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MARY LOUISE KELLY, host:

This is WEEKEND EDITION fro NPR News. I'm Mary Louise Kelly.

The new healthcare law is back in the news this week after some time out of the spotlight. Six months after President Obama signed the measure, several new provisions took effect on Thursday, and Republicans have made the law a major centerpiece of the agenda they put forward this week. They're vowing to try to repeal it and replace it with far more limited changes to the health care system.

In a minute, we'll talk about how the health care law is playing out on the campaign trail in Florida. But first we're joined by NPR health policy correspondent Julie Rovner. Morning, Julie.

JULIE ROVNER: Good morning.

KELLY: Let me start with the timing of this. As we said, it comes six months after they signed this into law, also just a few weeks before the midterm elections. Coincidence?

ROVNER: Not at all. The people who wrote this bill knew it was going to take a good long time to get the major benefits up and running, so they wanted to have something tangible and popular to show voters before those important midterm elections, and these are some of the more popular benefits. They were - this was mostly the so-called patient's bill of rights that kicked around Congress in the late 1990s, aimed at curbing insurance industry abuses.

KELLY: OK. And specifically, take us through what's come into effect this week.

ROVNER: Well, starting with new policies and existing policies as they renew, there'll be things like not allowing insurance companies to impose lifetime caps on benefits. Insurance companies will have to allow young adults to stay on their parents' plans until they turn age 26. They'll have to let people get certain preventive care without co-pays or deductibles, and they won't be able to cancel policies retroactively unless they can prove fraud. And they'll have to allow parents to buy policies for children who have preexisting health conditions.

KELLY: OK. Now, I know all of those have been controversial. Let me stop you on that last one: children with preexisting conditions. Because insurers are trying to find a way around that one, aren't they?

ROVNER: That's right. Now, this is one of the problems with a law that really relies on private insurance. What we saw this week is that some of the largest insurance companies - Aetna, Cigna, Anthem Blue Cross - said that rather than abide by that they would simply stop selling insurance policies only for children. They're worried that their market for those child-only policies would be swamped by sick children.

KELLY: Let me steer you back to the politics here. We mentioned Republicans would like to see this law repealed altogether. Could they actually realistically do that if Republicans were to pick up a lot more seats in the House and Senate in these elections coming up?

ROVNER: You know, there's considered to be a realistic chance that Republicans could take back over control of the House and the Senate. But in order to get enough votes to repeal the law, they would have to overcome a veto by the president. That means they would need two-thirds in both the House and the Senate. Nobody really thinks that's doable.

But as part of this Pledge to America document that the Republicans put out, they said they would like to try to repeal it and replace it with some more modest changes instead.

KELLY: And what would those modest changes be?

ROVNER: Well, mostly these are things that we've seen before, Republicans have been talking about for years. Things like capping damages in medical malpractice lawsuits, letting people buy insurance across state lines. But there's really one big difference between then and now, and that's the existence of these new benefits that took effect this last week.

KELLY: The ones that just took effect. Now, why are those so significant?

ROVNER: Well, that's because Republicans remember, the patients' bill of rights that we were talking about earlier, was bipartisan. Republicans would like to keep those benefits intact. But remember, Democrats are having issues with the insurance industry; Republicans are having issues with the insurance industry too.

And in fact, at a hearing in 2009 before the law was passed, when a Republican asked three insurance company CEOs if they wanted to allow some of these more modest changes to go into effect without having any other changes, here's what those insurance CEOs said.

Mr. DON HAMM (Assurant Health): In the current system, that would not be feasible. We need to have an environment where all Americans are required to participate.

Mr. RICHARD COLLINS (Golden Rule Insurance): A guarantee issue product that would fit all people at an affordable price is economically practically impossible.

Mr. BRIAN SASSI (Wellpoint): So the answer would be no.

ROVNER: And in order, that was Don Hamm of Assurant Health, Richard Collins of Golden Rule Insurance, and Brian Sassi of Wellpoint. Basically what they're saying is they can't even do smaller things like selling policies to people with preexisting conditions unless everybody's required to have insurance. That's exactly what the Republicans want to repeal.

So bottom line is: even doing the more popular things is difficult in health care without doing the less popular things.

KELLY: NPR's Julie Rovner. Always good to talk to you.

ROVNER: Thanks.

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