16. CO-OPs, IPAB, IRS defunded: Congress made further cuts to agencies implementing Obamacare. It trimmed another $400 million off the CO-OP program, cut another $305 million from the IRS to hamper its ability to enforce the law’s tax hikes and mandates, and rescinded $10 million in funding for the controversial Independent Payment Advisory Board. (December 23, 2011)
17. Slush-fund savings: Congress slashed another $11.6 billion from the Prevention and Public Health slush fund and $2.5 billion from Obamacare’s “Louisiana Purchase.” (February 22, 2012)
18. Less cash for Louisiana
: One of the tricks used to get Obamacare through the Senate was the special “Louisiana Purchase” deal for the state’s Democratic senator, Mary Landrieu. Congress saved
another $670 million by rescinding additional funds from this bargain. (July 6, 2012)
19. Trimming the Medicare trust-fund transfer: Congress rescinded $200 million of the $500 million scheduled to be taken from the Medicare Part A and Part B trust funds and sent to the Community-Based Care Transition Program established and funded by the ACA. (March 26, 2013)
20. Military benefits: Congress clarified that plans provided by TRICARE, the military’s health-insurance program, constitutes minimal essential health-care coverage as required by the ACA; its benefits and plans wouldn’t normally meet ACA requirements. (April 26, 2010)
21. VA benefits: Congress also clarified that health care provided by the Department of Veterans Affairs constitutes minimum essential health-care coverage as required by the ACA. (May 27, 2010)
22. Drug-price clarification: Congress modified the definition of average manufacturer price (AMP) to include inhalation, infusion, implanted, or injectable drugs that are not generally dispensed through a retail pharmacy. (August 10, 2010)
23. Doc-tax fix: Congress modified the amount of premium tax credits that individuals would have to repay if they are over-allotted, to help offset the costs of the postponement of cuts in Medicare physician payments called for in the ACA. (December 15, 2010)
24. Extending the adoption credit: Congress extended the nonrefundable adoption tax credit, which happened to be included in the ACA, through tax year 2012. (December 17, 2010)
25. TRICARE for adult children: Congress extended TRICARE coverage to dependent adult children up to age 26, when it had previously only covered those up to the age of 21 — though beneficiaries still have to pay premiums for them. (January 7, 2011)
Changes by the Supreme Court:
26. Medicare expansion made voluntary: The court ruled it had to be voluntary, rather than mandatory, for states to expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, by ruling that the federal government couldn’t halt funds for existing state Medicaid programs if they chose not to expand the program.
27. The individual mandate made a tax: The court determined that violating the mandate that Americans must purchase government-approved health insurance would only result in individuals’ paying a “tax,” making it, legally speaking, optional for people to comply.
This law is being dismantled even before it takes full effect because it is so fatally flawed. Congressional Democrats continue to mock House Republicans for their efforts to repeal and dismantle the law when so much of the law has already been changed.
Obamacare must go, but in the meantime, the American people’s elected representatives need to protect them as much as possible from harm. The 27 “fixes” that already have been made to the law have not repaired the law, but some have indeed protected some Americans from even further damage.
— Grace-Marie Turner is president of the Galen Institute, where a version of this list was first published. Tyler Hartsfield is a policy analyst at the institute.