Barry barry barry barry, well, you're wrong Stamos, lying is what you're doing...<quoted text>Where in the law does it say that Barry can make changes without Congressional approval which he already has done with his crony waivers?
"It is also clear that Obama did not drive the majority of the changes. They emerged as Congress worked on various elements of a multi-faceted law. Still, Obama signed off on those changes as part of larger pieces of legislation."
And it's NOT without Precedence!!
"Graves’ comments suggest that so many changes to the health care law means it's fundamentally flawed. Actually, major pieces of legislation rarely remain the same as the day the president signs them into law.
The Medicare prescription drug benefit, passed under President George W. Bush, was changed several times after its initial passage.
Both that law and the recent health care law lay a government program on top of a complex private market system, said Ted Marmor, a professor of health policy at Yale University.
"Patches on a patchwork mean making a coherent quilt very difficult," Marmor said.
Even though the country had about two years to get ready for the Medicare drug program, about the same as with Obamacare, some pieces were not in place when the program launched, said Jack Hoadley, a research professor at the Health Policy Institute at Georgetown University.
"States were worried that bunches of people would show up on Jan. 1, 2005, and not be able to get their prescription drugs," Hoadley said. "So some of them started picking up the tab."
Later, Hoadley said, the Bush administration pulled money from another fund to reimburse the states."
Changes to the Affordable Care Act
Some items on the list qualify as significant in the eyes of the health policy experts we contacted. One of the country’s leading authorities on health care law, Timothy Jost at the Washington and Lee School of Law, pointed to three:
A one-year delay in requiring firms with over 50 workers to provide insurance
Scrapping a long-term care insurance program (for nursing home care, for example) called the CLASS Act
Lifting the requirement on businesses to file a form called a 1099 for a variety of business expenses
The administration acted on its own to delay the employer mandate, explaining that the systems were not in place to implement it. The other two changes came through votes in Congress.
"Congress couldn’t find a way to make the CLASS Act actuarially sound," Jost said, "so they repealed it and put the money elsewhere."
As for the business reporting rule, "businesses said this was a huge burden and Congress responded," Jost said. "There was strong bipartisan support, and you could find the votes to make those sorts of changes."
In addition to those three, a program to create consumer health insurance cooperatives was retained but lost $2.2 billion in funding.
Most of the items on the Congressional Research Service list, however, are less dramatic. Several clarified that certain government health insurance programs would count as coverage under the individual mandate. This included Tricare, which covers the military, and insurance through Veterans Affairs.
Other adjustments extended tax breaks, such as a tax credit for families that adopt a child. There were changes in the Medicaid federal matching formula (to keep money flowing to Louisiana after Katrina), and a tweak to the calculation of income that determines the level of premium subsidies in the insurance exchanges.
Such changes are common in Congress, according to our experts.
"Legislators aren't perfect," said Jost. "They don't get everything right the first time. That’s the nature of the legislative process."
It is also clear that Obama did not drive the majority of the changes. They emerged as Congress worked on various elements of a multi-faceted law. Still, Obama signed off on those changes as part of larger pieces of legislation.