By our count at the Galen Institute, more than 54 significant changes have been made to the Patient Protection and Affordable Care Act since it was enacted in 2010 – at least 34 that the Obama administration has made unilaterally, 17 that Congress has passed and the president has signed, and three by the Supreme Court.

Our latest count has added two more changes made by the Obama administration contrary to statutory language, and one rewrite of the law’s text from the latest U.S. Supreme Court decision.