On Friday afternoon, as many Americans braced for Hurricane Irene, Virginia state health officials quietly released draft regulations requiring state abortion providers to meet the physical plant requirements of hospitals. The guidelines — the result of legislation Gov. Bob McDonnell (R-VA) signed earlier this year — were formulated through an “emergency” process that bypassed the normal public notice procedures and require existing abortion clinics to meet the standards of brand new construction. For instance, examination rooms at clinics must now “contain at least 80 square feet of clear floor space; some operating rooms must have at least 150 square feet; and public corridors must be at least 5 feet wide – 6 feet if patients are wheeled through them on stretchers.”

Officials at the clinics have described the rules as an “‘attack on reproductive rights‘ intended to force clinics to close, not enhance safety as some proponents suggest.” But during his monthly call-in radio show this morning, McDonnell defended the regulations, saying that they were “in the interest of health”:

“There’s ample time for the public to be involved, to give us their input,’’ McDonnell said. “We’re just following what the General Assembly has passed, and that is these clinics be regulated as hospitals.” [...]

McDonnell, who opposes abortion rights, said he signed and supported the bill and that the regulations are not designed to close clinics.

“There will be some increased costs, and many of these providers obviously are for-profit entities and they will factor that into their costs,’’ he said.

But if the proposed guidelines aim to improve health and safety, then why didn’t legislators allow appropriate time for the state to conduct a proper assessment and review of the kind of changes that could be necessary? Instead, legislators — who had been pushing this initiative for years — mandated “that the rules be written no more than 280 days after the bill was signed into law.”

First trimester abortions (the only kind that can be legally performed in Virginia clinics) are also “one of the safest medical procedures available in this country and [are] already heavily controlled by state and federal regulations.” Should the Board of Health vote to approve the rules on September 15th, at least some of the state’s 22 clinics will likely shut down and access to abortion for Virginia women — 86 percent of Virginia’s counties already lack any abortion providers at all — will be further compromised.

Conservatives have long criticized Mitt Romney for implementing an individual mandate in Massachusetts and have suspiciously eyed Newt Gingrich and Jon Huntsman for flirting with similar proposals in the past. Well, now right-wing activists still learning about Rick Perry’s record may have new reason to worry about the Texas governor’s purity on the health care issue. The Daily Caller has dug up old reports of a 1993 letter then-Agricultural Commissioner Perry sent to First Lady Hillary Clinton, commending her efforts to reform the health care system and asking the administration health task force in charge of drafting the bill to take the needs of Texas farmers into consideration:

In a letter to Clinton, who is now U.S. Secretary of State, Perry wrote: “I think your efforts in trying to reform the nation’s health care system are most commendable.” “I would like to request that the task force give particular consideration to the needs of the nation’s farmers, ranchers, and agriculture workers, and other members of rural communities,” Perry continued, noting his administration’s focus on economic development for rural Texans. “Rural populations have a high proportion of uninsured people, rising health care costs, and often experience lack of services.”

“Again, your efforts are worthy,” Perry concluded, ”and I hope you will remember this constituency as the task force progresses.”

The letter first surfaced in 2005, when Sen. Kay Bailey Hutchison’s (R) unsuccessful gubernatorial campaign attempted to use it against Perry. Watch the ad:

Perry has since condemned Clinton’s failed reform as “a government-run, one-size-fits-all health system” — the very same rhetoric he employs against President Obama’s very different (and and likely more conservative) law.

Sarah Kliff points to this survey of the uninsured, which finds that an overwhelming majority — 76 percent of the uninsured — would rather comply with the individual mandate in the Affordable Care Act and purchase insurance than pay the far less onerous penalty for forgoing it. “That would reduce the number of people without insurance to 5 percent of the population and have 25 million Americans purchasing through the exchanges, just slightly higher than the 24 million that the CBO projected,” she writes:

All of this of course depends on the affordability of coverage. Should the premium credits and out of pocket protections prove sufficient — and the federal government implements an effective get-insured campaign — then we will likely experience the kind of mandate success seen in Massachusetts (where most are now insured even though the maximum penalty in actually substantially below the federal amount!) But there is also an interesting behavioral dimension in how people will perceive the mandate. As the Congressional Budget Office has concluded, “health insurance mandates differ from some other requirements, such as the requirement to pay taxes” because “enrollees individually receive a tangible good–health insurance—that they value.” And when considering purchasing coverage, people compare the price of insurance with their perception of its value — not the size of the mandate penalty.

