今日关注：奥巴马 医改 中期选举
Health care and the mid-term elections
一
传统来讲，金融集团和军工企业是共和党的支持者，高科技企业和知识精英是民主党的主要支持者，两党曾经平分秋色。但随着金融集团的力量越来越强大，共和党的势力越来越大，这也是共和党长期占据美国执政位置的原因。
二
北京时间10月15日上午消息，据外电报道，美国佛罗里达州地方法官罗杰-文森（Roger Vinson）周四判定，各州可继续推进寻求推翻奥巴马总统的医疗改革法案的诉讼案。上月，文森曾在听证会上表示将阻挠美国司法部驳回该诉讼的努力。那些反对奥巴马的2.5万亿美元医疗改革法案的人表示，该法案实行非法税收，要求公民必须获得医疗保险等规定违反宪法。今年3月，以共和党为主的多个州总检察长提起诉讼，要求推翻新的医疗改革法案。允许该诉讼继续进行的判决对奥巴马而言是一大挫折。奥巴马将医改作为其任期议程的基础。而在11月2日举行的中期选举中，他还将面临着共和党的强大挑战。文森驳回了针对医疗改革法案的六项控诉中的四项，并称他看到另两项控诉继续推进的理由，其中一项指控是针对该法案会迫使各州政府在医疗方面投入巨额资金。法律专家指出，该诉讼案很有可能会送至美国高等法院，但大部分专家称各州获胜的几率很小。
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（选民，选举人；构成全体的，组成的）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（时常，经常）， is Barack Obama’s controversial new health-care reform bill， enacted back in March. His strategy has been to tackle the issue head-on（正面的；正面地）， 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（做了错事而未被察觉、能为所欲为而不受约束， 犯了大错而没有收惩罚），” 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（和解）。”
Another strategy is to challenge the unpopular “individual mandate（命令，指令；授权，委任）”， 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（关小，调低；拒绝） 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（不妥协，不让步） 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（勒马绳；约束，控制，遏制） rising health costs and premiums（保险费；溢价；红利，奖金；优惠让价；高价的，优质的）。 That may or may not happen; a lot depends on how a new panel meant to hack away at the cost of government-reimbursed（政府报销的） 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 down（陷入泥淖， 陷入困境）Obamacare. 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（繁重的;麻烦的；负有义务的;有偿的）provisions in the new health laws. Administration officials rushed to offer a waiver（豁免；弃权） to the firm， fearing a stampede（蜂拥；惊逃） for the exit（退出） from other big employers of workers who are on low wages. Mr Butler believes that many more such arbitrary（随意的，任意的；武断的，专制的） 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（牵连;连累；意味着;暗指）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（不悦的） 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（无偏袒的， 无党派性的） 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（（使）结晶， （使）具体化， （使）变得明确）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.”
