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Salt Lake City residents are generally young and healthy, and the population is growing. Payment reform, healthcare data collection, and care coordination innovations continue. Thanks to a successful ballot initiative in the 2018 mid-term elections, Medicaid will expand. The existing Medicaid ACO program will increase in value, and the uninsured rate, which is already sloping downward, will continue to shrink. Health systems, legislators, and employers have enacted policies and initiatives that could shape future drug costs, including CivicaRx, a provider-driven drug manufacturer, and a legislative push to reward consumers for cutting healthcare costs. New payment reform efforts, new facilities, and new medical marijuana laws have been put in place to combat the opioid epidemic.