coming back to bite him

　　republicans want to repeal barack obama’s health laws. how badly could they hurt the reforms—and how much will this help them in november’s elections?

　　oct 14th 2010 | new york

　　“what does mrs d’amico care about most?” that question, concerning a fictional but representative constituent from his long island base, is one that preoccupies steve israel, a moderate democratic congressman from new york. he worries that the answer, all too often, is barack obama’s controversial new health-care reform bill, enacted back in march. his strategy has been to tackle the issue head-on, by trumpeting the virtues of “obamacare”, such as the planned end to lifetime caps on insurance payouts or the guarantee that insurance must be offered to all, without discrimination on the grounds of pre-existing conditions. “i just got sick of the republicans getting away with murder,” he declares.

　　this makes him a rare bird, for most democrats running for re-election are staying mum or apologising for their votes for reform. republicans, who have noisily declared their intention to repeal the new health laws if they win control of congress, appear to have found a useful weapon in the campaign.

　　an outright repeal is impossible, as mr obama could simply veto any such bill. so republicans are planning instead a strategy of “defunding” the new health law. even tom daschle, a prominent democratic former senator, thinks this is the republicans’ best weapon. in “getting it done”, a new book published this week, he declares “it would be all too easy to kill the reform effort not by repealing it, but by starving it.” the bill will need over $100 billion in around 100 new authorisations over the next decade, all of which will require approval from congress. besides that, the republicans could attach provisions to vital bills, such as the budget, that would forbid federal workers (say, at the internal revenue service) from implementing the law. congressman paul ryan, an influential republican from wisconsin, insists that “we’ll try every angle, from defunding to budget reconciliation.”

　　another strategy is to challenge the unpopular “individual mandate”, which requires everyone to buy health insurance. coalitions of states are pursuing several different lawsuits challenging the constitutionality of this mandate. a federal judge in michigan ruled in favour of the obama administration earlier this month in one of the suits, but the matter is likely to be fought all the way to the supreme court.

　　the most promising mode of attack for the right may be state-led obstructionism. republican leaders in many states, most notably utah and alaska, have suggested they will simply not implement obamacare. governor tim pawlenty of minnesota has ordered state officials not to co-operate with the reforms, even turning down（關(guān)小，調(diào)低；拒絕） grant money. he insists states have the right to decide whether they want to implement the laws slowly or quickly. he vows to fight the “federal power grab” until a repeal bill can be signed in 2013 by a new republican president—perhaps, he hopes, even himself.

　　one excuse for such intransigence（不妥協(xié)，不讓步） comes from the messy transition now taking place in the insurance markets. in the long term new insurance exchanges, due to appear in 2014 and backed up with fines and subsidies, are supposed to curb rising health costs and premiums. that may or may not happen; a lot depends on how a new panel meant to hack away at the cost of government-reimbursed health care for the elderly works in practice. but in the short term, individual americans buying cover for next year have already seen their premiums increase by an average of around 20%. mercer, a benefits consultancy, estimates that bigger corporations think health costs will increase by around 10% next year if no preventive action is taken—with roughly a quarter of that increase stemming from new health regulations.

　　but then again…

　　clearly the republicans have the means and the motive to bog downobamacare. but that does not make this wise public policy. stuart butler of the heritage foundation, a right-wing think-tank, argues that their approach is a scorched-earth policy that will lead to “great uncertainty for a few years”. one straw blew in the wind recently. mcdonald’s, a hamburger chain, said it might be forced to drop its (already meagre) health-insurance coverage because of onerous provisions in the new health laws. administration officials rushed to offer a waiver to the firm, fearing a stampede for the exit from other big employers of workers who are on low wages. mr butler believes that many more such arbitrary waivers, both for firms and for states, are coming. so health care is likely to turn into a mess, and the less republicans are implicated in the disaster the better for them.

　　and would killing the bill really be popular? it is true that the reforms are unpopular at the moment. but a new poll published last month by the associated press found that twice as many americans think the new law did not go far enough as think it went too far. many of those disgruntled people are actively hostile to obamacare. but they might be even more hostile to any effort to kill the law.

　　some parts of it are popular. although the main provisions of the new laws do not kick in for a few years, the administration has already implemented some regulations that voters like. for example, it has stopped insurers from excluding pre-existing conditions from coverage for children, and they can no longer cancel policies for any reason other than fraud. subsidies are also already on offer to help smaller businesses with tax credits, and to offer prescription-drug rebates on medicare, the government health scheme for the elderly. polling by the kaiser family foundation (kff), a non-partisan think-tank, shows each of these provisions is popular with 60% or more of americans. and as people start to enjoy these new benefits, the popularity of the bill that created them may well rise.

　　perhaps the most convincing reason to think republicans will not win as much applause as they hope comes from drew altman of kff. a recent poll by his organisation found 49% in favour of the new laws and 40% against. crucially, of those who were angry about the reforms, 77% said it reflected a broader anger about the shortcomings of the federal government—and only a fifth had specific grievances against obamacare.

　　all this suggests that health care itself may not prove decisive at november’s elections, even as that vote itself may end up determining the fate of health reform. but mr ryan crystallises the anger he senses among ordinary people in wisconsin, a state that mr obama swept two years ago, this way: “this is not just about health care: it’s really about the role and goal of government in the 21st century.”

　　今日關(guān)注：奧巴馬 醫(yī)改 中期選舉

　　health care and the mid-term elections

　　【一】

　　傳統(tǒng)來(lái)講，金融集團(tuán)和軍工企業(yè)是共和黨的支持者，高科技企業(yè)和知識(shí)精英是民主黨的主要支持者，兩黨曾經(jīng)平分秋色。但隨著金融集團(tuán)的力量越來(lái)越強(qiáng)大，共和黨的勢(shì)力越來(lái)越大，這也是共和黨長(zhǎng)期占據(jù)美國(guó)執(zhí)政位置的原因。

　　【二】

　　北京時(shí)間10月15日上午消息，據(jù)外電報(bào)道，美國(guó)佛羅里達(dá)州地方法官羅杰-文森(roger vinson)周四判定，各州可繼續(xù)推進(jìn)尋求推翻奧巴馬總統(tǒng)的醫(yī)療改革法案的訴訟案。上月，文森曾在聽(tīng)證會(huì)上表示將阻撓美國(guó)司法部駁回該訴訟的努力。那些反對(duì)奧巴馬的2.5萬(wàn)億美元醫(yī)療改革法案的人表示，該法案實(shí)行非法稅收，要求公民必須獲得醫(yī)療保險(xiǎn)等規(guī)定違反憲法。今年3月，以共和黨為主的多個(gè)州總檢察長(zhǎng)提起訴訟，要求推翻新的醫(yī)療改革法案。允許該訴訟繼續(xù)進(jìn)行的判決對(duì)奧巴馬而言是一大挫折。奧巴馬將醫(yī)改作為其任期議程的基礎(chǔ)。而在11月2日舉行的中期選舉中，他還將面臨著共和黨的強(qiáng)大挑戰(zhàn)。文森駁回了針對(duì)醫(yī)療改革法案的六項(xiàng)控訴中的四項(xiàng)，并稱他看到另兩項(xiàng)控訴繼續(xù)推進(jìn)的理由，其中一項(xiàng)指控是針對(duì)該法案會(huì)迫使各州政府在醫(yī)療方面投入巨額資金。法律專家指出，該訴訟案很有可能會(huì)送至美國(guó)高等法院，但大部分專家稱各州獲勝的幾率很小。