Kathleen Sebelius, Secretary of HHS, has full control of who is writing, and what they are writing. HHS has complete and unfettered jurisdiction on what and who is writing the regulations. The 2600 page document is only a framework that was written and voted on before anyone was able to read it. A continuance of written rules and regulations written by unelected government agency workers is what you are referring to and it continues to accumulate.
Read about the Patient Protection and Affordable Care Act at: http://housedocs.house.gov/energycommerce/ppacacon.pdf.
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