NBC’s presidential historian Michael Beschloss added one more important point of historical context to the ongoing question of how much the actual policies in the Affordable Care Act have contributed to the Democrats’ poor showing in the polls and tomorrow’s expected Republican electoral wave. Beschloss recalled that despite a two-thirds majority in the House and the Senate, President Lyndon B. Johnson recognized that he had a narrow window of opportunity to pass Medicare and other “Great Society” programs before the public turned against him.

He did and they did:

BESCHLOSS: Look at 1965. Lyndon Johnson came in, if you can believe it Rachel, two-thirds of the senate was Democrats, two-thirds of the House was Democrats. But even despite that, LBJ said, this doesn’t happen very often, I’ve got six months. He used those six months to get through the Great Society, Medicare, voting rights, very basic programs. He said after that they’re going to start voting against me and there will be a backlash. He was absolutely right. The Democrats had huge setbacks in Congress in 1966, but LBJ and the Great Society had probably more of an influence on Americans in terms of saying where the Democratic party is, for well or ilk, than probably any other president of the period.

Watch it:

If anything underscores the point that these kinds of social reforms are investments that could yield long-term dividends for the country it’s that today most Republicans are pledging to protect Medicare from the cuts in the health law and are campaigning against reform’s cuts to the program.

Of course, what’s unique about the health reform debate is that Republicans are still opposing the legitimacy of the law. As James Morone — a professor of political science at Brown University — has pointed out, “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.” “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,” he added.

Insurance industry sources are telling the National Journal’s Meghan McCarthy that the Department of Health and Human Services (HHS) may be “leaning” toward allowing student health plans (SHP) — health insurance policies offered to college students — to be classified as “short-term-duration” coverage, potentially exempting these policies from some of the law’s consumer protections. The news comes after various youth groups had been lobbying the agency to classify SHPs as individual health plans to ensure that the policies have to abide by the regulatory baseline created in the Affordable Care Act. McCarthy reports:

Whatever the final determination, HHS has yet another difficult decision to make on how specific consumer protections in the health care law will apply to a subset of insurance plans before exchanges start operating in 2014.

Health insurance coverage offered to students by colleges and universities arguably falls into a gray area under the health care law, especially when it comes to deciding whether certain consumer protections apply to the plans. That’s because the law, as written, applies certain consumer protections only to individual, small-group, and large-group plans.

Insurance companies and colleges argue that their student health plans do not fall within any of those categories, but are instead “short-term” coverage, a categorization that could ultimately exempt the plans from many consumer-protection regulations.

But those colleges — represented by The American Council on Education — that are lobbying for the “short-term coverage” label are insisting that their goal isn’t to exempt plans from the minimum standards. “First, colleges are not seeking either an exemption or a waiver from the law,” Terry Hartle, senior vice president of ACE and Steven Bloom, the organization’s assistant director of federal relations write in today’s Inside HigherEd. “[W]e have asked HHS to provide rules of the road on two key topics: What insurance reforms in ACA apply to student health plans?… [and] Assuming student health plans incorporate required insurance reforms and provide at least a minimum ACA-defined level of coverage, will that satisfy the individual mandate to purchase health insurance under ACA?”

Presumably, if the plans do meet the minimum standards for coverage — that is, by 2014, if a student is enrolled in a SHP she or he will meet the individual requirement — the plans will have to abide by the basic floor of coverage and will thus have to comply with at least some of the consumer protections found in the health law — regardless of their legal classification. And if that’s the case, then regulators will have to ensure that the industry cleans up some of its most egregious practices.

A recent investigation by New York Attorney General Andrew Cuomo, for instance, found that some college plans “provide woefully deficient coverage, with maximum overall caps or limits on particular types of services which can leave students with large, unreimbursed medical bills.” What’s more, the investigation found that “[m]any student plans payout far too little in claims compared to the premiums charged to the students,” exclude coverage for pre-existing conditions, and “provide no coverage at all for preventative services which college students typically need.”

