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MADISON, WIS. - Two weeks after President Obama signed the nation's health-care overhaul into law, then-Wisconsin Gov. Jim Doyle (D) issued an executive order creating an Office of Health Care Reform.
Over the next eight months, the Badger State made more headway than virtually anywhere else in the country at preparing to carry the statute out. It designed - and presented at the White House - the country's only prototype for how people and small businesses could navigate a new health insurance marketplace online. It produced a 205-page blueprint envisioning that marketplace as a "transformative force," steering people toward care of high quality and low cost.
Then, in late January, Doyle's Republican successor, Scott Walker, issued his own executive order, dissolving the health reform office and replacing it with the Office of Free Market Health Care.
"We view this as a fundamentally different approach than what the past [Wisconsin] administration was doing - and what . . . the Obama administration is pushing," Walker said in the first interview he has given about health-care reform since assuming office.
Wisconsin's U-turn, as sharp as anywhere in the country, illustrates how the views of state leaders are shaping the way the health-care overhaul envisioned by Congress will work on the ground. It illustrates, too, the treacherous terrain the Obama administration and congressional Democrats are walking by entrusting states to carry out major parts of the plan now that 29 governors are Republicans, including 18 who - like Walker - have taken office this winter. In Wisconsin, as in five other states, both chambers of the legislature also have just switched to GOP control.
"We've gone from one kind of boldness to another," said Robert Kraig, executive director of Citizen Action of Wisconsin and a leading liberal activist on health care in this university town with its granite-domed state Capitol.
But being dead set against the health law is not proving to be a simple matter of saying no to everything it contains. The new opposition is subtler but no less profound - a process of picking and choosing provisions to embrace or reject, of taking some grants offered by the federal government while spurning others, of striving to kill the law in Congress or the courts while preparing a conservative alternative.
Walker, best known for his effort to demolish rights to collective bargaining for government employees, thinks that the health-care statute is unconstitutional and that the government has no business influencing people's health-care choices. Doyle's aides estimated that the law would save Wisconsin $850 million by the end of the decade; Walker's estimate that it would cost $433 million.
Where Wisconsin is coming from
With states required by 2014 to carry out the law's core features - among them, widening access to private and public insurance - Wisconsin is in a more auspicious starting place than most. Just 6 percent of its residents lack health coverage, the second-lowest proportion in the country. And over the years, Wisconsin repeatedly has expanded Medicaid, called BadgerCare here, so that an unusually large share of people already has public insurance.
Those distinctions are part of the Walker administration's justification for resisting federal requirements. "Wisconsin . . . already has accomplished much of what [the law] aspires to do," said Dennis G. Smith, the new secretary of the state's Department of Health Services.
Smith, the driving force behind Wisconsin's about-face, arrived from Washington in January with a reputation as a mild-mannered, highly conservative thinker on health policy. Under President George W. Bush, he was in charge of Medicaid at the U.S. Department of Health and Human Services. More recently, he was at the Heritage Foundation, writing criticisms of the new federal law. He said in an interview that he did not have ties to Wisconsin or know Walker before mutual acquaintances, including Rep. Paul Ryan (R-Wis.), chairman of the House Budget Committee, suggested to both men that they should talk.
In a primary example of obeying the law selectively, Walker and Smith said they will create, as the statute envisions, one or more marketplaces called exchanges to help individuals and small businesses buy insurance. But the exchanges will not do everything the law says. "We believe it's got to be free-market driven, not government driven," Walker said.
President Obama told a group of governors Monday that he would support moving up the timetable in which states may opt out of the federal health care law, making a major overture to critics of the legislation.
In his speech to the governors, who were attending the winter meeting of the National Governors Association, Obama said he would approve of allowing states to opt out of the Affordable Care Act by 2014 if they could offer health-care coverage for as many people as they would under the law and not increase the deficit. Under the original law, states could not opt until in 2017. Still, 2014 is a critical year, as many of the most important provisions of the bill, including the mandate, go into effect.
The new opt-out provision was first proposed by a bipartisan group of senators that included Sen. Scott Brown (R-Mass.) and Ron Wyden (D-Ore.).
"I think that's a reasonable proposal. I support it," Obama told governors of both parties assembled in the State Dining Room. "It will give you more flexibility more quickly, while still guaranteeing the American people reform. If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does - without increasing the deficit - you can implement that plan. And we'll work with you to do it."
Obama's move comes as a number of states, nearly all with Republican attorneys general, have filed suit to invalidate the law, arguing that requiring all Americans to purchase health insurance is unconstitutional. Three federal courts have ruled that the current law is constitutional, while two have struck it down.
The flexibility on opting out could appeal to Republicans both in Congress and in statehouses, who have been the main critics of the legislation. And some more liberal states, such as Oregon, have said they might consider alternative ways to expand insurance.
The governors said Obama's willingness to support an earlier opt-out from the law was welcome, but they stopped short of fully embracing it.
"A number of our fellow governors would be very interested in supporting this," said Gov. Christine Gregoire (D-Wash.), the current NGA chair. "We need to talk to them to see if we can put our support behind that bill as the National Governors Association. But I can assure you there is conservable interest among the governors."
