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The most important questions to ask when picking a health care plan

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Selecting a health insurance plan in the US is a little like going through a maze, or solving an impossibly difficult crossword puzzle. It can be a morass of hard-to-figure-out terms — HMO, PPO, deductible, premium, coinsurance — and plans. Under another Donald Trump presidency, understanding Affordable Care Act insurance plans may get even more confusing. Whether you’re choosing an employer-sponsored plan or you’re shopping on the health insurance marketplace, this chore might be one of the more complicated things you do all year. “Things change year to year, so even if you think that you’ve got it figured out, you could have a plan that works super and then the insurers will make changes and then that can throw things off for you next year,” says Jessy Foster, the deputy director of policy and partnerships at the Pennsylvania Health Access Network. “There’s a lack of transparency … that makes it hard for people to know what the cost of any specific service is going to be.” There are generally four ways to get health insurance in the US: employer-sponsored health insurance, individual or private plans purchased through the health care marketplace formed by the Affordable Care Act, Medicare, and Medicaid. You can’t just decide to do so whenever you want, however. There are a few conditions under which you can enroll in health insurance: If you start a new job, you’ll be able to elect health coverage if your employer offers it. If you’re turning 65, you can sign up for Medicare. If you are low-income, you may qualify for free or reduced-cost health insurance through Medicaid. Each state has its own eligibility requirements. If you’re turning 26 and are still on your parents’ plan, you’ll need to get on your employer’s plan or find coverage through the health care marketplace. If you’ve experienced a qualifying life event — like losing coverage, getting married, having a baby, or moving — you can enroll in health insurance. Otherwise, you can sign up or make changes to your existing plan during open enrollment. Employers set their own open enrollment period for employees to make their selections. Open enrollment for the health care marketplace is November 1 through January 15. Whether you’ve just turned 26 and are selecting a plan for the first time or are making a change during open enrollment, here are some questions to ask yourself before choosing health insurance. No single factor will determine your choice; rather, take all things into consideration. What is my budget? The language associated with health insurance can be confusing. Here are important terms to know: The premium is the amount you pay every month to your insurer for coverage. If you get your insurance through your job, this comes out of your paycheck before taxes are taken out. The deductible is the amount of money you pay for health services before your insurance kicks in. Once you’ve hit your deductible, you’ll pay copayments for any health care service that’s covered under your plan. The amount — for instance, $20 — is fixed for each appointment. Coinsurance works similarly but is a percentage of the cost of a covered service and not a flat fee; again, this is only applicable after you’ve hit your deductible. Out-of-pocket maximum is the most you have to pay for deductibles, copayments, and coinsurance in a given year. Once you hit the out-of-pocket maximum, your insurer pays 100 percent of the costs. This cost doesn’t include your monthly premium or out-of-network care. For example, your premium could be $115 a month with a $2,000 deductible. You’ll need to pay for the first $2,000 of covered services yourself; after that point, when you go to a doctor, you’ll only pay a copay (say, $20 for a doctor’s appointment) or coinsurance (where you’ll be responsible for 30 percent of the total bill, for instance). Once you hit your out-of-pocket maximum — say, $4,000 — after spending that amount on deductibles, copayments, and coinsurance, you won’t pay anything for services. Do you have a question or idea for Even Better? Submit it by filling out this form. When selecting a plan from the marketplace, you’ll have four price options to choose from: bronze, silver, gold, and platinum. Bronze has the lowest monthly premium but highest copays and deductibles. As you ascend from silver to platinum, the monthly premium rises but the copays and deductibles are lower. For people who are shopping for health care on the marketplace and have lower incomes but don’t qualify for Medicaid, they’re likely to qualify for cost-sharing reductions, Foster says. A cost-sharing reduction lowers the amount of copayments, deductibles, and coinsurance. But you must enroll in a silver-level plan to get the extra assistance. “If they are eligible for that extra assistance,” she says, “that might lower or, in some cases, totally get rid of some of those deductibles and those plans will suddenly become comparable to a gold-level plan or, in some cases, even better.” Even if you don’t qualify for cost-sharing reductions, you likely have access to tax credits that lower your monthly premium if you’re purchasing insurance through the marketplace. These credits are based on your income and your household (i.e. if you’re single, married, or have children). You’ll want to take all costs into consideration when choosing a plan, not just the premium. “Comparing premiums across health plans is like comparing apples to oranges to lemons to limes,” says Noah Lang, the CEO and co-founder of Stride Health, a platform that helps independent workers find the best Affordable Care Act health insurance plan for their needs. “These are different fundamental financial products you’re buying at the end of the day.” What can you realistically spend