Politico’s Sarah Kliff reports that governor turned full time possible presidential candidate Tim Pawlenty (R-MN) has agreed to accept some funds from the Affordable Care Act, undermining an executive order that prevented state departments from applying for the funds:

The state’s Management and Budget Office was one of 700 new organizations that signed up for the Early Retiree Reinsurance Program, a $5 billion program that helps pay for the insurance costs of retirees between the ages of 55 and 64. [...]

But the executive order came with a caveat that the governor’s office would still evaluate federal funding opportunities on a case by case basis, “on the basis of whether they will support existing state initiatives or programs, or whether such federal funding opportunities create new encroachments by the federal government under the recently passed federal legislation.”

Pawlenty spokesman Bruce Gordon says participation in the new program does not violate the executive order because it promulgates existing state polices.

“Governor Pawlenty’s executive order directs state agencies to not submit grant applications connected with Obamacare unless otherwise required by law or in keeping with existing state policies and approved by the Governor’s office,” he told POLITICO. “In order to cut state spending, the governor has authorized an early retirement incentive program for state employees. This grant supports the governor’s ongoing policy to reduce state spending, in this case, by incentivizing early retirement.”

Recall that Pawlenty had defended his EO by likening federal dollars to “drugs” and the government to a drug dealer. “Federal government’s acting increasingly like a financial drug dealer, handing out tastes or free samples, trying to get people addicted, further addicted,” he told Fox News’ Greta Van Susteren. “We’re not taking the free samples anymore. This is an executive order that says we’re sending them a strong message, but we’re also going to try to make sure the policies are for Minnesota not because some big federal bureaucracy tells us what to do.”

Indeed, Pawlenty is attempting to nationally position himself as a strong opponent of ACA funding, while simultaneously carving out exceptions to his own restrictions. So far, Minnesota has received some $11.1 million in ACA grants and Pawlenty has separately accepted $263 million in federal dollars to bolster the state’s Medicaid program.

Appearing on Meet the Press yesterday, Gov. Haley Barbour (R-MS) — the chairman of the Republican Governors Association — predicted that if Republicans aren’t successful in repealing the health care law outright, “they will make such big changes in it over the next three years that you won’t recognize it.” And indeed, the GOP has promised to repeal the law “lock, stock, and barrel” if it regains the majority in the House after the midterm elections and has advocated defunding large parts of the measure. As as Kaiser Health News’ Marilyn Werber Serafini reports, the GOP seeks to use committee hearings and “oversight” investigations to build public support for this effort:

If Rep. Joe Barton becomes chairman of the House Energy and Commerce Committee next year, the Texas Republican vows to make life miserable for Democratic defenders of the health care overhaul law.

He will drag Health and Human Services Secretary Kathleen Sebelius and Medicare chief Donald Berwick to Capitol Hill for regular grilling….

And that’s just the beginning. Barton has a list of seven problems he intends to spotlight, including how he believes the Obama administration covered up cost estimates of the law before it was enacted, inappropriately silenced insurers from warning customers about what they believed would be rate increases and wrongly spent money on brochures touting improvements to the Medicare Advantage program even though funding is being reduced.

Key Republicans are threatening to withhold funding for overhaul initiatives and to relentlessly pursue hearings and oversight investigations to challenge administration officials’ regulations and communications with the public. Committee chairmen have subpoena power, although holding the gavel is usually enough to get officials into the witness chair.

“Oversight of the existing law will build a case for full repeal,” said Barton. “We have to aggressively work to repeal the entire bill. As part of the process, we’ll have very aggressive oversight.”

In several recent reports, the Government Accountability Organization (GAO) has cleared the administration of any wrongdoing in disseminating pamphlets about the new Medicare Advantage cuts, but the validity of the attacks are less of a concern than their practical effects on the agencies’ implementation efforts.

Whatever the success of Republicans in repealing or defunding the law, over the short term, the GOP could slow implementation to a trickle, forcing regulators to reconsider potentially controversial regulations and defend even the most benign of decisions. Republicans, who have already released numerous reports detailing reform’s “broken promises” and attributing almost every story about rising health care costs to the Affordable Care Act, will redouble their efforts as they gear up their campaign against the law. But if there is a silver lining in the coming fight it’s that the renewed focus on the ACA could give the administration another opportunity to sell reform just as some its most popular provisions go into effect.