While Senate and House leaders work to reconcile a final, single version of their health care bills, the Republican opposition is preparing for the next round of battle. Aided by a vast medical industry lobbying machine and motivated by that machine's rich campaign contributions, Republican opponents are preparing to pursue their fight to kill or stall health care reform from the level of state legislatures.

Republicans in a dozen state capitols are collaborating on their first round ploys for the new year.

Punching ball tactics

One strategy is to pursue a legislative campaign for state authority to opt-in or opt-out of any federal requirements or mandates in the final health care bill. GOP opponents of federal health insurance reforms, for example, are considering demanding the right to opt out of federal requirements for states to establish general health insurance exchanges in order to expand citizens' choices for insurance.

Another tactic is to have state attorneys general file lawsuits challenging the constitutionality of particular mandates, such as one expected to require most citizens to purchase health insurance, or to require states to expand the reach of federal Medicaid to the poor.

Florida's attorney general, William McCollum, for example, called the insurance-purchase requirement "an affront to our country's principles" when he announced last Tuesday that he was considering a lawsuit over the mandate. He also encouraged other states to do the same. Mr. McCollum, a Republican who is running for governor this year, surely won't be the only Republican candidate in Florida grandstanding on biased charges concerning health care reform.

Big lobbyists' bucks behind it

Among Florida's lawmakers, 42 Republicans have signed on as co-sponsors of a bill that would challenge federal mandates as unconstitutional assaults on citizens' liberties. Not coincidentally, virtually all 42 were among the legislative recipients of huge campaign contributions from the medical industry.

According to a new report by the National Institute on Money in State Politics, a non-partisan group based in Helena, Mont., the 42 co-sponsors received a total of $765,000 in campaign contributions from medical industry lobbying groups alone in the last election cycle in 2008. If divided among them equally, that would give each an average of $18,215 from health-care industry lobbyists alone.

Spending across the country

Such vested-interest largesse is just part of the larger, nationwide picture of large campaign contributions from the medical industry and its lobbyists. Nationally, the Institute on Money in State Politics found, medical industry groups -- hospitals, health insurance and pharmaceutical companies and medical device makers, for example -- contributed approximately $102 million to state-government level political campaigns around the country in 2008. That compares with the $89 million spent by the same medical-industry lobbies for 2008 campaigns at the federal level.

There's a reason for the difference. Health industry lobbyists generally exert far more control and influence on state legislatures, and their votes on health care issues, than they exert at the federal level. Weak state campaign and ethics laws allow them more access and influence, and most states do not have the sort of strong consumer protection organizations that exist at the national level.

What's more, the framework for their state-level contributions in the 2008 elections served a specific and well-planned political strategy. The politically astute health-care industry accurately foresaw what most independent analysts saw: That a grass-roots rejection of the costly Bush era would propel a Democratic victory that fall, and that Democrats would pursue their goal of health-care reform with new zeal.

Positioned for battle

The medical industry wanted to position itself for battle against precisely the health-care reform legislation that is now pending a final vote. And armed with a mountain of disinformation and long-time collaborators among Republicans who again stand ready to use health-care reform as a major opposition issue, both the industry and the GOP have girded for this moment for the 2010 elections.

Still, state-level lawsuits are not given much chance of staving off the federal-to-state mandates in question. Yet an outright victory in such lawsuits this year is perhaps less important than consuming time and creating noise in the looming election battles.

Old plot against progress

The latter will allow opponents to keep dispensing their disinformation campaigns to distort the public's view of health care reform for the 2010 elections. Republicans would be happy to win seats; medical industry lobbyists would be heartened by a shift in power in Washington.

The hand-in-glove cooperation between lobbyists for the medical industry and Republicans who do their bidding is precisely what has killed health care reform for decades.

Republicans gladly take medical lobbyists' rich campaign contributions and formulate their industry-friendly view accordingly. They will argue with a straight face that Americans actually prefer to risk medical bankruptcy and early death by keeping the greedy insurance industry's status quo of denying Americans' claims, dropping their policies when they become ill, denying policies for so-called pre-existing conditions, and cruelly limiting treatment when it is most needed.

A dressed-up stall

Republicans, of course, gussy up their opposition with talk about the need for reforms to bring down the soaring costs of insurance and its mounting deductibles and exclusions. They will say they want all that -- just not right now, and not this way, but rather by some unspecified better way at a distant date to be determined when they and insurance companies and hospitals are assured that any changes don't fundamentally spoil their profits, executive salaries and campaign contributions.

Tennessee's legislature is in play on these issues. It is clearly in the grip of the health insurance industry. State rules are lax to non-existent on insurers' use of exclusions to deny or limit private policies, or to pay a state-mandated percentage-minimum in actual health care reimbursements from policy-derived revenues.

But Republicans will pitch this sorry state of affairs as something better than the pending reforms. It would be foolish to believe that.