on a premium each month? How much money comes out of each paycheck for health insurance? What is the maximum amount you would be okay with spending for a doctor’s visit? Would enrolling in Medicare cost less than remaining on your employer plan if you’re over 65 and still working? Would you rather pay a higher premium but get charged less when receiving care? Or do you feel more comfortable paying a lower premium monthly but shouldering higher costs for care? What are my medical needs? To help determine your answer to the latter two questions, you’ll need to evaluate what your medical needs are and whether your doctors are in-network. There are different types of plans that determine your network of providers. You’ll most likely encounter plans that fall under one of five plan types: health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO), point of service (POS), and high-deductible health plans (HDHP). HMOs cover care you receive from in-network providers, with exceptions for emergencies. You’ll need a referral to see a specialist. HMOs generally have lower premiums and out-of-pocket and prescription costs. PPOs have a list of preferred providers that cost less if you use them. This list may be broad or limited, so definitely see if your preferred providers are on it. You don’t have to stay in-network for care, but it will be more expensive to go out of network. You don’t need a referral to see a specialist. PPOs are also more expensive. EPOs have lower monthly premiums than PPOs but require you to stay in-network when seeking care. You typically don’t need a referral to see a specialist. POS plans allow patients to choose between staying in-network and going out of network for providers, but you’ll pay more for out-of-network services. You’ll need a referral before going to a specialist. POS plans may be more expensive than HMOs and less expensive than PPOs. HDHPs have lower monthly premiums, but as the name implies, a higher deductible — for 2025, the minimum HDHP deductible is $1,650 for individuals and $3,300 for families. You may be able to see both in-network and out-of-network providers, based on the plan. You’ll also be able to open a health savings account (HSA), an account that you and/or your employer can contribute to that you can use to pay for medical expenses not covered by the HDHP, like copays and prescriptions. The funds in an HSA are not subject to federal income tax. Determine your health priorities based on the plan options available, Foster says. If your priority is staying with your preferred doctor, you may want a PPO. If you want to see a lot of specialists and don’t want to get a referral every time, a PPO or EPO might work for you. If you haven’t been to the doctor in a while but suspect you’ll need to catch up on a lot of appointments, you may want a plan that has lower copays and a higher monthly premium. If you’re mainly focused on keeping costs down and are generally healthy, you could opt for a high-deductible plan. Just be aware of the exact dollar amount in these high-deductible plans. “We’ve seen some really, really high deductible plans where it’s $7,000 to $8,000 per person, or double that for the family,” Foster says, “and not a realistic amount that most people can pay.” While it’s hard to know in advance, consider how often you will be seeking medical care. Are those preferred providers and prescriptions covered? Will you want to seek referrals from your primary care doctor? If you’re anticipating surgery or pregnancy, you may want to choose a plan with a lower deductible. If you regularly visit specialists, you’ll want a plan that doesn’t require referrals but lists your doctor as an in-network provider. If you don’t anticipate seeking care beyond a preventative visit, you may want a plan with a lower premium. “If you’re one of these people that says ‘I want a plan where I don’t have to have referrals, I can see any doctor that accepts Medicare, I can go to any hospital or facility that accepts Medicare,’ then that type of flexibility will cost you money,” says David Luna, the president and co-founder of Connie Health, a digital platform that helps seniors choose a Medicare plan. “If you’re okay with having a plan similar to your employer plan where you’re paying zero [in premiums], but when you use it, you’re paying a copayment, then you would look at a Medicare Advantage plan.” Keep in mind that some plans don’t offer dental or vision coverage and you might need to add on those services through the marketplace or a separate plan offered by your employer. Does this plan cover doctors and medications I already know and like? A lower premium won’t be as effective if your preferred providers are out of network. “If you have a doctor you love and you want to keep, that might drive you to pick a health plan that you’re willing to spend more for,” Lang says. While researching plans, look through their provider list to see if your doctors are in-network. Most insurance providers have a searchable directory where you can input your practitioner’s name. “You don’t want to enroll in a health plan that doesn’t have very many doctors or one clinic in your area,” Lang says, “because then you might not have easy access to care.” Don’t forget to look up any specialists you see, too: dermatologists, therapists, chiropractors, orthopedic surgeons, or fertility clinics. If you’re unsure if a provider is in-network, call them and ask. Some plans have tiered provider networks where they are priced based on the value of care they provide, Foster says. Keep in mind where your preferred providers fall if your plan is tiered. “There can be a tier one, tier two, tier three,” Foster says. “Tier one might be, let’s say $10, $20 copay. But if your doctor’s in-network but they’re tier three, that $20 copay might suddenly be $80 per visit.” Similarly, check to see if your current prescriptions are included in the