Jonathan Bernstein considers the results of the latest Kaiser Family Foundation tracking poll and persuasively argues that public indifference and time may ultimately save the Affordable Care Act from repeal. It’s a good point, but one that may not hold true if a Republican becomes president in 2012.

As Inside Health Policy’s Sahil Kapur reports, while the executive branch doesn’t have the authority to outright repeal a law passed by Congress, a president can rely on a variety of tools and appointments to delay or weaken its implementation:

– GRANT WAIVERS: “The president could generously grant waivers to employers and other entities from having to abide by some of its regulations or taxes (such as the tax on so-called cadillac health plans). [...] The health law also allows states to receive “innovation waivers” from the law, beginning in 2017, if they set up their own health care systems that seek to achieve ACA coverage goals in a different way. A president who’s uninterested in observing the reform law’s intended aims may conceivably grant waivers to states even if they do not set up adequate alternate systems.”

– DELAY IMPLEMENTATION: “[T]he executive branch is tasked with making sure states set up and operate insurance exchanges for individuals and small businesses to pool risk — state legislatures can do this on their own, and if they refuse, the federal government would take over. A president could “drag their heels” on issuance of further exchange regulations — or alter or reverse existing ones — and move slowly with procedures to identify people who are uninsured to bring them into the exchanges.”

– NOMINATE OPPONENTS OF REFORM: “The administration could slow-walk the implementation by not hiring regulators tasked with implementation of the law..And you could put somebody in charge of CMS who is hostile to [the health reform law]” and tries to roll back some of its provisions. Among the future appointments are 15 officials to sit on the reform law’s Independent Payment Advisory Board, a powerful panel charged with finding Medicare cost-savings in payments to providers, which is set to take effect in 2014.”

– STOP DEFENDING ACA IN COURT: The Justice Department could “switch sides” and argue that the individual mandate and perhaps the law in its entirety is unconstitutional. A Republican president could point to the Obama Justice Department’s reversal of stance on the Defense of Marriage Act as precedent for an administration arguing against the constitutionality of a federal statute.

All of this becomes a lot harder as reform is implemented and Americans begin to experience its benefits, and so a Republican wishing to undermine the law has to start peeling back its provisions following the election. But even that is not without its political obstacles, for as Bernstein points out, “are Republicans really going to restore the ability of insurance companies to deny coverage based on pre-existing conditions? Are they really going to bring back the donut hole (which isn’t closed yet, but is closing under ACA)? Are they really going to remove the other provisions that people have been living with for a while now?” Realistically, they probably won’t — particularly if they offer no viable alternative.

Inside Health Policy’s Sahil Kapur notices that Sen. Orrin Hatch (R-UT) is arguing that Congress should repeal the health care law in order to reduce the deficit, dismissing the debt savings from the measure and the Congressional Budget Office’s projections that eliminating the law would “would worsen the budget outlook.” From Hatch’s press release:

With the national debt more than $14.5 trillion and unemployment still over nine percent, U.S. Senator Orrin Hatch (R-Utah) called for the repeal of ObamaCare to be considered as a means to reduce the deficit and create jobs.

“We all knew that ObamaCare was going to be disastrous for our economy and every day that goes by proves that point,” Hatch said. “Whether it be the trillions of dollars in tax hikes or the sheer number of job losses directly from ObamaCare itself, it’s clear that repealing ObamaCare must be on the table during any talks to slash our nation’s debt and create much-needed jobs.”

When Kapur confronted Hatch’s office with CBO data which found that repeal would increase the deficit by $230 billion over 10 years, raise the number of uninsured by 32 million, eliminate subsidies, and force millions of American families to pay higher premiums, and increase premiums for employer-based coverage, Hatch spokeswoman Julia Lawless called its projections “gimmicks.” “That includes all of ObamaCare’s gimmicks,” she said in an email. “The true cost of the bill is $2.6 trillion and that’s a real budget-buster.”