1. Government and health care are like oil and water — they don't mix.

Endless amounts of material has been written this year about how the Patient Protection and Affordable Care Act has created huge issues with employers, the self-employed and unemployed, as well as a host of other organizations. According to HealthPocket, PPACA requires individual and small group plans to include categories of coverage called the Essential Health Benefits.

Insurance companies may not reject applicants based on medical status, and premium costs may only vary based on age, location, smoking status, and number of people covered by a plan. However the new PPACA regulations may lead to increased costs for some consumers, state governments, and the federal government. Here are just a few pros and cons:

PRO: Insurance companies are required to issue a health plan to any applicant, regardless of the applicant's health status or other factors.

CON: Underlying behavioral issues contributing to health care expenses (e.g. obesity, diet, lack of exercise) besides tobacco smoking are not addressed by PPACA, and positive behaviors are not incentivized with subsidies.

PRO: Citizens and legal residents without health insurance will be able to obtain coverage in 2014. In particular young adults under age 26 will be able to stay on their parents' plans.

CON: The implementation of PPACA and the increasing number of primary care doctor visits could lead to primary care doctor shortages.

PRO: "If you like your plan and your doctor, you can keep it," President Obama.

CON: Between three and five million insured individuals and families had their plans cancelled by insurance companies because the coverage no longer met the EHB requirements, forcing people to make difficult choices of new plans that were often more expensive with reduced benefits and less access to health care providers. The Kaiser Family Foundation said, "It's definitely the case (based on conversations with insurers and with providers) that insurers have decided to limit networks in some instances in order to price their health plans more competitively."

PRO:  The federal exchange website for coverage — Healthcare.gov.

CON:  The federal exchange website for coverage — Healthcare.gov.

2. Legal wacky weed doesn't help, it hurts.

Marijuana use and abuse have increased significantly during the past few years, especially in states where use of the substance is now legal, new research suggests according to Medscape. Making a wrong a right still doesn't make it right. The US Healthcare Cost and Utilization Project showed that emergency department visits with coding for cannabis use grew 50.4 percent between 2007 and 2012 in Colorado one of the first two states to legalize both medical and recreational use of marijuana.

Also, a sampling of random states where marijuana is only legal for medical use also showed high increases in cannabis-related ED visits during the same period. The largest increase was found in Hawaii (by 55 percent), with New Jersey and Arizona having increases of 49.1 percent and 32 percent, respectively. People with access to marijuana are using it and then coming to the emergency rooms at hospitals.

According to Edmund Hartnett, deputy chief and executive officer, narcotics division, New York City Police Department, New York, the legalization advocates claim that if drugs are legal it will be a financial windfall for the American economy. They believe that all the public funds now wasted on the enforcement of drug laws and related matters could then be used for the good of society in areas such as education, health care, infrastructure and social services. 

And, some believe that drugs could eventually be taxed and thus create much-needed revenue. The DEA's response is: "Ask legalization proponents if the alleged profits from drug legalization would be enough to pay for the increased fetal defects, loss of workplace productivity, increased traffic fatalities and industrial accidents, increased domestic violence and the myriad other problems that would not only be high-cost items but extremely expensive in terms of social decay."

Additionally, the advocacy group Drug Watch International points out that drugs are illegal "because of their intoxicating effect on the brain, damaging impact on the body, adverse impact on behavior, and potential for abuse. Their use threatens the health, welfare, and safety of all people, of users and nonusers alike." 

Photo: A customer buys retail marijuana in Denver in May. Associated Press/Brennan Linsley.

3. Private exchanges are race cars waiting to get out of the pit.

The evolution of private exchanges is similar to that of other innovations in employee benefits, such as 401(k)s or health savings accounts. Both took multiple years to become widespread and mainstream, according to Liazon. Private exchange operators and employers who switch to private exchanges report one of the main reasons they are making the move is because the exchanges provide many decision-support tools.

Read: The exchange wave? Alan Cohen started it

The growth of exchanges in the private market is both organic and through acquisition. Not only did the exchanges see growth, there was also consolidation within the industry in 2014. It's been a year of massive growth for private exchanges, with estimates of more than three million people receiving employer health benefits through them by mid-2014, according to business management consultancy Accenture. Multiple benefits consultancies including Aon Hewitt, Towers Watson and Buck Consultants, as well as numerous brokerages launched their own exchange or are partnering with others to provide a white-label solution.

Employers have been slow to engage private exchanges even though the growth in 2014. However, the shift toward this type of health care option for the market is definitely happening, and next year should be huge.

4. HSAs are going bust the dam open.

Health savings accounts have grown to an estimated $22.8 billion in assets and roughly 11.8 million accounts as of the end of June, according to the latest figures from Devenir — that's a year-over-year increase of 26 percent for HSA assets and 29 percent for accounts.

According to UMB, "The long-term investment opportunity with an HSA is tremendous — likely better than any other tax-advantaged financial instrument as deposits grow tax-deferred and distributions are potentially tax-free. Many HSA providers now offer multiple investment options, including money market funds, self-directed accounts for mutual funds or individual stocks and FDIC-insured accounts for cash needs.

While many factors will determine the actual returns these investments make, the bottom line is that regardless of the level of risk, investment options are currently underutilized. In the 2014 Midyear HSA Research Report from Devenir, it was noted that only a little over three percent of accountholders across all providers have HSA investment accounts. There is definitely room for improvement and a need for educating accountholders about their options.

As investment options with HSAs become more popular, brokers and agents will also need to consider the investment options that different providers offer and how they compare. Providers are making considerable investments in their investment platforms to ensure their offerings are competitive and appealing for accountholders. The future of HSAs is tied closely to their value as a long-term savings vehicle and the opportunity that presents for investing. Employers, along with brokers and agents, can play an important role in educating employees about their investment options."

Read:

• 2015 HSA and FSA cheat sheet
• Advising employers on HSAs

5. Voluntary benefits are a good fit for employers.

Voluntary benefits are a small slice of the $1.1 trillion insurance industry, but it's a market that's growing. Meanwhile, new sales of voluntary benefits rose to $6.6 billion in 2013, up 4.3 percent from the previous year and 60 percent from a decade ago. It's a form of cost shifting — all driven by employers only having so much money and much of it going to medical, as reported by Sun Life.

Read: Voluntary market forecast for 2015

Several factors are contributing to the trend, but probably none more than the rising costs of health care. To control these costs, employers are turning to less expensive polices with higher deductibles and copayments and offering employees the option of buying additional coverage to help pay these bills.

PPACA has also accelerated the growth of voluntary benefits, part of it driven by pending taxes on certain plans that some employers offer. Voluntary benefits, though, aren't just driven by health insurance. Employers still offer these benefits as way to attract and retain workers and help them to save money. Some companies provide group plans for legal counseling or assistance in buying new cars, in addition to the standard health care products like dental and vision.

Learning how to do health care is not rocket science. You find out what works and then implement it. However, it goes without saying that organizations, including the government, insurance carriers, and other product manufacturers need to do their homework before launching a program or a product. Hopefully, 2015 may profit from lessons learned in 2014.