On Friday, the News & Observer in North Carolina reported that Blue Cross Blue Shield of North Carolina — the largest insurer in the state — would be increasing premiums to keep up with medical inflation and the requirements of the new health care law:

“With everything that’s been added, you can’t really expect costs to go down,” he said.

The situation isn’t likely to improve any time soon. As more provisions of the health overhaul law take affect in 2014, Blue Cross officials said they expect rates to rise further.

“We do expect significant premium volatility in 2014 as the industry moves to an entirely new rating structure,” said Patrick Getzen, Blue Cross’ chief actuary.

But aside from allowing dependent coverage and eliminating annual limits, BCBSNC is also taking early steps to implement other provisions of the health law. The company is starting to move people into a single risk pool and is slowly eliminating the rating bands that many insurers are so infamous for. That sounds good, but it means that younger people who now pay relatively little for individual policies will pay substantially higher premiums, with some rates going up as much as 30%.

Adam Linker, a policy analyst with the N.C. Justice Center’s Health Access Coalition, doesn’t think that policy holders should have to bear the brunt of the issuer’s decision to adopt early changes, particularly since they’ll have to pay higher premiums without the added benefit of the law’s subsidies or Medicaid expansion (both of which don’t begin before 2014). He believes that if BCBSNC wants to institute a policy of early compliance, then it should pay for these changes itself. After all, the issuer does has an unusually high amount of money set away in its reserves and could certainly afford it.

“I’d like to see insurers take a small hit now and then figure out what adjustments they need to make in 2014,” when federal subsidies will help the uninsured afford coverage, Linker said. At that point, health insurers also will get a boost in business from new members.

But what’s really interesting about this approach is that BCBSNC is trying to get its policyholders to pay for its early compliance efforts and any “premium volatility in 2014″ — the very same kind of “volatility” that early compliance is presumably designed to reduce. The problem is that the health care law provides many insurers with an easy scapegoat, even if actuaries have estimated that the initial provisions (dependent coverage and eliminating annual limits) would increase costs by as little as 1%. They can raise premiums higher and blame all the increases on the taxes and coverage provisions of the new health law.

Virginia Politics’ Anita Kumar reports that activist Attorney General Ken Cuccinelli, who has led the charge against global warming, health care reform and nondiscrimination laws in the state’s colleges and universities, is now setting his sights on abortion providers. Late on Friday, Cuccinelli “issued a legal opinion allowing greater restrictions on abortion clinics“:

The opinion, issued late Friday, provides legal guidance for the state Board of Health, and does not require legislative action. But pro-choice advocates accuse Cuccinelli of trying to circumvent the General Assembly, which has considered but failed to pass further restrictions on abortion clinics for at least eight years. …Pro-life legislators — including Cuccinelli who served in the state senate — supported bills that would have treated abortion clinics as ambulatory surgery centers and required them to meet hospital-type regulations with regard to equipment and space.

Currently, abortion clinics are regulated the same way as offices where patients receive oral or plastic surgery.

Abortion providers fear that clinics won’t be able to afford the costs of making the changes and will shut down or increase their prices. [Tarina] Keene [executive director of NARAL Pro-Choice Virginia] said if the Board of Health imposes the restrictions, 17 of the 21 abortion providers in the state would most likely have to close their doors.

Putting aside the irony that the Tea Party’s Attorney General is attempting to circumvent the democratic process (i.e. the legislature) and impose new costly mandates on health care providers (the very same kind of mandates he opposes so stringently in the health care law), this maneuver sounds an awful lot like the so-called TRAP (Targeted Regulation of Abortion Providers) legislation that’s been passed in states across the country.

TRAP bills impose costly and medically mandates and regulations on abortion providers that are unrelated to women’s health and don’t actually make abortion any safer. Their sole purpose is to down clinics and increase costs. These laws have a particularly pervasive affect on states that already have a shortage of abortion providers, of which Virginia is one. As the National Abortion Federation points out, “Often, the resulting regulations are based on existing hospital guidelines including specific dimensions for procedure rooms and hallways, doorway widths, and complex ventilation systems. Some regulations mandate what types of medical professionals must be on staff, assign certain duties to various staff members or require patient evaluations that are not medically necessary.”

For example, a TRAP law in Mississippi requires that the abortion facility be located in an “attractive” setting. In South Carolina, abortion can only be performed in facilities that keep their outside areas “free of grass that might serve as a haven for insects.” And in Arizona, “there’s a provision that requires that the doctors provide the care that they give in a manner designed to enhance the patient’s self-esteem and self-worth.”

Given that providers have already left states with TARP regulations, Keene’s estimate that 17 of the 21 abortion providers in the state would most likely have to close their doors, seems plausible. And of course for Cuccinelli, that’s precisely the point.

TRAP laws are also very difficult to overturn. Advocates have to prove that the law imposes a “substantial obstacle in the path of women seeking abortions” and have found little success in the courts. Recently, the Fourth Circuit Court of Appeals upheld South Carolina’s TRAP law even after pro choice advocates “proved that the law would increase the cost of abortion in the state by an average of $100 per procedure and would close down the only provider in one fairly big geographic area of the state.”

On Sunday, the New York Times ran an editorial asking how Republicans can continue to bemoan the growing national deficit and rising health care costs, while simultaneously introducing legislation to eliminate the cost-saving measures of the health care law. The GOP has introduced several bills to repeal the entirety of reform and at least two measures to rescind the new Independent Payment Advisory Board, “which is supposed to come up with ways to rein in excessive Medicare spending — and stiffen Congress’s spine“:

Starting in 2014, whenever Medicare’s projected spending exceeds a target growth rate, the board of 15 members (drawn from a range of backgrounds, appointed by the president and confirmed by the Senate) will have to recommend reductions in payments to doctors and health care providers to bring spending back to target levels. These recommendations would become law unless Congress — not known for its political courage in such circumstances — passed an alternative proposal that would achieve comparable savings.

None of this poses any real threat to Medicare beneficiaries. The law prohibits the board from making proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase premiums or cost-sharing, or reduce low-income subsidies for drug coverage. It cannot call for a reduction in payments to hospitals before 2020.

If anything, we fear that the board’s power will be too limited. But its power to curb payments to other providers is projected to save $15.5 billion to $24 billion between 2015 and 2019.

That has not stopped Senator John Cornyn of Texas from trying to kill off the board. In July, he introduced the ever so cutely named “Health Care Bureaucrats Elimination Act.” It currently has 11 co-sponsors, and a similar version, introduced earlier in the House by the Republican Phil Roe of Tennessee, has 54 co-sponsors.

The bill will provide Republicans with the opportunity to reiterate their top line health care messages in the midterm elections and I expect to hear many of the familiar arguments about rationing health care and pulling the plug on grandma that animated last year’s reform debate. But this kind of tactic only works because the bill will never actually make it to the floor for a debate, much less became law.

In reality, it’s not in the GOP’s political interest to actually vote for such a thing. As the CBPP’s Robert Greenstein points out, “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 policymakers from either party will need to find efficiency savings in Medicare. IPAB’s savings will be particularly valuable because they’ll target “payment and delivery system reforms, rather than from the more unpopular approach of cutting beneficiaries’ benefits and raising premiums.”