The more flexibility in managing health care the better, Gov. Mary Fallin (R-Okla.) said. But "we'll see if it's going to be flexible enough."
Mississippi Gov. Haley Barbour (R) was also cautious. "The devil's in the details," he said. "We have to learn more about it before we know."
Kansas Gov. Sam Brownback (R-Kan.) opposed the health-care law while he was still in the Senate. He said the president's proposal doesn't negate what he and other Republicans see as a fatally flawed law. "This offers a little bit of flexibility, which I think is a positive thing, but it doesn't change the overall objection to the bill."
Brownback said he and others who are challenging the law in court will "implement what we're required to do" while continuing to fight it.
KANSAS CITY, Missouri | Tue Apr 9, 2013 5:45pm EDT
KANSAS CITY, Missouri (Reuters) - Residents of the central United States braced for a night of nasty weather on Tuesday, with high wind, rain, sleet, hail and possible tornadoes forecast from north Texas through Nebraska.
Meteorologists said the stormy weather would result from a clash of warm southern air with a cold air mass sweeping through eastern Colorado, where heavy snow in Denver closed the airport and forced the cancellation of 535 flights on Tuesday.
"These are a couple of last hurrahs for winter," said Mike July, a meteorologist for the National Weather Service in Kansas City. "We are going through that phase of the season when we can have some rapid changes."
Moderate to heavy snow and gusty winds were forecast for Colorado, Nebraska, South Dakota and Wyoming. A day earlier in northeast Colorado, four tornado sightings were reported.
Areas south and east of the snowstorm will see sleet and freezing rain and potential flash flooding as the storm moves east, the weather service said.
Strong to severe thunderstorms were expected to move through north Texas, Oklahoma and Kansas through Tuesday evening, the weather service said.
The biggest threat in Kansas and Missouri on Tuesday evening will be hail of up to one inch in diameter, July said.
In Oklahoma, the National Weather Service warned that severe storms with possibly baseball-sized hail were likely to strike the area on Tuesday evening into Wednesday. Sleet and snow were expected, and winds gusting up to 45 miles per hour were forecast, the Weather Service said.
Oklahoma could also get some tornado activity, July said.
"There will be heavy rains through Thursday of 1.5 inches up to 3 inches in the Plains and central Midwest with 3 to 12 inches of snow in Nebraska, northeast Colorado, South Dakota, Minnesota and northern Iowa," said Don Keeney, a meteorologist for MDA Weather Services, a private forecaster.
In Denver, rain turned to snow overnight, with up to 11 inches of snow expected Tuesday. Temperatures that had been in the low 70s (Fahrenheit) on Monday dropped into the teens on Tuesday in Denver and in western Kansas, weather officials said.
In Washington County east of Denver, a microburst destroyed a mobile home and sheared off three 45-foot power poles, temporarily knocking out power to residents of Akron on Monday night, said Mike McCaleb, the county's director of emergency services.
A microburst is a sudden rush of air downward that is sometimes confused with a tornado and can do similar damage.
Large parts of western South Dakota including the Black Hills could get up to 20 inches of snow through Wednesday morning, the National Weather Service said.
Heavy snow was falling in western Nebraska, where a winter storm warning was in effect and Interstate 80 was closed in both directions due to blowing snow and poor visibility, according to the Nebraska Roads Department.
(Additional reporting by Jane Sutton in Miami, Katie Schubert in Omaha, Carey Gillam in Kansas City and Steve Olafson in Oklahoma City; Editing by Maureen Bavdek, Greg McCune and Jim Loney)
Geckos use thread-like fibres on their hands and feet to stick to surfaces. Synthetic gecko-inspired adhesives rely on the same fibrillar structures. In both cases nonchemical adhesion is created by concentrating the intermolecular forces between two bodies.
In 2007 researchers from the Leibniz Institute for New Materials, Germany created adhesive materials which could be switched on and off using differences in pressure. Now the same research group have shown precisely how to do this by adjusting the shape of the surface fibres.
Dr Paretkar and his team identified the key parameters that influence adhesion switchability; namely the fibrillar contact shape, radius, aspect ratio, orientation and the applied compressive load. They found that adding flap structures to the ends of the fibrils significantly enhanced how effectively adhesiveness could be switched on and off.
The synthetic adhesive materials are 'switched' on by pressing them against a surface and 'switched' off by increasing their pressure on the surface, which causes loss of adhesion.
The findings mean that new materials can be developed in which adhesiveness can be precisely controlled. This study was conducted using biocompatible material; if the same results can be repeated in biodegradable materials then they could be used during delicate medical procedures in which small objects have to be moved around. These adhesive materials could also be scaled-up and used as fillers in operations such as repairing a damaged ear drum without the use of stitches.
More information: Paretkar, D. et al. Preload responsive adhesion: effects of aspect ratio, tip shape, and alignment, Journal of the Royal Society Interface. dx.doi.org/10.1098/rsif.2013.0171
Provided by The Royal Society 