If you thought 2014 was a crucial year for health care reform, just you wait. Here are ten stories that defined the narrative last year, and which will in all likelihood continue to be pivotal in the New Year.1) The future of the ACAWith Texas now considering expanding Medicaid and the Republican Congress not exactly poised to pass an immediate ACA repeal, it looks like the law will be with us all through 2015 and perhaps well into the future. How politically entrenched it becomes will depend on whether states continue to expand Medicaid and how the rest of the implementation goes, as well as whether it survives the King v. Burwell challenge at the Supreme Court. Because of a delay pushed by President Obama, January 1, 2015 was the date for the employer mandate to start coming into full effect. That same day was also the start date for new limits on out-of-pocket costs and co-pays. The consequences of those decisions will unfold throughout the year.2) The GOP programAfter its stunning victories in the 2014 midterm elections, the GOP has promised, at the least, small tweaks to the ACA. We will see in 2015 whether those pass—and inspire bolder changes to the law. But whether the ACA stays in place as is, is slightly changed, or is significantly altered, the challenges facing U.S. health care will largely remain the same. One big question for the New Year is whether the GOP will push a bold health care reform of its own—or be content to fiddle about on the edges of the ACA and let health care policy slide into neglect.3) The single payer pivot2014 saw Vermont’s plan to create a single payer system collapse, which will likely put a serious chill on calls for that particular policy for some time to come. Still, in a health care policy vacuum, single payer naturally suggests itself to many health wonks, so if 2015 becomes a year of a slow, small-bore skirmishes around various parts of the ACA without either party advancing an agenda beyond that, the pivot could return.4) Access restrictionsBecause of the ACA, the number of uninsured Americans decreased in 2014. But in America, access to insurance does not guarantee access to health care, because high deductibles or co-pays keep people away or doctors turn down people with lower-quality insurance (like Medicaid). Recent cuts to Medicaid reimbursement rates suggest that this problem with get worse in 2015, and those with private insurance could also face access problems that should become more clear throughout the year.5) Medical debt/Wage cutsThe other crunch point for health care is the financial burden our system continues to place on individual Americans and families. That can be in the form of acquired medical debt—which has increased in recent years—or in lost wages. With many businesses now saying that they will shift even more of the burden onto their employees, health care costs could take a big toll on the American worker in 2015.6) The cost slowdownIn 2014, wonks identified the national slowdown in rising medical costs as one very tangible victory we’d achieved. Data released during the year established that the slowdown continued through 2013, making 2013 the fifth consecutive year of slower spending growth, at a rate unprecedented since the government first started measuring in 1960. But experts continue to debate whether the slowdown is temporary, due in large part to the recession, or more permanent. Look for more data on that question in 2015.7) Hospital consolidationRecent years have seen hospitals combine with each other to create local monopolies, absorbing many independent practitioners along the way. When this occurs, prices tend to go up, leaving the average American worse off. This trend will very likely continue in 2015, as doctors overlburdened by administrative costs look to join the hospital conglomerates, and already-large hospitals use their size and clout to get even bigger.8) Medical innovationTechnologies, innovations, and companies of all sorts that create space for new kinds of service delivery could help offset some of the effects of megahospital conglomeration. From medical applications of smartphone technologies to more efficient medical devices to clinics located in big-box stores, these innovations can help people get cheaper care without much of the overhead costs of a hospital and empower health care providers other than doctors. 2014 saw a number of encouraging developments in this field; 2015 will likely see some of these innovations mature and new ones arise.9) Price TransparencyPerhaps the most encouraging development in health care this year has been the increased awareness of just how insane American health care pricing is, with its huge, unexplained variations, and the opacity that protects this pricing. And though many states continue to do poorly at providing price information to their residents, some states made real progress on rectifying that this year. Price transparency is one of reform’s lowest-hanging fruits , and we hope more states will get wise to that simple fact in 2015.10) Scope of practice/provider poolAnother low-hanging fruit is allowing nurse practitioners to do more primary care without direct doctor supervision. That could become increasingly important in 2015 as those newly insured continue to seek care, and doctors themselves close up practices all together out of weariness with a system many of them find too difficult to work within. Whether the pool of doctors continues to shrink and whether scope of practice laws let in more NPs are important stories to watch in 2015.