If the 2018 midterm elections proved anything, it’s that healthcare remains a top issue – if not the top issue – for millions of Americans across both sides of the aisle.

In one poll released right before election results rolled in, a whopping 71 percent of voters said the issue of healthcare was “very important” to their voting decision. The next closest issue, the economy, came in seven points behind that.

And with the recent ruling from Texas Judge Reed O’Connor in December, 2019 is already setting up to be another huge year for healthcare with plenty at stake for voters, providers, insurers and more. Those in the industry recognize that, one way or the other, dramatic changes are coming to the healthcare space. But at this point, which way those winds of change are blowing remains to be seen.

While larger conversations about possible “Medicare for All” proposals will likely have to wait until the next election cycle, there are plenty of other healthcare topics to follow in 2019 that will almost assuredly come to a head or see significant changes over the next 12 months.

Here are three predictions on the biggest topics that will affect healthcare in the year ahead.

1. Texas judge’s ruling on ACA continues to ruffle feathers and traverses the appellate process      

On the other side, all eyes will be on the Democrat-controlled House and whether the progressive wing of the Party will be able to convince leadership to hold hearings on moving toward a single payor or Medicare-for-all system.

Outside this ruling, expect the ACA to remain a big topic of conversation in the 116th Congress. Republican Senator Chuck Grassley will be taking over the Finance Committee and has vowed to hold hearings on the law. Additionally, Republican Senator and Senate HELP Committee Chair Lamar Alexander has signaled that he is open to revisiting ACA stabilization efforts that fell apart a year ago.

However, while many expect the ruling won’t make it too far in the appeals process, the political implications of it cannot be understated. President Donald Trump could use the decision as a way to force Democrats to come to the table again to re-work the country’s healthcare law. If Democrats rebuff the move, Republicans could use it as a tool to say that the left refuses to make any meaningful change or improvement to healthcare.

For now, the ACA will remain as is while the ruling makes its way through the appeals process. The ruling has no immediate impact on any aspects of the ACA program and does not give the government any authority to alter it just yet.

If the ruling stands, it would eliminate many universally popular parts of the ACA, including provisions allowing parents to keep their children on their plans until age 26, guaranteed coverage for essential health benefits, and coverage protections for people with pre-existing health conditions – something Republicans said repeatedly during the midterms would not be removed. Simply put – it would completely transform healthcare as we know it for consumers, healthcare providers, insurers, suppliers, technology providers, and much more.

In mid-December, U.S. District Judge Reed O’Connor, a George W. Bush appointee from the Northern District of Texas, ruled that because of a recent change in federal tax law, the entirety of the Affordable Care Act (ACA) is therefore unconstitutional. The unprecedented decision was based on the fact that, since the tax penalty for the individual mandate was eliminated with the passing of the Tax Cuts and Job Act, the entire healthcare law is unconstitutional because the ACA and the mandate are inseparable.

2. Telemedicine moves out of the fringes into the mainstream     

However, some obstacles still remain. Incompatible EHRs, state medical licensing restrictions, and limited (though expanding) federal reimbursement for telehealth services are hurdles that will need to be addressed in order for telehealth to fully transform the industry. Providers and plans also need to consider how to integrate patient-generated data and give patients easier, more seamless access to their own data. And with Amazon getting into healthcare, all providers need to be thinking about how their patients (especially younger generations) want their healthcare delivered in the future.

Through telemedicine, patients are increasingly gaining access to healthcare faster, leading to better patient engagement and improved outcomes. It is expanding services and reimbursement possibilities for providers, opening up new avenues of revenue and efficiency. Doctors and nurses can now diagnose, treat and monitor ICU patients throughout the night, and offer high-risk cardiac patients the ability to receive and participate in their care using advanced video technology from their own homes. Additionally, telemedicine has the potential to lead to greater collaboration among health systems, with greater possibilities for cost-savings for patients and providers.

According to the American Telemedicine Association, more than one-half of all U.S. hospitals have some form of a telehealth program, and 90 percent of healthcare executives say their organizations are in the process of developing or already have a telehealth application.

Telemedicine is already changing the way healthcare is delivered to patients. Trends indicate it will continue to grow in both availability and acceptance from consumers, providers, and insurers in 2019.

3. Congress pushes for greater transparency in drug pricing

Regardless of which way the debate goes, the industry should anticipate that discussion and congressional hearings on drug pricing will springboard into the need for transparency in healthcare costs in general. When neither providers nor patients know definitively what the cost of services will be before entering the ER, undergoing surgery, or a more long-term healthcare strategy, it’s a sure sign of a problem that needs fixing. And as healthcare costs only continue to rise, don’t expect momentum towards some form of universal healthcare or a Medicare-for-all system to go away in the new year.

As for the left, in mid-December, Senator Elizabeth Warren unveiled a bill that is sure to cause heartburn for the pharmaceutical industry. To lower drug prices across the board, she wants to let the government start manufacturing generic drugs in a few scenarios, such as if no company is producing a generic version of a drug, if only one or two companies are producing a drug and there is either a price hike or a drug shortage, or if only one or two companies are producing what the World Health Organization classifies as an “essential medicine” and the price makes it difficult for some patients to afford. But, as one might expect, there remain obvious questions about how suited the government is to make medications in the first place.

In October, the White House released a plan that would see Medicare set the reimbursement level for certain drugs administered in doctors' offices and hospital outpatient centers based on their cost in other countries, which typically pay far less. However, many in the President’s own party aren’t fans of his proposal because, they say, importing price controls is anti-free market and the antithesis of Republican ideals.

It’s one of the very few issues both the left and the right agree on these days, but expect transparency in drug pricing and overall healthcare costs to be a big topic of conversation of the 116th Congress.

As it stands, 2019 is shaping up to be another transformative year for the U.S. healthcare industry. With advancing competition and impending change on the horizon, the need for strong partnerships and advocates in Washington and at the state level has never been greater than it is right now.