1.      The Affordable Care Act rode a political roller coaster. The law also known as Obamacare survived multiple attempts to repeal it in Congress. But it did not come out unscathed. The White House cut marketing and enrollment time in the ACA exchanges, and halted cost-sharing payments to health insurers selling exchange policies. Then, in late December, Congress passed tax legislation that abolished the ACA’s mandate for people to have health insurance, a key provision. Still, in Georgia and nationally, exchange enrollment proved surprisingly robust as the year ended.

2.      The opioid epidemic deepened. More people died from overdoses of opioid drugs, which include heroin and prescription painkillers. Gov. Nathan Deal eased rules on the use of the anti-overdose drug Narcan. But separate episodes of street drug overdoses in Middle Georgia, killing at least five people and hospitalizing dozens, showed the problem was rampant – and difficult to deal with.

3.     The rural health care crisis continued. Hospitals across rural Georgia struggled to keep their doors open in the wake of closures over the past four years. A legislative panel on rural development called for some ambitious (and potentially controversial) solutions, including extending medical authority to non-physicians, enabling ‘’micro-hospitals,’’ and revamping the state’s CON process that determines the creation and expansion of health care facilities.

4.     The state approved a Lee County hospital. In the biggest state licensing decision in years, the Department of Community Health approved a new hospital in Lee County. This was seen as a triumph for competition in southwest Georgia and a major setback for Albany-based Phoebe Putney Health System, which has long dominated the region.

5.      Weaknesses on testing for lead contamination exposed. Lead in water is dangerous, especially to children. But an investigation by GHN and WebMD revealed that testing for lead by local water systems was plagued by poor record-keeping and an apparent failure to follow a federal rule that’s been on the books for more than 25 years. About half of the water systems did not focus on homes at highest risk of contamination, as required. State follow-up of lead problems showed gaps, and public schools’ testing for lead contamination was reported as often inconsistent – or nonexistent.

6.      Hospitals continued their ‘combination game.’ Piedmont Healthcare, Northside Hospital, Navicent Health, Emory Healthcare and HCA all struck major deals to add hospital assets to their systems. It’s a “game” with major stakes. Amid revolutionary changes in health care payments, such moves help cut costs and give hospitals more bargaining power in negotiations with health insurers.

7.      Funding for health care programs got bogged down. As the year closed, long-term funding for PeachCare (part of the Children’s Health Insurance Program), community health centers and indigent care for hospitals remained up in the air, as congressional leaders wrangled over the details of how to pay for them.

8.      Georgia’s Public Health commissioner became CDC director. Dr. Brenda Fitzgerald, widely praised for her tenure at Georgia’s Department of Public Health, was appointed CDC director by President Trump. Fitzgerald’s tenure at the Atlanta-based federal agency got off to a bumpy start, with questions about her investments and an alleged ban on use of certain words by CDC personnel.

9.      Prison health care found substandard. Unsafe and unsanitary conditions at Georgia’s flagship prison medical facility jeopardized the health of inmates already dealing with cancer and other serious illnesses, the AJC reported. The warden in charge at Augusta State Medical Prison for the last 18 months was reassigned, a signal that state corrections officials wanted new leadership at the facility as it dealt with sanitation and safety concerns.

10.   Tom Price became HHS chief, then resigned. Georgia Congressman Tom Price, a physician with a long involvement in health care policy issues, was picked by President Trump as his secretary of the Department of Health and Human Services. But he was forced to resign a few months later amid controversy about his use of private jets for official travel.

Other big stories:

** The Georgia Supreme Court ruled in favor of open records access in a widely watched case involving Northside Hospital.

** The Georgia General Assembly approved a bill allowing dental hygienists to practice in safety-net settings, schools and nursing homes without a dentist present.

** A young mother moved from Georgia to Colorado to obtain better health care benefits for her disabled son.

** Georgia continued to get poor national grades on preterm births, infant mortality, hospital safety and the overall health of adults, seniors and children.