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In the coming few months the Supreme Court is likely to rule on the constitutionality of federal health care reform passed in 2010. But regardless of whether insurance purchase mandates or other rules stay or go, for most of us the next several years of health care will actually look a lot like the last several years.

Here are forecasts that I believe will hold true for the next several years:

• Whether purchased traditionally or through the state-run 鈥渆xchange,鈥� health insurance will continue to grow more expensive.
• The advent of electronic medical records will create great accessibility, but also may lead to excessive data collection.
• Health insurance exchanges will work well for people purchasing individual coverage, but not for businesses that need a higher level of agent and actuarial expertise.
• Employers will remain the majority purchasers of health insurance.
• Guaranteed coverage and mandatory insurance regulations will reveal more problems in our system; more reforms will be necessary to control health care costs.
• There will be a reduction of traditional family physician practices and an increase in easily accessible medical care in nontraditional venues.

The state health exchange

When we talk about an 鈥渆xchange,鈥� it is best to think of it like a state-sponsored Expedia or Travelocity for health insurance. Much like online shopping, the exchange will work great on occasion. Other times, better fits will be found elsewhere.

Officials have reported in recent months that they won鈥檛 be able to simply set prices without considering the actual costs to health providers 鈥� shocking, I know. To some extent, they had actually assumed they could just 鈥減ick鈥� an affordable price and provide coverage. The fact that this realization is occurring tells me that while the state exchange will provide some people some form of value, it is not the proverbial silver bullet to making insurance coverage affordable.

Coordinated Care Organizations

One state-sponsored change that does hold promise is Coordinated Care Organizations. According to the Oregon Health Policy Board鈥檚 website, local CCOs will be fully launched by Aug. 1.

鈥淭hey will have one budget that grows at a fixed rate for mental, physical and ultimately dental care. CCOs will be accountable for health outcomes of the population they serve. They will be governed by a partnership among health care providers, community members, and stakeholders in the health systems that have financial responsibility and risk.鈥�

Convenience medicine

The number one change people will see in health care in the coming years will be the increase in availability of and accessibility to actual medical care and their medical information. Two trends will meld together to lead to a new era of easy and fast visits.

First, expansion of electronic medical records will let health care providers readily access people鈥檚 information wherever they go for treatment. Second, while doctors will continue to conglomerate into larger clinics (for shared liability reasons), physician assistants and nurses will be able to diagnose people inside just about every mall, amenitized apartment complex and grocery store 鈥� much like a local bank or pharmacist.

Because it will be a PA or a nurse, people will have to tell their story only once and will likely receive only a cursory exam. Whether people receive a drop-in while on a shopping trip or a virtual exam via a tablet device, as long as more advanced care of an MD isn鈥檛 needed, basic care should be obtained quickly and easily.

These changes in regulation and market should have a Jevons Paradox effect that drives higher levels of utilization. In other words, the ease of seeing a medical provider created through these various efficiencies will likely increase early medical treatment. Because early treatment is generally seen as a relief of vastly more expensive hospitalization costs, the plan may work.

Why should contractors care? Because these factors will impact decisions about whether to provide health insurance to employees. And various market niches should be considered as the field of health care grows to cover an aging and growing population鈥檚 demand.

John Killin is president of the Associated Builders and Contractors鈥� Pacific Northwest chapter and executive director of the Independent Electrical Contractors of Oregon.