By Evan Falchuk

Here are a few quick reactions to the House’s passage on Saturday of its health care reform bill.

1. It’s a huge bill, and that’s the problem.

It’s 1,990 pages long, and it’s trying to do an equally massive number of things.  It would create a public health plan;  establish insurance exchanges; federalize much of state insurance regulation; change the ways in which the federal government pays for health care; address issues in medical education; try to deal with fraud and abuse in Medicare; make changes to dental care, hospital price transparency, health care for native Americans, long term care insurance; establish subsidies and taxes for individuals, taxes on pharmaceutical and medical device makers, spending on public health programs; eliminate the anti-trust exemption for health and medical malpractice insurers, and on and on and on.  You can get a taste of the bewildering extent of this legislation by just scrolling through its table of contents.

I’m not sure there’s ever been such a big piece of health care or health insurance legislation ever passed.  I mean, like, ever.  It’s not going to become law, though, since the Senate has yet to pass its own bill and the Senate and House versions will need to (somehow) be reconciled.   And if one of the problems with reform is the public anxiety its complexity creates, this bill won’t help.  Still, it’s a big milestone and should be recognized for that.

2.  The stock market seems to like it.

The stocks of a broad range of health insurance companies were up as much as 3% today.   The market doesn’t seem to think this bill is bad news.  Why?

Maybe the market likes that the House bill brings back the mandates on individuals and employers that will create the bounty of new, paying customers Vice President Biden promised.  Or maybe the market thinks the bill is so complicated it won’t become law, which might also benefit the insurers.  Or maybe when the market closed Friday it expected the final bill to be much worse than it ended up being.  Or maybe health insurance company stocks go up every time the Patriots beat the Dolphins.

What is clear is that the market did not treat the passage of this monumental legislation, designed to completely transform the health insurance industry, to be an especially significant event.

3.  Health care and politics mix badly

Back in July, I warned that abortion would end up being part of the fight over health care reform, and it was.  A bi-partisan group of 240 representatives (20 more than voted for the final bill) voted for an amendment to the House bill dealing with abortion.  The amendment would ban the sale of insurance policies that cover abortion in the government-sponsored exchange that the bill would create.  However you feel about abortion, this is an example of the same old way of regulating health insurance that the states have been doing for generations.  It’s what created such an uncompetitive market for health insurance in the first place.

The states, which until now (perhaps) are the sole regulators of insurance, regulate health insurance by telling insurance companies what they have to cover if they want to sell in their states.  In all, states impose nearly 2,000 mandates on health insurance policies in this way.  Of course, whether something is mandated or not depends on the political clout of the group lobbying for it.  Now, the federal government seems to want to try its hand at this same old approach to regulating insurance.  Abortion, it seems is the first of what promise to be many such mandates.

Don’t believe me?  Take a look at the action in the Senate.  Last week, Senator Hatch proposed that policies sold in the Senate’s version of the exchange be required to cover Christian Science prayer treatments.