It feels that way, but let's remember that Republicans have held the governorship in Massachusetts for most of the past 30+ years. That's an interesting broader phenomenon, though. A number of other states have turned reliably blue in congressional and presidential elections while voting in Republican governors. New Hampshire is like that, and I was recently surprised to learn that Vermont is too.
Those Republican governors in blue states try to run as "old fashioned" conservatives, more about economic policy than culture war. It can work within the state but less well when the national platform is at stake.
The provisions for moving beyond paper was one of the biggest, and most relevant to people here. Examples are the use of electronic records, the incentives to actually use them (both for patents and for metrics), etc.
Due to the market power of Medicare, it also changed payments from per procedure to per outcome.
Many of these changes were quite deep. I would not use trivial to describe it.
Within that framework the changes can be seen as significant. But that framework is widely despised in the US and considered insane everywhere else.
It did derail the Democratic agenda, but mostly because Republicans made it their mission to ensure that Obama was a one term President. That has been policy ever since, and effectively zero legislation has come out of Congress since.
Democrats did manage to finesse the sole legislative accomplishment of the last couple of decades, the Affordable Care Act. In a lot of ways it was a fairly trivial change to the health care system, but getting anything passed at all was, in the Vice President's words, "a big [effing] deal".