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zoom RSS 医療制度改革への新たな戦い/米国医療事情

<<   作成日時 : 2010/11/04 20:08   >>

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 共和党が今すぐ新たな医療制度改革法を廃止するという選挙公約を果たすことはできないが、新税や皆保険制を含む不人気な法律を徹底的に再調査するよう議会を動かすことはできるようになった。
 中間選挙での共和党の勝利で、連邦議会や州のレベルで医療制度改革法に関して今後長い戦いが続く。この問題での党派分裂が、2012年の大統領選挙への準備段階で大きな問題であり、オバマ大統領と民主党員にとり広範な民衆の支持を得ることが難しくなった。
 法案制定を無理をして急いだことを認め、より効果的な医療制度改革案が示されれば修正すると、大統領は言う。議会は重大な変更が必要だとのメッセージを受けたことになるが、どう改善するのが現実的だろうか?
 最優先課題は、雇用者による従業員の保険費用支払い規定の変更や廃止であるとする。雇用創出を妨げ、雇用コストを増大させていると、Gelfand氏は言う。労働組合によっては、2018年から始まる予定の新税の中止について雇用者に同調する可能性がある。共和党員の中には、医療器具産業への新税の軽減や廃止を訴えているものもいる。
 ウォール街と多くの雇用者は突然の変更を求めてはいない。民主党上院と大統領がおり、徹底的な廃止案の可能性はないとAndrew Webberは言う。
 しかし、州レベルでは共和党の影響力が大きく地域でどう実行されてゆくかが決められることになるだろう。議会共和党が、より多くの裁量を州に与えるようにするだろう。
 下院共和党は、私的保険業者によるMedicare Advantage plansへの支払い削減を元に戻すと、言っている。また、保険取得義務のような不人気な規定は廃止するが、持病を持つ人への保険加入の保護については支持するとも言う。

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Promise of Renewed Battle Over Reach of Health Care
By ROBERT PEAR and REED ABELSON
Published: November 3, 2010
http://www.nytimes.com/2010/11/04/business/04care.html

画像While Republicans cannot fulfill their campaign promise to repeal the new health care law any time soon, they can lead Congress in a sweeping re-examination of its more unpopular provisions, including new taxes and a requirement for most Americans to carry health insurance.

Joyful over Republican gains in the midterm elections, Representative John A. Boehner of Ohio, the man in line to become speaker, told reporters at the Capitol on Wednesday: “The American people are concerned about the government takeover of health care. I think it’s important for us to lay the groundwork before we begin to repeal this monstrosity.”

The election results promise a continuing battle over the health care law, not only on Capitol Hill but also at the state level, where many changes are scheduled to take effect in coming years. The partisan divide on this issue is likely to be a prominent feature in the run-up to the 2012 presidential election, perhaps making it more difficult for President Obama and the Democrats to secure broad public acceptance of the law.

The results will also probably complicate efforts to carry out the complex measure, which is expected to provide coverage to more than 30 million people by 2019. At a news conference on Wednesday, Mr. Obama delivered a stout defense of the health care law, saying, “This was the right thing to do.”

He acknowledged that the process of enacting it had been “an ugly mess,” and he said he would consider Republican ideas to modify the law, provided they “deliver faster and more effective reform” to the health care system. Mr. Obama mentioned one example, saying he would accept changes in a provision that imposes a huge information-reporting burden on small businesses. Under the provision, businesses would generally have to file 1099 tax forms identifying anyone to whom they had paid $600 or more for goods or services in a year.

James P. Gelfand, director of health policy at the United States Chamber of Commerce, said Wednesday: “I don’t think we’ll see a repeal of the health care law tomorrow. But I believe Congress got the message that we need serious changes. The question now is, what kinds of changes are realistic?”

A top priority, Mr. Gelfand said, would be to alter or eliminate a provision that will require many employers to contribute to the cost of coverage for employees. The requirement, he said, would hurt job creation and increase the cost of hiring workers.

Some labor unions may join employers in trying to roll back a new tax on high-cost, employer-sponsored health plans, scheduled to take effect in 2018. Several Republicans said they would try to reduce or repeal a new tax on manufacturers of medical devices.

Wall Street and many employers do not expect sudden changes. “Reform is here to stay,” said Andrew Webber, the chief executive of the National Business Coalition on Health, which represents employer groups that buy health care coverage for workers. Les Funtleyder, a portfolio manager and health care strategist at Miller Tabak in New York, agreed. “We place the chances of outright repeal at virtually nil, given the Democratic Senate and president,” he said in a note to investors on Wednesday.

But with Republicans winning control of many governors’ mansions and making gains at the state legislative level, they will be able to determine how the new law is carried out locally.

Republicans in Congress said they would try to give states more latitude and discretion on issues like the design of health insurance exchanges. The law calls for creation of an exchange in each state and says only government-approved insurance plans can be sold on the exchange.

The new rules, though stricter than in the past, may well be less stringent than they would have been if Democrats had not taken what Mr. Obama described as “a shellacking.” In addition, Republicans said they would try to cut the budget for federal enforcement of the law and related rules.

House Republicans said they would also try to reverse some of the law’s cuts in Medicare, particularly cuts in payments to Medicare Advantage plans run by private insurers, though they will be hard-pressed to find ways to offset the cost of such changes.

Republicans said they might agree to keep popular provisions of the new law, like protections for people with pre-existing medical conditions, while trying to scrap unpopular provisions, like the requirement for people to carry insurance. However, administration officials and insurance executives said such a combination would not work in practice.


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