In theory, most of the U.S. health care delivery system and most of the health care finance system could work about the same way in 2018 as they've worked in 2017.
Medicare and group health plans look as if they'll continue on something like the same path.
Even the 2018 individual major medical market could go through some bumps and then settle down into looking like a creakier version of the 2017 market.
At press time, however, the future of the U.S. health care delivery and finance systems was up in the air.
Most of the Affordable Care Act was still in place. The Trump administration was administering the ACA system, including HealthCare.gov, about as well as possible, in some ways, but appeared to be working to block it in other ways.
The administration appeared to be close to working out a settlement with health insurers on billions of dollars in ACA cost-sharing reduction subsidy payments, but, whatever happens to the subsidy payments, the administration has made the point that it could change health insurance system administration procedures quickly, without much apparent concern for how the changes might affect health insurers.
Many nonprofit health insurers seem to be hunkering down and trying to stand up to the administration: they have elected chief executives from two of the most enthusiastic insurance company players in the ACA system to lead both America's Health Insurance Plans and the Blue Cross and Blue Shield Association.
But some of the biggest, publicly traded health insurers seem to be coping by doing when they can to retreat from the individual major medical insurance market, and avoid talking too much about their role in the fully insured employer-sponsored health plan market.
UnitedHealth Group Inc., for example, is calling itself a health care company.
Aetna Inc. is trying to become a division of a drug store chain.
If the individual major medical market stays as unpredictable in 2018 as it's been in 2017, and some of that upheaval spills over into other health insurance sectors, what then?
Trying to make anything as firm as a "prediction" for the health insurance system seems foolhardy, but here are some questions that might shape our coverage of health insurance in the coming year.
1. Will more companies could try to disguise more major medical insurance products as something else?
One symptom of a regulatory-driven market breakdown is participants' efforts to escape from the official market, into black market or gray market alternatives.
Many insurers, agents and consumers have already been trying to sidestep the challenges plaguing the individual major medical market by focusing more on partial individual major medical substitutes, such as short-term health insurance or hospital indemnity insurance.
Up till now, fear of patients' facing serious gaps in coverage, and lawsuits, have held down many agents' sales of major medical substitutes.
The more the individual major medical market deteriorates, the less squeamish market players may be about trying to work around it.
2. Will everyone get religion?
The Affordable Care Act includes a provision officially allowing the sale of a kind of arrangement that could, in theory, provide something like true individual major medical insurance: health care cost-sharing ministry memberships.
Ministries in effect when the ACA came along can continue to sell memberships without facing ACA mandates, or any other federal regulations or oversights whatsoever.
