Critics have denounced the Republican attempt to repeal the healthcare reform law, the Affordable Care Act (ACA), as an empty symbolic gesture, intended to make good on a campaign promise to the Tea Party. It’s all a bit of C-SPAN theater dressed up in reality-defying buzzwords. The Repealing the Job-Killing Health Care Law Act would, in fact, kill jobs, since without the ACA employers would face sharp increases in healthcare costs and reduce their workforce. And repeal would increase the federal deficit, which conservatives claim to be so worried about. But no matter, Republicans can afford to grandstand because they know the repeal bill has no chance of becoming law; even if it prevails in the House—at press time a vote was under way—majority leader Harry Reid has pledged to block it in the Senate, never mind Obama’s veto pen.

Maybe voters will reward the GOP for posturing; maybe they won’t. Polls vary on support for repeal depending on how the question is asked—50 percent in a recent CNN poll; just 26 percent in a Kaiser Family Foundation study—and by 2012 more tangible benefits of reform will have reached more people. But there is one group for whom the repeal show is an undeniable boon: insurance companies, which are using the vote as a giant distraction to draw attention away from their fifty-state strategy to subvert healthcare law so that it skews even more in their favor. As health insurance whistleblower Wendell Potter puts it, "The rhetoric of repeal is just a smoke screen to obscure the real objective of the ‘repeal and replace’ caucus: to preserve the sections of the law that big insurance and its business allies like and strip out the regulations and consumer protections they don’t like."

Health insurance companies, Potter pointed out during a recent visit to the Nation office, are quite happy with the ACA’s mandate that everyone purchase health insurance because it creates a captive market, and they’re delighted that there’s no federal public option to compete against. What they’re not happy about are bans on using pre-existing conditions to deny consumers coverage, which could apply to up to half of all Americans under 65. And they rankle at the new requirement that they spend 80 to 85 percent of premium dollars on medical claims.

The devil is in the details, and those will be largely determined not in Congress but by state regulators and insurance commissions. (In Congress, the real action will be during the appropriations process, when Republicans will mess with the individual mandate by stripping funding for low- and middle-income people—that’s a fight Democrats can and should win.) According to Potter, insurance lobbyists are already on the prowl. At a meeting of the National Association of Insurance Commissioners last spring, Potter was one of about twenty consumer representatives overwhelmed by the more than 1,000 insurance industry hacks in attendance. "I’d never seen anything quite like it," he says.

State action does create some possibilities for progressive movement: California’s legislature twice passed a single-payer plan, only to have it vetoed by Republican Arnold Schwarzenegger, who’s been replaced by Democrat Jerry Brown. Connecticut is debating whether to fund a public option, and Vermont is considering a single-payer plan too. But the Republican triumph at the state level in 2010 means that many Americans will face watered-down regulations and weak insurance exchanges—unless there’s a movement to counter the insurance lobby with a people’s fifty-state strategy for meaningful healthcare reform.