PolitiFact: Claim misrepresents source and reasoning behind changes to Obamacare

The Republican effort to defund the Affordable Care Act threatens a government shutdown at the end of the month. U.S. Rep. Tom Graves of Georgia is one lawmaker who believes the dangers of the health care law justify extreme measures.

The Republican from Ranger has called the law, known as “Obamacare,” “destructive” and a “job killer.”

“We need to make every effort to ensure Obamacare is never implemented,” he said.

Graves said President Barack Obama’s actions highlight the law’s terminal flaws.

“Something very important has happened since the president did win the election,” Graves said on ABC’s “This Week.” “He himself has amended, delayed or repealed 19 components of his very own law. So if it’s so good for America, then why is he delaying it for his friends in big business?”

We wondered whether Obama has made that many changes in the law.

Graves’ office pointed us to a letter from the Congressional Research Service, the nonpartisan think tank for Congress. The CRS review listed 19 times the Affordable Care Act has changed since its passage in 2010. The report counted 14 public laws and five administrative actions.

For the record, we note that a dozen of those adjustments took place before the 2012 election, not afterward as Graves said. The timing seems less important than the substance of what was done.

Changes to the Affordable Care Act

Some items on the list qualify as significant in the eyes of the health policy experts we contacted. Timothy Jost of the Washington and Lee School of Law pointed to three:

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“Congress couldn’t find a way to make the CLASS Act actuarially sound,” Jost said, “so they repealed it and put the money elsewhere.”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.

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 CRS list, however, are less dramatic. Several clarified that certain government health insurance programs — such as Tricare, which covers the military — would count as coverage under the individual mandate.

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 Hurricane 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, our experts said.

“Legislators aren’t perfect,” Jost said. “They don’t get everything right the first time.”

It is also clear that Obama did not drive the majority of the changes. They emerged as Congress worked on various elements of a multifaceted law. Still, Obama signed off on those changes.

We’ve been here before

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.

Our ruling

Graves said Obama “himself has amended, delayed or repealed 19 components of his very own law.” Based on an analysis by the nonpartisan Congressional Research Service, Graves has the right number. But he simplifies the way many of those 19 changes came about, and by doing that, makes it seem as though the president were more directly involved.

Graves cited these changes as evidence that the law is fatally flawed, but he glossed over the differences among them. Some of the changes were significant, and some were technical or tangential to the health care law itself.

The basic number is right, but there are lot of details missing from Graves’ assertion.

We rate the claim Half True.