We have known this since the begin­ning.  If Con­gress failed to act, the Pres­i­dent still had the pow­er to change the ACA by either with­hold­ing pay­ments, chang­ing juris­dic­tions or sim­ply, as the Pres­i­dent has become so fond of doing, issu­ing an Exec­u­tive Order that just does what he wants.  So here we are, in the midst of an Exec­u­tive Order, that does the following:

Directs the Depart­ment of Labor to con­sid­er expand­ing Asso­ci­a­tion Health Plans.  The idea here is that by let­ting car­ri­ers com­pete and expand beyond state bor­ders, they will be able to low­er costs and offer more options to poten­tial pol­i­cy­hold­ers in a giv­en state.  Sounds good…except that car­ri­ers already have sub­stan­tial pools they insure, may not have the where­with­al to expand, and many of the major car­ri­ers in the health care mar­ket­place are already nation­al – and already in Cal­i­for­nia (e.g. CIGNA, Anthem, Aet­na and Unit­ed Health Care).  By the way, how did the mul­ti state Co ops work under the ACA?  That’s right, they no longer exist.  Nice try, though.

Directs Health and Human Ser­vices to expand cov­er­age through low cost short term dura­tion plans.  Which already exist.  Which are already inex­pen­sive.  This sim­ply relieves them of some of the respon­si­bil­i­ty to act like ACA plans.  Any­way, it’s short term, so whatever…

Directs HHS and Trea­sury to con­sid­er changes to Health Reim­burse­ment Accon­ts.  Now we’re talk­ing – these help com­pa­nies do par­tial self fund­ing, allow expens­es that are not nor­mal­ly tax free to be so, and so, and so.