The latest batch of adjustments came Wednesday, when the administration disclosed that it was delaying, once again, the deadline for people with old private health plans to buy beefed-up versions required under the health-care law. The cancellations of the old plans have been politically damaging for Democrats and the White House, because President Barack Obama had vowed that the law would not prevent people from keeping insurance plans that they liked.
By allowing many people to keep their old plans for two years longer, the administration softened the blow for congressional Democrats up for re-election this fall. No longer do members have to fear a wave of cancellation letters right before the November midterm election.
But the changes have contributed to consumer confusion, as people try to sort through their options on the already hard-to-understand subject of health insurance, and race to meet a March 31 deadline to carry health coverage or face a fine. And the changes fuel suspicions that the law is deeply flawed, forcing the administration to try to patch it on the fly.
Republicans immediately leapt on the Wednesday announcement as a recognition that the law, as written, is unworkable.
"The administration has acted dozens of times over the last year to unilaterally delay or change the law because it was not ready for prime time," House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said shortly after the change was announced.
Since April 2010, there have been about two dozen legislative or administrative actions changing the Affordable Care Act, according to media reports and the Congressional Research Service.
The changes range from small clarifications to major shifts, like last year's delay of a major provision that requires employers with at least 50 workers to offer health coverage to full-time employees.
To add to the confusion, some modifications are changes to previous changes. For example, this is the second time that the administration has allowed some people to keep noncompliant plans for longer than previously announced.
Many experts had predicted that the law would need to be tweaked. It is typical that large, complex pieces of legislation are adjusted and clarified during the implementation phase, as policies move from paper to the real world. Usually, Congress makes such technical corrections.
But, because the parties have been so polarized over the law, Congress has been unwilling to pass bills aimed at fixing the problems, with Republicans bent on repealing the law and Democrats fearful of reopening debate on such a divisive subject. As a result, the administration has made certain changes using the president's executive authority.
"I broadly view the administrative delays as a pragmatic realization that it is actually harder to do some of these things in reality than we thought when we put it down on paper," said Bob Kocher, a former Obama health-policy adviser.
Some of the adjustments came as a result of the rocky rollout of HealthCare.gov, the main federal portal for people in three dozen states to buy subsidized health insurance. For example, in December, the administration announced that there would be a "special enrollment period" to give people who ran into technical glitches on the website more time to sign up for coverage.
Meanwhile, people appear to be as confused as ever about the law. In a February poll taken by the nonpartisan Kaiser Family Foundation, about half of uninsured people said they do not have enough information to understand how the law will affect their families.
Some critics view the constant moving of the goal posts as a sign that the White House is not confident that consumers will ever warm to the health-care law.
"It sure looks like we're on a ramp to more changes, and those changes are occurring because people aren't buying it — literally and figuratively," said Robert Laszewski, an insurance industry consultant who has been an outspoken critic of the administration's handling of the rollout.
Many supporters acknowledge that the law is playing out differently than envisioned when it was enacted, but they contend that it remains on track to accomplish its goal of curbing the rise in health-care costs, improving the quality of care and making insurance affordable for virtually everyone.
"It's just that it is accomplishing it much more slowly and painfully than anyone ever imagined," said Sara Rosenbaum, a health law professor at George Washington University and a supporter of the law.
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