"In sum, nothing happens yet, nor is it likely to happen until the heads of HHS, Treasury, and probably Labor, as well as the CMS Administration and IRS Commissioner are in place; even then it will take a while for changes to be put into motion. In the long run a great deal may change ... But change will only be 'to the maximum extent permitted by law.' There may be, for example, a fairly dramatic shift in the interpretation of section 1332 of the ACA, which permits HHS to grant innovation waivers to states, but waivers will still have to be granted subject to section 1332's requirements. Sale of insurance across state lines is already permitted by the ACA, but subject to state approval and consumer protections that will have to be observed."