“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 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 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 down 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 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.”