Quora: Have Democrats Ever Changed the Affordable Care Act?

An insurance store advertises Obamacare in San Ysidro, California, January 25. Mike Blake/Reuters

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Answer from Ross Cohen, B.A. in History and Political Science:

The Affordable Care Act (also known as ACA or "Obamacare") became law in 2010, but it was phased in gradually and didn't fully take effect until 2014.

In 2014, the U.S. House of Representatives was controlled by Republicans who made it abundantly clear that they would not allow any healthcare legislation to come to the floor that did not completely repeal ACA. In addition to their many statements leaving no ambiguity about how they felt, they had already taken many symbolic votes to that effect.

In 2015, the Republicans took over control of the U.S. Senate, meaning they had full control of Congress. Their position on Obamacare did not change and they remained committed to full repeal.

Even so, there actually were legislative improvements made to ACA by Democrats that few remember. If you want to get technical, the Democrats passed a revision to ACA almost immediately after passing the original, but that was for all intents and purposes part of passing ACA, so few would count that. Beyond that though, there were a number of legitimate changes made to ACA just in that first year.

In 2010, Democrats passed the Medicare and Medicaid Extenders Act, "to help offset the costs of the Medicare and Medicaid program extensions and the postponement of cuts in Medicare physician payments."

In another law passed the same year, they modified the ACA's definition of "average manufacturer price (AMP) to include inhalation, infusion, implanted, or injectable drugs that are not generally dispensed through a retail community pharmacy." Not very interesting but you asked for a timeline and obviously they believed this improved ACA.

In that same year, they passed another law to "clarify that health care provided by the Department of Veterans Affairs constitutes minimal essential health care coverage as required by the ACA." This protected veterans and prevented a potentially big problem so is obviously an improvement as well.

In that same year, they passed the TRICARE Affirmation Act for similar reasons, to protect American service men and women and their families, which obviously avoided a big problem later.

Those four were all done in 2010, in the months after ACA passed, and that's not even all of them. Each of these legislative actions were taken by Democrats prior to Republicans taking power.

Once 2011 rolled around, the Republicans had taken control of part of Congress so things got a little more complicated since all they wanted to do was repeal the whole thing, not fix it.

Under these circumstances, the question really becomes what counts as "trying" since there was little chance any ACA improvement bill they attempted would get anywhere close to a vote. In truth, they had no legislative power and had their hands full simply defending the law from constant attack and efforts to undermine it, battles which they unfortunately did not always win. In 2015, Sen. Marco Rubio (R-FL) slipped in an amendment that prevented the government from paying obligations it owed to insurance companies, which significantly damaged the law and raised premiums (Marco Rubio Quietly Undermines Affordable Care Act).

It would take some heavy research to go back and see what kinds of bills and amendments Democrats futilely proposed knowing Republicans in power would never allow them to get anywhere, but that is not a research project I wish to undertake. However, even without doing that heavy research to come up with an exhaustive list, I can point to some things that were not only tried, but actually passed in little known instances of bipartisanship to tweak ACA.

In 2011, Congress passed and President Obama signed a law reducing ACA's reporting requirements for small businesses. It repealed a provision requiring businesses to report to the IRS any time they made a purchase of more than $600 to a single vendor. Democrats supported it in the House and Senate (the latter of which they still controlled at that point) and signed it into law, so this obviously qualifies as them trying to improve Obamacare.

In 2013, Congress passed and President Obama signed a repeal of Title VIII of the ACA, known as the CLASS Act, which had been one of Ted Kennedy's contributions to the law. It was supposed to create "a voluntary and public long-term care insurance option for employees" once implemented, but the Obama administration determined it was unworkable so Congress went ahead and repealed it, which Obama signed. Since it was the Obama White House that proposed/signed it, and a Democratic Senate that passed it, in addition to Democrats in the House supporting it, this too qualifies as Democrats trying to improve Obamacare legislatively.

In 2015, Congress passed and President Obama signed the Protecting Affordable Coverage for Employees Act which:

…makes a minor fix in the definition of a small business that could result in thousands of dollars of savings for 150,000 businesses. Under the original law, small businesses of less than 50 employees have their own special rules requiring specific types of coverage with a higher cost to employers. Beginning in 2016, those special rules were scheduled to apply to small businesses of 51 to 100 employees.

The new law gives states the ability to decide how to classify businesses of 51 to 100 employees, potentially saving premiums for small business employees from going up 18 percent or more, according to an estimate from the consulting firm Oliver Wyman. And there's a bonus: Reducing workers' insurance premiums means increasing their taxable income, resulting in a $280 million in additional revenues to the federal government over 10 years. That money will go to bolster Medicaid. [1]

The bill had 47 Democratic cosponsors in the House, passed both chambers essentially unanimously (by voice vote), and was signed by President Obama, so it was bipartisan and certainly qualifies as another thing Democrats legislatively tried to improve Obamacare.

Many would be surprised to learn so many legislative improvements to Obamacare were actually made. It's explained quite well by this passage from the USA Today article linked in the footnotes:

Grace-Marie Turner of the Galen Institute, a prominent Obamacare critic, said the congressional action comes just under the wire, as insurance companies finish pricing contracts for 2016 coverage. And the quick, businesslike way in which the bill was passed just shows that neither side saw any benefit in politicizing the issue, she said.

"I think here the White House certainly doesn't want to announce with big fanfare that the Republican Congress has led on making changes on the president's health law," she said. "And the Republicans don't want to say that they're fixing it, because they want to repeal it entirely."

So, Democratic efforts to improve Obamacare legislatively were certainly there, not to mention all the regulatory and executive actions. If we wanted to spend weeks combing through the Congressional Record, I'm sure we could find Democratic amendments that never got anywhere in a Republican Congress, but you'll have to hire your own researcher for that.

In the meantime, if Republicans were to drop their insistence on full repeal, severe damage to Medicaid, drastic tax cuts for the wealthy out of funds currently used for healthcare, and similarly inconceivable destruction to Americans' healthcare, many Democrats have said they're willing to work with Republicans to improve ACA. Unfortunately, without the Republicans giving up on destroying Medicaid and cutting nearly all funding from ACA, they'd just be talking past each other.


[1] Obama signs 14th bill making changes to Obamacare

Since Obamacare became a law in 2010, how many times have the Democrats tried to improve it legislatively? originally appeared on Quora - the place to gain and share knowledge, empowering people to learn from others and better understand the world. You can follow Quora on Twitter, Facebook, and Google+. More questions:

Quora: Have Democrats Ever Changed the Affordable Care Act? | Opinion