plan’s formulary, a list of prescription drugs covered by the plan. Could I use some help with this? It’s completely normal to still have questions even after reviewing plans. For help navigating the health care marketplace online portal, you can call the Marketplace Call Center where someone can walk you through enrollment. Platforms like Stride Health allow for a more user-friendly enrollment experience, plus offer free support from advisers, Lang says. You can seek the help of a professional navigator or assister who can answer your questions and help you enroll. Navigators are funded by federal or state grants while assisters are funded by different grants administered by the states. These services are free and you can chat in person, over the phone, or online. Navigators and assisters are unbiased and will not vouch for one insurance company or plan over another. The government maintains a searchable database where you can find local navigators and assisters. According to Foster, it can be difficult to get an appointment with a navigator or assister during the first few days and last days of open enrollment. Make a plan early if you want to work with these professionals. You can also opt to get contacted directly by a health insurance agent or broker, who is trained to help you enroll in a plan. Agents and brokers may work for a specific health insurance company and thus won’t sell plans for companies they don’t represent; they may also earn commissions. You don’t need to pay extra to work with agents or brokers. “Ask all the questions. Don’t be shy,” Foster says. “I always tell folks if it was easy, we wouldn’t have jobs like navigators and assisters because we would be obsolete.” Update, January 2, 2025, 10:30 am: This story, originally published October 16, 2023, has been updated with 2025 numbers and information.

The Vox guide to using your benefits

Sometimes, it seems as if navigating health insurance benefits requires its own language (and maybe an actuarial degree to boot). The questions are endless: Is it better to have a high premium and a low deductible, or the other way around? How are you supposed to guess how much money to put in a flexible spending account? Please remind me, what is

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The huge stakes in a new Supreme Court case about pornography

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Former Attorney General John Ashcroft, whose name is on a seminal First Amendment decision that a far right appeals court decided it could openly defy. | Tim Sloan/AFP via Getty Images If you’ve studied First Amendment law, it’s impossible not to experience déjà vu while reading the briefs in Free Speech Coalition v. Paxton, a Supreme Court case the justices will hear on January 15 about online pornography. That’s because the Texas law at the heart of Free Speech Coalition is in all relevant respects identical to a federal law the Supreme Court blocked in Ashcroft v. ACLU (2004). (That federal law was meant to keep minors from being able to view pornography, and the Texas law attempts to do the same, albeit through a slightly different mechanism.) If the justices take seriously some of the more aggressive arguments Texas makes to defend its law, they could eliminate longstanding free speech protections for sexual content. Even the United States Court of Appeals for the Fifth Circuit, which upheld the Texas law, conceded that the two laws are “very similar” — though the Fifth Circuit did, in an unusual act of defiance by a lower court, conclude that it was not bound by the Supreme Court precedent established in Ashcroft and was free to uphold the Texas law anyway. It’s tempting, in other words, to dismiss Free Speech Coalition as an insignificant case that should end in the justices rebuking their insubordinate colleagues on the Fifth Circuit. That court has a history of handing down poorly reasoned opinions supporting right-wing results. And the Supreme Court, even with its 6-3 Republican supermajority, frequently reverses the Fifth Circuit’s most disruptive decisions. And yet, despite the Fifth Circuit’s weak reasoning and a poorly argued brief by the state of Texas defending its law, the state does make one plausible argument that the Court should tweak First Amendment law to make it less friendly to pornography producers. What is Free Speech Coalition about? Free Speech Coalition involves a 2023 Texas law that requires many — but not all — websites that distribute pornographic content to verify that their users are over the age of 18. The plaintiffs, a trade association for the pornography industry along with various members of that industry, argues that this law forces “adult users to incur severe privacy and security risks.” Many adults, in other words, don’t want to submit a picture of their driver’s license to a porn site which could be hacked or subpoenaed, revealing intimate information about its users’ sexual desires. In Ashcroft, the Supreme Court ruled against a largely identical federal law, which made it a crime for businesses to post material online that is “harmful to minors,” but which also allowed those businesses to escape conviction if they took certain steps to verify the age of their consumers. There are some distinctions between the law at issue in Ashcroft and the Texas law at issue in Free Speech Coalition — most notably, the Texas law only imposes civil, as opposed to criminal, penalties on violators — but even the Fifth Circuit conceded that these distinctions do not change how Free Speech Coalition should be analyzed under the First Amendment. In Ashcroft, a majority of the justices concluded that the government should have used “less restrictive” methods of keeping children away from porn sites, such as promoting “blocking and filtering software” that allows parents and teachers to prevent a particular computer from loading pornographic