Next week, the House, with a Republican majority of 242, will vote to repeal the health care law signed by President Obama last year. This will fulfill a promise that GOP candidates made to voters in last fall's campaign. Republicans argue the law is driving up costs. The law "was sold to Americans as something that was going to allow more access to health care and lower the cost of health care. Neither one of those things has been done by this bill," said newly elected Rep. Diane Black, R- Tenn., who represents a district that had been held by Democrat Bart Gordon for 26 years and was once represented by Al Gore. Black said the law's mandate to insure adult children up to age 26 is causing insurers in her district to stop offering coverage.

In last Tuesday’s elections, Republicans scored massive gains in state legislative races from New Hampshire to Colorado. Next year they will control both houses of the legislature in 26 states. In addition, 29 states will have GOP governors. Some of the newly elected Republicans want to find ways for their states to escape from the provisions of the federal health care law. Can Republican governors and legislatures use waivers to opt out of certain parts of the law?

The health care law signed by President Obama on March 23 requires that, as of Sept. 23, new health plans must offer more than 50 specific preventive services without requiring those who are covered by the plan to pay a copayment or coinsurance. These services include colorectal cancer screening for adults over age 50, depression screening, a wide range of immunizations, and diet counseling for adults at high risk of chronic disease. The mandate does not apply to plans in existence on March 23 if they avoid making certain changes, such as increasing the employees’ share of the cost of coverage. Such plans are “grandfathered” and exempt from the preventive care mandate.

Taxing workers’ health insurance benefits seemed to be a politically radioactive idea when Congress debated its overhaul of health care last year. Apart from health care economists, no one was keen on the idea of the federal government suddenly taxing the $106 billion a year in health benefits that employees now enjoy as tax-free compensation. In the end, Congress did impose a tax on some high-cost “Cadillac” health plans, effective in 2013, and that tax will be passed on to workers in some way. But some Democrats in Congress say privately that Congress will dilute that tax before it really starts affecting many workers. What about taxing health benefits in a different way, including taxing the medical care you get in a hospital, or the care your dad gets in a nursing home?

On Tuesday, Missouri voters approved by 71% Proposition C which said, "No law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system." This conflicts with the federal law which requires most individuals to buy insurance if they don’t have it. In a state that has long been a good national barometer, this was an emphatic rejection of the health care legislation Congress passed earlier this year. But voter turnout was only a third the size of the 2008 turnout. And the electorate skewed Republican, with far more ballots cast in GOP primary races than in Democratic ones. Nonetheless it sends a warning to Democrats such as Rep. Russ Carnahan of Missouri who voted for the federal law. The fastest-growing county in Carnahan’s district voted 72% for Proposition C.

A provision in federal law called COBRA allows certain people who lose their jobs to keep their employer-provided health insurance coverage, if they pay for it. Last year’s Recovery Act, or stimulus, reduced the premium for COBRA coverage for people who were laid off. It effectively limited an individual’s cost of purchasing coverage to 35 percent of the premium. For a typical family, the subsidy reduced the cost of COBRA from about $13,500 to $4,725, according to the Treasury Department. As many as two million households benefitted from the premium assistance in 2009 at a cost of about $2 billion. Congress extended the period to qualify for the premium reduction until May 31, 2010. The Recovery Act made COBRA premium assistance available for a maximum of 9 months, but in March Congress extended that to 15 months.

Every year, the trustees of the Medicare system publish their report on the condition of the insurance system. The trustees include the Treasury secretary, the secretary of Health and Human Services, and the commissioner of Social Security. Last year’s report, issued on May 12, 2009, found that Medicare’s Part A hospital insurance fund would be “exhausted” by 2017, which means it would be able to pay only about 80 percent of the expected costs. The predicted exhaustion date was two years earlier than in the prior year’s report, “reflecting much lower projected payroll tax income as a result of the recession,” said the trustees. Since the economy hasn’t recovered to pre-2008 growth rates, one might expect this year’s report to be downbeat, but its release has been delayed so that actuaries can estimate the new health care law’s effect on Medicare.

Some congressional Republicans have promised to repeal or cut back the health care reform law which Congress enacted this year. Public opinion polling shows a sharp division between age groups on the law. In a Gallup survey conducted June 11 to June 13, 60 percent of people age 65 and older called passage of the health care bill a bad thing. But only 40 percent of people 18 to 24 opposed the bill, while 43 percent of people age 30 to 49 opposed it. A Gallup survey last fall found high satisfaction among older people with Medicare. But Medicare is about to undergo $430 billion in cuts required by the new law. Elections are never a pure referendum on one issue, but polling indicates that the new health care law will be one of the paramount issues.

One recent caller to C-Span's Washington Journal program contended that "nothing was taken out of Medicare (by the new health care law) except for the subsidy that was paid to business for something that they didn't need; and it was being paid for by 90 percent of the other Medicare patients." Some Democratic members of Congress make the same claim, arguing that all that will be cut are the payments to Medicare Advantage plans, the private-sector alternative to traditional Medicare, which cover nearly 11 million people, about 24 percent of Medicare beneficiaries. Medicare Advantage beneficiaries get benefits such as vision care that aren't available to traditional fee-for-service Medicare recipients.

The Medicaid insurance program for low-income people is the second biggest item in most states’ budgets. A recession is when Medicaid is most in demand by jobless people who have lost their insurance. But a recession is also when states have a hard time paying for it, since their tax receipts plummet. During this recession, state revenues are about 8 percent below their 2007 levels and 46 states have reported revenue collections below their estimates in the current fiscal year, according to the National Association of State Budget Officers. As part of last year’s stimulus, Congress boosted the federal Medicaid matching rate by 6.2 percentage points for all states, and by even more for states with high unemployment. But that money will stop at year’s end. Will the Congress save the states, yet again?