House Republicans will begin planning their agendas this week. Many of these candidates made their opposition to the President's health care law a central issue in their campaigns. But to what extent will Tuesday's elections actually affect the course of reform?

Likely Speaker of the House John Boehner has been an outspoken proponent of the "repeal and replace" approach, telling reporters yesterday that he wants to begin "lay(ing) the groundwork" to repeal the law. But overturning health care reform would require a two-thirds majority to beat an Obama veto, a mark the GOP falls far short of in the House and the Senate.

Instead, Republicans may have a better chance of limiting the law's scope by tightening oversight — and the purse strings. Majority Whip Eric Cantor, R-Va., acknowledged this in his 22-page letter to Republicans yesterday, saying that if necessary he intends to "begin repealing [the law] piece by piece, blocking funding for its implementation." This could gum up the works enough to cause headaches for Democrats trying to meet the law's various deadlines.

The election may have significant impact at the state level, as well. State insurance commissioners have already had a hand in determining how the health care law is implemented. As we reported earlier this year, a body of commissioners has influence over what percent of premiums insurers must spend on patient care. It's a detail of the law that's been hotly debated by insurance companies and consumer advocates, and was reported on a great deal of lobbying reports after the law passed.

Insurance commissioners also have varying degrees of control over companies' ability to raise their premiums. California's outgoing commissioner, Steve Poizner, helped beat back a proposed 30 to 39 percent rate hike by Blue Cross licensee WellPoint earlier this year. Commissioners have the power to enforce various aspects of reform, and to determine, for example, how state exchanges will operate. This could have a big effect on how the law impacts consumers.

In most states, governors appoint insurance commissioners, although in four states, they were elected directly on Tuesday. (Three of the four were opponents of the law). Republican gains in governorships will likely bring more commissioners into the "opposed" column: new GOP leaders in Iowa, Michigan, New Mexico, Tennessee, Wyoming, Florida, Wisconsin and Ohio all have the power to choose their commissioners. (Maine's is appointed as well, but the next one won't be named until 2013).

Three states also put one of the reform law's key provisions up for a direct referendum on Tuesday. Arizona, Oklahoma and Colorado residents voted on whether individuals could be forced to purchase health insurance in their states. Many policy analysts say the ballot measures — which passed in Arizona and Oklahoma — will ultimately have little effect, because they'll be overridden by federal policy, but proponents say they'll give state officials leverage to fight portions of the law.

Feature photo by Mike Baird.