ANALYSIS: US health care tussle far from over

By Chris Cermak Jan 20, 2011, 0:12 GMT

Washington - As US President Barack Obama and Chinese President Hu Jintao on Wednesday pledged to redefine their ties for the next three decades, much of the United States remained distracted by the contentious domestic health care debate that still simmers.

The House of Representatives on Wednesday evening voted 245-189 to repeal an overhaul of the US health care system that was signed into law by Obama in March. The vote fulfilled a promise from conservatives made during the November congressional elections that catapulted Republicans back to power in the chamber.

The repeal vote marked the latest sign of just how passionate and current the debate remains over reforming the health care industry, which makes up about one sixth of the US economy. Last year's reform marked the most ambitious overhaul of the sector in four decades.

The domestic issue that dominated much of Obama's first two years in office is clearly far from over, and could well sap more political energy in the second half of his term and into the 2012 presidential elections.

'This is indeed a war, and one that is virtually certain to continue for at least two more years and, probably, a good deal longer than that,' Henry Aaron of the Brookings Institution said in a web chat Wednesday with reporters.

The repeal has no chance of becoming law as long as Democrats control the Senate and Obama wields a veto pen. But it marked the first step in what conservatives have vowed will be an all-out effort to stymie the implementation of Obama's signature domestic achievement.

Battle has been joined on a series of fronts. Republicans have launched court challenges against a new requirement that Americans purchase health insurance. Lower court verdicts have been mixed, and the case is almost certain to end up before the US Supreme Court.

In Congress, Republicans plan a steady stream of votes to try to repeal different aspects of the health legislation, and have also promised to find ways to halt its implementation in coming years.

'Make no mistake ... we are here to stay and our resolve is firm,' said Michele Bachmann, a Republican congresswoman and leader of the conservative Tea Party movement. 'We will continue this fight until Obamacare is no longer the law of the land and until we can pass reform that will actually cut the cost of health care.'

At its core, the health care overhaul aims to extend insurance to about 50 million people in the United States, one of a very few Western countries that does not have universal health coverage. Republicans have slammed it as a 'government takeover.'

Funding for some of the bill's provisions was already built into last year's law, including an expansion of subsidies for poorer Americans to buy insurance and the creation of state-based insurance exchanges to boost competition.

But Aaron said Republicans can withhold funding from elements of the bill where the money has not yet been handed out. That includes funding for government-backed research and for federal agencies that are tasked with implementing the bill.

'There are likely to be fierce battles that could lead to deadlock and even to shutdowns of part of the government,' Aaron said. 'Without this funding, the administration will be unable or seriously delayed in rolling out various provisions of the bill set to take effect on January 1, 2014.'

But there are some signs that the debate could slowly tip in favour of Obama's Democrats, who have launched their own more aggressive effort since the start of the year to defend some of the legislation's provisions that have already come into effect.

Among the more popular measures, the legislation bars insurance companies from rejecting consumers who have pre-existing conditions, and allows younger people to remain on their parents' plans until age 26.

Opinion polls recently have shown that once-fierce opposition to the health legislation has eased somewhat. A poll by the Wall Street Journal and NBC on Wednesday found the public evenly divided with 46 per cent favouring repeal and 45 per cent opposing.

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