As partisan positions have crystallized at the federal level, changes to the Patient Protection and Affordable Care Act (PPACA) through legislation look increasingly unlikely. While Congress and President Obama agreed to change the 1099 reporting mandate through legislation, future bi-partisan health care policy agreements will be rare. If American voters have developed a new respect for divided government, this could be the case well after full implementation of the PPACA in 2014. Accordingly, employers and states have been seeking, and getting, waivers from PPACA requirements based on executive authority already present under the law. While contested in some instances, PPACA health policy changes through waiver are in most ways a continuation of a long-standing state/federal relationship. They may also indicate how states will meet the design and time demands for implementation of state health benefit exchanges.