Wall Street Journal’s Janet Adamy and Jonathan Weisman offer some specific insights into why health insurers have been so heavily funding Republicans this election cycle and what they’re hoping to buy with the increased contributions:

Insurers want to reverse tax increases and loosen restrictions on insurance premiums, and several groups hope to tack on medical malpractice protections. [...]

The insurance industry is working to persuade the next Congress to roll back a roughly $70 billion tax on insurance companies that takes effect in 2014, saying it will disproportionately hit small businesses that insure their workers. It also wants lawmakers to allow insurers to widen the rating bands that dictate how much more insurers can charge older customers.

Insurers also want to tackle the growth of health costs by enacting a new measure to give robust protections against medical malpractice lawsuits to doctors who follow certain “best practice” guidelines, said Karen Ignagni, the insurance industry’s top lobbyist.

“We always reach out to both sides of the political aisle and we’ll continue doing that because we have had concerns,” said Ms. Ignagni, president of America’s Health Insurance Plans. She said her group would be most focused on parts of the bill that it believes fail to lower the growth of health costs.

Recently, Ignagni also hinted that she would like to see Congress soften the employer responsibility provisions in the law, since the penalties could some employers to drop their existing employer-based coverage and send their workers into better regulated plans within the exchanges.

Of course, other sectors of the health industry — many of which cooperated with Democrats to pass reform — are also trying to weaken the law’s most important cost containment mechanism: The Independent Payment Advisory Board (IPAB). The American Hospital Association (AHA) and drug makers have their sights set on the board, which will begin recommending cuts to reduce the per-capita rate of growth in Medicare spending.

But some of the groups that cooperated with Democrats may have trouble influencing the expected Republican majority, the Washington Post reports. “Some businesses joined in on the hang-me-last strategy,” said Rep. Peter Roskam (R-Ill). “I think upon reflection, in moments of candor, they may say they were foolish to do that.” House Minority Leader John Boehner (R-OH), for instance, blasted PhRMA for cooperating with Democrats on reform and the group has been trying to patch up relations ever since.

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.

I’m enjoying Jonathan Cohn’s, Greg Sargent’s, and Ezra Klein’s counterfactuals about Democrats’ mid-term election prospects had they they never taken up health care reform. All agree that Democrats would find themselves in the same spot, or be even worse off than they are today:

- COHN: A Newsweek economics columnist called Obama’s failure to address health care costs, at a time when the political forces for action were finally aligned, an unforgivable act of political cowardice. It’s hard to know whether voters share that assessment, but the perception that Obama whiffed at tackling the nation’s major issues certainly isn’t helping his approval ratings. The phrase “Carterbama” comes up a lot in conversation.

- SARGENT: There are a host of reasons to believe Dems might have been in a pretty bad position even if they hadn’t attempted reform at all. And if that had happened, and Dems had sustained big losses all the same, it could have postponed action on reform for a decade or more. Those who think Dems shouldn’t have tried reform this time around need to be asked when Dems would have gotten their next bite at the health care apple — particularly with such big majorities.

- KLEIN: In conversations over the past few weeks, some of the party’s leading strategists told me that it all comes down to accomplishments, or — here’s that ubiquitous word again — “deliverables.” The president, who ran such a brilliant campaign, they argue, has utterly failed to live up to the promise of his election. They cited perceived missed opportunities like the president’s decision to expand S-CHIP rather than pursuing health-care reform and suggested that he hadn’t done enough to re-regulate the financial sector in the aftermath of one of the worst financial crises in the nation’s history.

I agree with the above, but also wonder where Democrats would be today (regardless of the economy) if the President had approached reform in a more hands-on manner, publicly advocated for progressive priorities like the public option and drug reimportation, and crafted a more coherent and specific vision of what he wanted the final reform bill to look like. On one hand, it’s certainly possible that this more confrontational style would have put off the self-important lawmakers who took pride in personally crafting the law and pushed away the special interests whose acquiescence the administration bought with special agreements and tradeoffs. Reform might have died a slow death and Obama would likely be no better off than he is today — again, maybe even worse.

But had these Clintonian tactics led to a different result — if reform passed, it would have either included the kind of progressive ideas that Democrats could rally around or it would have mirrored something similar or even more conservative than the Affordable Care Act. In either outcome, if Obama steered the ship, the actual reform process could have been cut in half and even in the latter instance, Obama could have been seen as someone who stood and fought for what he campaigned for. And, it’s possible that his progressive base would have been more likely to stand with him than many are today. Conservatives, moreover, would have had less time to smear the law and concoct lies; without those falsehoods, and with a shorter legislative process, the American public would have been more receptive to the policy.”

Of course, all of this is mere speculation, but one can’t help but question if Democrats would see more public support for the law and their party today had the President publicly acted like it really mattered to him 16 months ago.

National Journal’s Josh Kraushaar makes the case that “health care is fueling the Democrats’ dismal situation” going into the midterm elections by pointing out that “Democrats who opposed the bill are in surprisingly decent shape,” while those who went along with the White House are in very tight re-election races. When voters in competitive races “were asked an open-ended question about what gives them the biggest pause about voting for their sitting member of Congress, a solid plurality said it was health care – ahead of the economy and jobs,” Krausharr adds.

But if the unpopular legislation contributes to the predicted Democratic loses in the House — a point that is under some contention — it won’t be because the legislation itself is so rotten. Much of the blame should also fall on the Democrats’ failed effort to sell the law and the GOP’s success in tarnishing it.

Yesterday, Greg Sargent pointed out that “opponents of the legislation, including independent groups, have spent $108 million since March to advertise against it” — “six times more than supporters have spent, including $5.1 million by the Department of Health and Human Services to promote the new law.” That $108 million went to finance the false claims that individuals who don’t purchase coverage will go to jail, or sex offenders will have access to government subsidized Viagara and seniors will lose all their Medicare benefits.

As Sargent notes, after the elections, some Democrats will surely argue that the administration overreached in its health care policy, a contention that’s undermined by these ad campaigns and polls which still show that the individual components of the bill are very popular. For instance, last night’s New York Times poll found that 41% of Americans thought Republicans should repeal the law, but that number dropped to 25% when the respondent was told that “repealing the law meant that insurance companies were no longer required to cover people with existing medical conditions.” Forty-six percent of respondents also said that “the Democratic party is more likely to improve the health care system,” while just 28 percent thought Republicans were.