1. Will COVID-19, influenza or an infectious disease to be named later make every other story look trivial?

This seemed like a filler question on New Year's Day in 2020. Then COVID-19 showed up.

2. What does the ferocious downsizing of the original federal anti-government-shutdown package mean for health legislation in Congress in 2025?

The package started out with 1,547 pages of text and some provisions of interest to benefits buyers and benefits advisors, including a provision that would have required pharmacy benefit managers working for self-insured employer health plans to pass all rebates and discounts they negotiate with the drug manufacturers on to the employer plans.

The PBM measure suddenly disappeared from the final, 117-page version of the American Relief Act 2025, along with many other popular provisions, such as reauthorization of a program that provides 900,000 meals per day for frail elderly Americans.

Are those provisions really dead, or are they about to reappear in a big package of provisions with enough bipartisan appeal to cause Democrats and Republicans to link arms and begin singing songs from "Wicked" together?

3. How will budget fights affect the situation?

The United States already has about $28 trillion in federal government debt, or about as much debt as gross domestic product, and the Congressional Budget Office thinks it could add another $22 trillion in debt over the next 10 years if current trends continue.

Many Republicans also want to find ways to cut enough government spending and add enough tax revenue to pay to keep the tax cuts created by the Tax Cuts and Jobs Act of 2017.

One sign of health insurers' and benefits groups' concern about the situation is fierce efforts to defend the federal tax exclusion for employer-sponsored health benefits.

4. How angry are the doctors, dentists and hospitals that are still around?

Many hospitals are saying reimbursement rates are too low and shutting down.

Many doctors and dentists are shifting to cash-only reimbursement arrangements or retiring.

Are tough negotiators at employer health plans and other payers simply flushing out weaker, inefficient providers, or have payers pushed prices down to a point that has no relationship with what honest, qualified providers are willing to accept?

5. Will anything change all that much?

Moderates in the Senate have resisted most sweeping changes to the U.S. health care system in recent years. The biggest ones that have become law were the ones needed to support sales of major medical coverage without medical underwriting.

Will the moderate middle give way this year, or will it continue to keep the current system creaking forward?

Related: The 2025 BenefitsPRO planner