On Monday, a judge in Virginia ruled that the state’s lawsuit challenging the individual mandate in the new health care law should proceed partly because the state’s recently enacted ‘Virginia Health Care Freedom Act’ — which protect Virginia citizens from the individual requirement — conflicts with the federal requirement and “therefore encroaches on the sovereignty of the Commonwealth and offends the Tenth Amendment of the Constitution.”

“Although this lawsuit has the collateral effect of protecting the individual interests of the citizens of the Commonwealth of Virginia, its primary articulated objective is to defend the Virginia Health Care Freedom Act from the conflicting effect of an allegedly unconstitutional federal law,” Judge Henry Hudson wrote in his opinion. “Despite its declaratory nature, it is a lawfully-enacated part of the laws of Virginia. The purported transparent legislative intent underlying its enactment is irrelevant.”

Indeed today, during an appearance on MSNBC, Virginia Governor Bob McDonnel practically admitted that Virginia’s standing in suing the federal government is derived almost solely from the legislation he signed “about four months ago”:

MCDONNELL: Well Andrea, Virginia is one of 21 states that have a suit. Virginia has its own challenge in part because of the bill I signed about four months ago that makes it illegal under Virginia law for anybody to be forced to buy health insurance. That gives us unique standing. Twenty other states have joined a suit in Florida that are also challenging it. That is in a separate federal court. But Andrea, I would suspect that no matter what happens out of Judge Hudson’s ruling in October that one side of another is likely to pursue this up to the Supreme Court.

Watch it:

Here, McDonnell is almost gleeful about inventing standing for his state. And while Hudson believes that “the purported transparent legislative intent” of manufacturing tension between state and federal laws is “irrelevant,” one must wonder about what kind of precedent this establishes. If Virginia has standing, then the restriction on state standing is a joke. States can follow McDonnell’s lead and legislate around it, challenging any federal law they disagree with, resulting in a plethora of the very kind of frivolous lawsuits that Republicans typically detest.

A new Medicare Trustees report finds that the Independent Payment Advisory Board [IPAB], the payment reform demonstration projects, and productivity improvements in the new health care law will save Medicare $8 billion by the end of 2011, and $575 billion over the next decade. The law will also extend the life of Medicare’s hospital fund (Medicare Part A) by 12 years, which will now remain sustainable through 2029.

This afternoon, during a conference call evaluating the new report, Robert Greenstein of the Center for Budget and Policy Priorities (CBPP), argued that should Republicans attempt to repeal all or portions of the health care law, the would significantly undermine the longevity of the Medicare program. Greenstein maintained that if the GOP becomes the governing party, it would be against their political interests to suspend IPAB and the payment reform demonstration projects — which the GOP has pledged to repeal:

GREENSTEIN: If the entire Affordable Care Act is repealed, that’s a different story, but then the Medicare trust fund finances would be in much worse shape. But assuming the bill remains in affect, I think that the fiscal pressures on the whole federal budget moving going are going to be so severe and Medicare plays such a central role in this, that it is really hard for me to imagine policymakers of either party…whoever is in the position of governing is going to desprately need to find efficiency savings in Medicare and it will be in their political interest…. to pursue whatever measures can devleop and produce savings, especially savings that result from payment and delivery system reforms, rather than from the more unpoular approch of cutting beneficiaries’ benefits and raising premiums.

Greestein also responded to the GOP’s claims that the trustees’ findings are contradicted by the CMS’s own actuary, Richard Foster, who has predicted that some of the savings from health care reform may not materialize. Under Foster’s more pessimistic analysis, only 60% of the projected savings would be realized. Consequently, the insolvency of the Medicare Trust Fund would be moved back to 2028 instead of 2029 and only half of the current shortfall would be closed (instead of four-fifth as the actuaries predict.)

“Under either conclusion, this is still a dramatic improvement.” “The most likely scenario probably lies in between those two.” But in their report, the trustees underscore the “the crucial importance of moving forward strongly with the pilots and the demos and the research and really running what results from that.”

The Democrats have responded to the success of the Missouri anti-health reform ballot initiative by arguing that the results were an anomaly. The heated Republican primary attracted a disproportionate number of conservative voters, most of whom don’t share the sentiment of the rest of the country, where support for reform is actually increasing. “It’s very obvious that people have a lack of understanding of our health care reform bill,” Senate Majority Leader Harry Reid (D-NV) said in response to the Missouri news. “The more people learn about this bill, the more they like it.”

Indeed, the opposite could be said for the GOP strategy of repealing the mandate requiring everyone to purchase health insurance — the more voters learn about that, the less they’ll like it. I’ve been arguing that eliminating the mandate would remove any incentive for younger and healthier Americans to purchase coverage and increase premiums for all American. Well today, MIT Professor Jonathan Gruber has released a report that estimates how much more we would all be paying for health coverage, should conservative efforts to repeal the mandate and other parts of the health care law succeed:

Consider this:

Gruber writes that health reform is like a three-legged stool with insurance regulations, the mandate, and subsidies representing the separate legs. Remove one of these components and the stool (reform) falls apart.

Without the mandate, younger, healthier individuals won’t buy into the pool and insurers won’t be able to offer coverage at community rates or cover pre-existing conditions. Healthier individuals can wait until they become sick to purchase coverage, causing premiums for older individuals to skyrocket and further discouraging healthier ‘don’t need insurance yet’ Americans from purchasing insurance. The result is a death spiral “that leads only the sick to purchase insurance at very high prices.” Finally, to ensure that everyone is part of the system and can afford the community rates charged by insurers, the third leg offers subsidies to individuals and families up to 400% above the poverty line.

As Gruber concludes, “Critics who propose to “repeal and replace” the Affordable Care Act don’t seem to understand that all three legs of the stool are critical for reform. Pulling out any of the legs while leaving one or two intact will critically undercut gains from reform.”