Republicans have voted dozens of times to tweak or trash Obamacare, but here’s a little-known fact: A majority of the attempted changes have actually become law.
A new report from the Congressional Research Service finds that out of 78 changes lawmakers have attempted to make to the Affordable Care Act — including efforts to modify parts of the law or ditch it entirely — more have been signed into law than have been blocked by Democrats.
In total, President Obama has approved 44 changes to his signature health care law. None of them significantly revamp the law — as Obama has consistently said, and White House adviser Valarie Jarrett recently reiterated, he won’t remove its major elements.
Still, some of the changes Obama has endorsed have a broader effect than others. He signed a provision in spring 2014 removing a cap on the deductibles small group health plans could collect from patients.
But neither party has spent much time talking about the revisions to the Affordable Care Act. Republicans have feared that improving the law would make it more palatable to the public and therefore undercut chances of repealing the whole thing. And Democrats don’t see much political benefit from advertising the changes, either.
“Though the president largely welcomed (or at least could tolerate) everything he signed into law, he knows that hyping such changes don’t help the rare constructive (or at least not destructive) interactions with the [Republicans] on this subject,” former White House health care adviser Chris Jennings wrote in an email.
Instead, it’s been attempts in the GOP-led House to undo the law’s biggest parts that have gained the most attention, as Republicans hammered home their disapproval of the law and Democrats have defended it.
Over the last few years, their efforts have followed a familiar sequence: the House passes an anti-Obamacare bill and then the Democrat-led Senate refuses to take it up while Obama issues a potential veto threat.
Republicans have cast so many votes targeting Obamacare that there’s wide disagreement on the exact number.
When the House passed its latest repeal bill in early February, Democrats said it was the 56th time Republicans voted to repeal the law or undermine parts of the health law. Some news outlets wrote that the vote was the 67th while others said it was the 60th. An internal list kept by House GOP aides pegs the number at 61.
The disagreements underscore the difficulty in deciding which votes to count. The Congressional Research Service report separates them out by individual bills and provisions that were included in larger spending agreements.
According to the report, the House has passed 46 bills repealing or otherwise changing the law. Of those, Obama has signed 12 into law. And then there are another 32 changes to the law that were included in bills funding the government that the president has also agreed to.
The so-called “cromnibus” that Congress passed in December contained eight changes. It included a provision targeting a part of the law Republicans have complained about for a while. That provision blocked government funds from a program that provides extra money to health insurers who suffer deep losses by enrolling sicker patients.
Other provisions were changes lawmakers have passed before — like removing funds for a board intended to keep Medicare payments in check that weren’t going to be used anyway.
Similarly, many of the other changes buried in massive spending bills are so technical that they passed with relatively little attention.
“With some very few exceptions, the policy changes are relatively modest,” Jennings said. “They certainly do not alter the pillars of the law.”