websites. Ashcroft is one of a line of First Amendment decisions establishing that the government typically may not prevent adults from seeing sexual content, even if the goal is to also prevent children from seeing the same material. Under this line of cases, laws that burden an adult’s access to nearly all sexual material must be “narrowly tailored” to achieve a “compelling” goal, which is why Ashcroft required the government to use the least burdensome method to restrict speech. Laws that burden constitutional rights — such as the right to free speech — are often subject to this narrow tailoring requirement, which is known as “strict scrutiny.” A law can fail strict scrutiny if it sweeps too broadly, imposing severe burdens on a constitutional right in return for relatively small benefits to society. But laws can also fail strict scrutiny if they are underinclusive, on the theory that a law with too many exceptions and loopholes can still limit constitutional rights without actually achieving a goal that could justify such a limitation. Texas’s brief defending its 2023 law suggests that the Ashcroft line of cases should be overruled, and that strict scrutiny should no longer apply to laws that seek to prevent children from seeing pornography, but that also restrict the First Amendment rights of adults. If the justices agree, that would give the government far more power to limit adults’ access to sexual content. A key element of Texas’s argument seems to be that more oversight is necessary given the breadth of pornography available — the state’s brief is full of lurid descriptions of things like bondage and tentacle porn. Texas’s lawyers appear to believe they can coax the justices into supporting their favored result by bombarding them with graphic descriptions of online pornography. That said, Texas does make one good argument for allowing some laws restricting young people from viewing pornography to stand. Ashcroft is a 20-year-old decision, and Texas claims that, in the last two decades, new technologies have emerged that make it possible to verify that an internet user is over 18 without threatening that person’s privacy or revealing any other information about them. If Texas is correct that this technology does exist, and that it can be fairly easily be used, then at least some laws requiring porn sites to bar underage users are constitutional. That’s because the kind of age-gating software that Texas describes in its brief would achieve the government’s goal of preventing children from seeing online porn more effectively than the content-filtering software endorsed by Ashcroft, and it would do so while imposing only a minimal burden on adults who have a right to see pornography. So a law that requires age-gating may survive strict scrutiny today, even if it didn’t in 2004 when technology was less advanced. A decision holding that the law may require pornographers to use this kind of secure, privacy-protecting age-gating software would be consistent with Ashcroft, and wouldn’t require the Supreme Court to toss out its previous decisions establishing that adults may view sexual content — an approach that Texas advocates for in much of its brief. Ashcroft, after all, did not rule that age-gating software is forbidden by the Constitution. It merely looked at the state of technology in 2004 and determined that content filtering was the best available option at that time. What does current law say about free speech and online porn? For much of American history, the courts largely ignored the First Amendment’s language barring laws “abridging the freedom of speech.” The federal Comstock Act, which has never been formally repealed, made it a crime to mail “every obscene, lewd, lascivious, indecent, filthy or vile article, matter, thing, device, or substance,” and many states had similar laws that extended beyond the mail. Artists, art dealers, booksellers, and others were arrested for producing or distributing sexual material that the government — or even just a few particularly zealous government officials — deemed too lascivious. In one 1883 case, an art gallery owner was convicted for selling reproductions of famous nude paintings, including Alexandre Cabanel’s masterpiece “The Birth of Venus.” By the middle of the 20th century, however, the Supreme Court began to take the First Amendment seriously, handing down a series of decisions that gradually shrunk the definition of “obscenity” (a legal term that refers to sexual material that is not protected by the First Amendment) until virtually nothing qualified. Yet, while modern First Amendment law broadly permits artists, authors, and pornographers to provide sexual material of all kinds to adults, it’s also well established that the government may bar young people from accessing some content that adults have a right to see. Both Texas and the Fifth Circuit rely heavily on Ginsberg v. New York, a 1968 case holding that the government may restrict minors’ access to some sexual content. But the facts of this nearly 60-year-old case are very different from those in Free Speech Coalition or Ashcroft. Ginsberg upheld New York’s prosecution of a lunch counter operator who sold two “girlie” magazines to a 16-year-old boy. This case, in other words, did not involve a law that prevented adults from seeing sexual material. Under the New York law at issue in that case, adults who wished to buy similar magazines could simply show their ID to prove they were of sufficient age, and they could do so without much worry that a hacker or government investigator would discover that they bought a magazine full of nude pictures. The Ashcroft line of cases, by contrast, all involve technologies that can widely broadcast sexual material in ways that make it difficult to check whether each consumer of that material is an adult. One 1989 case, for example, struck down a ban on “dial-a-porn” services, where