In early May 2017 Republicans in the U.S. House of Representatives voted to repeal and replace the Affordable Care Act (or Obamacare). Subsequently, Republicans in the U.S. Senate began working on their version of a law to do the same. The House bill is flawed, leaving many uncertainties that the Senate has promised to address. While the fate of the bill is in flux, there are three immutable trends in the U.S. health care system that won’t change. As a result, regardless of how the law evolves, tremendous opportunities will remain for consumers, medical providers, health care payers, and investors to shape and improve the health care system.