Reiterating President Obama’s claim that the interim Patients’ Bill of Rights regulations shouldn’t provide insurers with an excuse to increase premiums, Washington and Lee Professor Timothy Jost takes a closer look at the text of the interim final regulations and concludes that “most of the reforms are expected only to increase premiums by tenths or hundreds of a percent.” That’s because:

- Relatively few individuals are directly affected by most of the regulations.

- Plans have the option prior to 2014 of avoiding the impact of some of the requirements by simply eliminating coverage for services or conditions (although they might lose grandfathered status by doing so).

- Some of the practices are already restricted in many states.

- Some of the regulations really do not impose additional costs (such as allowing individuals to choose their primary care provider or allowing children to be treated by a pediatrician)

“Individuals who may have benefited by some of these regulations, such as the ban on pre-existing condition exclusions for children or the removal of lifetime limits and restriction on annual limits, may be faced with high premiums when they seek to purchase or renew individual coverage,” he speculates, but “[i]n states that require some form of community rating, this barrier will be limited.” And “most insurers limit premium increases for persons in poor health to twice the standard rate.”

The most surprising aspect of the regulations, however, is the pre-existing condition provision. These interim rules prohibit insurers from denying coverage to children with pre-existing conditions; adults will receive this protection beginning in 2014, which is also when insurers will be required to offer a set of essential benefits. But before 2014, Jost notes that issuers can still get around this rule by excluding coverage for a certain conditions as long as they do not violate state law or other federal laws.

Kaiser Health News’ Phil Galewitz has more on the cost of the regulations here.

Lester Feder of Georgetown Law Center’s O’Neill Health Law Institute has an interesting new interview with James Morone — a professor of political science at Brown University — who points out that while we have seen partisan politics break out over past social reforms, never before has the partisan rhetoric extended into implementation:

Normally in our political system, when we have enormous battles over legislation, most political actors consider the politics done when the legislative battle is over. What’s new here is the idea that the battle goes on into the implementation phase. This wasn’t true for Social Security, it wasn’t true for Medicare, it wasn’t true for civil rights. Of course, interest groups always continued to fight to get the best deal possible in implementation. But that’s very different from it being Democrats versus Republicans or liberals versus conservatives. Today’s situation is very different.[...]

I’m not sure the Democrats have been quite this insistent after losing legislation. To have the Republican Party be this forceful about a position after the normal political process has run its course is pretty extraordinary.

Morone goes on to explain why he thinks this is in parts I and II of Lester’s interview (both of which are very much worth reading), but I just want to underscore the passion with which the GOP is opposing this law. When I spoke with some Republican staffers on the hill last week about what could only be described as relatively futile legislative effort to repeal the law, they practically screamed at me that they will never, ever, accept that reform has become law and will work very hard to repeal the measure. “Why should we accept something that’s unconstitutional,” they asked.

Indeed, Republicans are using every single obscure regulation and appointment to re-litigate the health care reform debate. In addition to Sen. John Barrasso’s (R-WY) weekly ‘Second Opinion’ speech, prominent Republicans take to the floor and pen op-eds on a daily basis to condemn the new law and celebrate the states that are refusing to implement it. On Monday, Sen. Jon Kyl (R-AZ) argued that the new grandfathering regulations would cause many Americans to lose the coverage they have. Yesterday Sen. John McCain (R-AZ) proclaimed, “we’re not going to quit on this issue, we’re not going to quit on this issue. It’s going to be repeal and replace.” And today, House Minority Leader John Boehner issued a 43-page report rehashing the GOP’s health care talking points.

It’s important not to overstate the cohesion of the GOP campaign, since different factions have adopted different strategies, but it’s safe to say that their larger goal is to goad Democrats into rehashing the 2009 health care legislative debate, rather than looking ahead towards implementation. But that kind of discussion, in which we argue back and forth about CBO scores, diminishes the legislative accomplishment and adds extra weight to the GOP critique. It’s not the role of the minority party to set the terms of debate — particularly when they’re doing so for such transparently political purposes.

President Obama said it best when he framed the discussion this way: “They want to go back to the system we had before.” “Would you?” he asked during yesterday’s Patients’ Bill Of Rights unveiling. Would you want to go back to discriminating against children with preexisting conditions? Would you want to go back to dropping coverage for people when they get sick? Would you want to reinstate lifetime limits on benefits so that mothers like Amy have to worry? We’re not going back. I refuse to go back.”

If the GOP continues to press ahead with repeal, they might slow down the implementation process, but they’ll also run the risk of fading into historical irrelevancy. Who remembers the legislators who led the fight against Social Security or Medicare and better yet, who celebrates them?

The Commonwealth Fund is out with a new report showing that the United States spends twice as much as any other country on health care, but still has a system with unbearably low quality, efficiency and equality standards:

For $7,290 per person, we’re buying a system that leaves 45 million uninsured and produces less quality and efficiency than a country that spends half as much ($3,000) and covers everyone. Germany, for instance, spends just $3,588 per person even though it has higher smoking rates and higher instances of chronic disease than the United States.

We should be spending less money and spending it differently, but any time you talk about diverting resources elsewhere or appropriating them in accordance with proven effectiveness, you’re met with charges of rationing care and death paneling seniors. The proponents of smaller government and responsible spending all rally (in fact, continually praise as the best in the world) behind a system that costs and wastes untold billions — all the while vilifying the more economically sound models of care.

Despite this opposition, there is certainly some sense that the payment reform demonstration projects and comparative effectiveness research provisions in the new health care law will begin to slowly push Medicare into paying for outcomes and lower spending over time. But that transformation is a slow crawl that will have to overcome the forces — politicians, providers — that are so determined to keeping America’s health care system in last place.

Ezra Klein notes that despite the orchestrated GOP campaign to transform any small regulatory change or news report into a ‘health care law is failing’ storyline, health-care reform is actually getting more, not less, popular:

But by coincidence, I had been looking at some of the polling on health-care reform moments before the report landed in my inbox. A USA Today/Gallup poll that came out this morning showed that 49 percent of Americans think the Affordable Care Act is a “good thing,” while 46 percent think it’s a “bad thing.”

This poll comes on the heels of an Associated Press-GfK poll showing the same movement. So that’s two recent polls showing a lift in the bill’s popularity, taking it from a slight plurality in opposition to a slight plurality in favor. Two polls is enough to make me curious, so I headed over to Pollster.com, and it does seem we’re looking at a trend. The site’s aggregate chart of recent polls doesn’t yet show support overwhelming opposition, but it does show support rising and opposition falling. In fact, the bill’s spread looks better than at any point in the past year.

Look:

This all sounds right, but I want to link back to my criticism of how the press covered health care reform. During the actual legislative debate, political tensions and negative stories received the majority of the coverage and that’s still the case today.

Just consider this WSJ report about the Gallup poll Klein references. It’s headlined ‘Gallup: Health Care Overhaul Support Flatlines,’ implying that ‘the reform patient is dead’ — despite the fact that the poll shows that a majority support the new law. This could be one in-artful headline, to be sure, but you can imagine that if the numbers were flipped, we’d be seeing more sensational accounts about how the Democrats’ top domestic accomplishment is floundering. But here, with support increasing, even in the face of daily GOP attacks, the press is running mixed stories at best.