The Patient Protection and Affordable Care Act is the law of the land and will likely continue to be for some time, despite opponents' best efforts to get it thrown out in court.

But what the law will look like a few years down the line is anybody's guess. In fact, the landmark legislation has already been changed significantly since it was originally enacted more than five years ago.

For the 14th time on Wednesday, President Obama signed a bill making changes to PPACA.

That's right. Despite unprecedented Congressional gridlock brought on by two parties that can't seem to agree on anything, 14 health care bills have earned the support of both Congress and the president.

That's hardly much compared to the more than 50 times House Republicans have voted in vain to repeal Obamacare, but it's better than nothing.

"Unbeknownst to the public, there is actually some governing going on," Larry Levitt, a senior vice president at the Kaiser Family Foundation, told USA Today.

The most recent bill Obama signed gives states the power to decide whether small businesses with between 50 and 100 employees will be subject to the costlier insurance requirements imposed on firms with fewer than 50 workers.

Originally, PPACA was going to begin treating both classes of business the same in 2016.

Why hasn't there been more awareness of these small but significant changes?

Talking to USA Today, Grace-Marie Turner, president of the conservative Galen Institute, which advocates for free market health care policy, argued that neither party saw a great advantage in touting the compromises they've achieved on the PPACA.

"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."

But asked why they pushed for the changes, Republicans who otherwise favor repeal were quick to say they were just trying to make the best of a bad situation.

"There are a lot of things in the bill that need fixing. I'm for repeal and replace," Brett Guthrie, R-Ky., the sponsor of the bill, said. "But here’s the situation: You have people being negatively affected, and so can we find a way to work together to fix it.

More prominent proposals likely coming up include a repeal of the "Cadillac Tax" and a repeal of the medical device tax. Both proposals have garnered bipartisan support, but both will no doubt face opposition from at least some Democrats.

The question is whether enough Democratic votes will be there to uphold a likely presidential veto of both bills.

Instant Insights /

Republicans and Democrats work together on PPACA--often

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