champion of health savings accounts, an approach to curbing consumer costs that has long been favored by Republicans. The 2003 Medicare revamp established such accounts, and she has since pushed to expand them. She also touts her advocacy of tort reform, to protect doctors from excessive malpractice judgments, and her efforts to promote cancer awareness and research.

Said Banning: "It's fair to say she's always had an interest in health care."