Just when you thought that the roll-out of the Affordable Care Act couldn’t get any worse, President Obama signs his 18th executive order altering the law. The latest unilateral White House change came with the decision to delay the large employer mandate for another year. This means that employers with more than 100 employees can wait until 2016 before they will be required to offer insurance to their workers.

In the past six months, the Obama Administration has changed the rules in the middle of the game to such an extent that it will be impossible in the future to gauge the success — or failure — of the massive federal health care overhaul.

Reporting requirements for employers have been delayed for another year.

Income verification — essential to the subsidy program for low-income workers — became a self-attestation program under another Obama executive order.

The program was later rescinded by Congress because of the likelihood of fraud.

The White House created an expensive new federal subsidy for members of Congress and their staff that was not part of the original law.

In October, the individual mandate was delayed until later this spring (March 31, 2014). The White House bent the rules after public outcry to allow insurance companies to offer cancelled plans that do not carry the same mandated benefits as the individual plans being offered through the federal exchanges.

Requirements that employers provide the same level of coverage for highly compensated executives as the lower-compensated workers receive has pretty much been scrapped for the time being by President Obama.

This means that the higher-ups will continue to receive better insurance than their less well-paid workers.

There are plenty of other changes to the Affordable Care Act that were made by the White House and many more will probably be enacted in the months ahead.

There is something terribly wrong with the Affordable Care Act that necessitates all these executive orders, but President Obama hasn’t asked Congress to help.

He would rather make the changes through executive orders, circumventing the Congressional process.

But the biggest question mark still lies ahead.

We hear all the time about the 5 million Americans that have already “signed up” for health insurance through the state and federal exchanges.

While this is certainly good news, it only reflects how many people have completed their applications.

The real question I want answered is this: Of the 5 million Americans who have “signed up” for insurance coverage, how many have actually begun paying their monthly premiums? Health insurance is worthless – and so is the Affordable Care Act, unless these 5 million Americans keep up their premium payments.