For 30 years, major changes to health care laws have passed via the budget reconciliation process. Here are a few examples:

1982 – TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs

1986 – COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care

1987 – OBRA ’87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program

1989 – OBRA ’89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care

1990 – OBRA ’90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid

1993 – OBRA ’93: created federal vaccine funding for all children

1996 – Welfare Reform: Separated Medicaid from welfare

1997 – BBA: The Balanced Budget Act created the state-federal childrens’ health program called CHIP

2005 – DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid