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.