callers could dial a phone number (and pay a fee) to hear a prerecorded, sexually explicit message. These decisions, moreover, established that laws which restrict adults’ access to sexual content generally must survive strict scrutiny, and they did so several years before Ashcroft applied this rule to the internet. In United States v. Playboy Entertainment Group (2000), for example, the Supreme Court struck down a federal law that effectively prohibited cable television stations from broadcasting pornography except between 10 pm and 6 am. Playboy could not possibly be clearer in holding that laws which prevent adults from seeing sexual material that they have a right to see must survive strict scrutiny — even if those laws are intended to shield children from pornography. In the Court’s words, “even where speech is indecent and enters the home, the objective of shielding children does not suffice to support a blanket ban if the protection can be accomplished by a less restrictive alternative.” Ashcroft, in other words, was hardly a groundbreaking decision. It simply took the rule which had already been established in cases like Playboy, and applied it to the new context of online pornography. And yet, despite this long line of cases that all point in exactly one direction, the Fifth Circuit concluded that it could defy all of these cases. It did so largely by implying that the George W. Bush-era Justice Department was staffed by rank incompetents. According to the Fifth Circuit, the Ashcroft opinion “contains startling omissions.” Though the opinion held that the federal law at issue in that case “would fail strict scrutiny,” Ashcroft did not actually explain why strict scrutiny should apply to a law restricting online porn. The Fifth Circuit claimed that “omission” occurred because the Justice Department lawyers who litigated Ashcroft failed to make the argument that strict scrutiny should not apply (instead, they claimed that the law at issue in Ashcroft survived strict scrutiny). According to the Fifth Circuit, because the DOJ never argued against strict scrutiny, Ashcroft never actually established a legal rule requiring courts to apply strict scrutiny in similar cases. It’s hard to know where to even begin with this argument. Lower courts are bound by Supreme Court decisions, even if they disagree with those decisions. Judges cannot refuse to follow Supreme Court cases because they think the lawyers who argued those cases did a bad job. In Ashcroft, moreover, there was a pretty obvious reason why the Justice Department decided not to argue against strict scrutiny. Playboy was decided in 2000, four years before Ashcroft was argued before the justices. So it was already settled law in 2004 that strict scrutiny applies to cases like Ashcroft. And, while the DOJ may have decided not to press the case against strict scrutiny in its Ashcroft briefing and arguments, one of the justices did. Justice Antonin Scalia published a dissenting opinion in Ashcroft which argued that his eight colleagues erred in “subjecting [the federal anti-porn law] to strict scrutiny.” So the justices who decided Ashcroft were hardly unaware of the arguments against strict scrutiny. Eight of them were simply unpersuaded by those arguments. So how should the Supreme Court handle Free Speech Coalition? The First Amendment issues presented by Free Speech Coalition are serious. And the question of whether technology has advanced to the point where it is possible both to shield minors from online pornography and ensure that adults can access any material they have a right to see is a difficult one that deserves a serious look by the federal courts. So it’s a shame that both the Fifth Circuit’s opinion and Texas’s brief are so poorly argued. Proponents of age-gating on porn sites deserve better advocates. They also deserve a more competently drafted law than the one at issue in Free Speech Coalition. The Texas law at issue in Free Speech Coalition appears to have been drafted without any input from a First Amendment lawyer. If Texas is correct that software can verify which consumers of online porn are adults without threatening their privacy, then the Supreme Court should uphold a properly crafted law requiring porn sites to use those services. But it should not uphold this Texas law. That’s because Texas’s law is not structured to survive strict scrutiny. Recall that strict scrutiny requires the courts to strike down laws that aren’t “narrowly tailored” to advance a “compelling interest,” and that this narrow tailoring requirement bars laws that are so underinclusive that they don’t actually do much to advance that interest. Texas’s law mocks this narrow tailoring requirement by applying its restrictions on online pornography to only a small subset of websites where pornography appears. Specifically, the law applies only to a business that “knowingly and intentionally publishes or distributes material on an Internet website … more than one-third of which is sexual material harmful to minors.” For starters, it’s unclear how, exactly, the law measures how much of a website is devoted to “sexual material.” Is this determined by looking at how many bytes of data are devoted to pornography? How many minutes of video? How many inches of screen space? But, even setting this vagueness concern aside, one of the main purposes of strict scrutiny’s narrow tailoring requirement is to block laws that burden constitutional rights without actually doing much to achieve the government’s goals. The Texas law’s one-third requirement means it would not actually block minors’ access to pornography, thus failing to achieve the state’s objective. As the Free Speech Coalition plaintiffs explain in their brief, the trial court which heard this case “found that social media platforms like Instagram and Facebook contain ‘material which is sexually explicit for minors,’ and sites like Reddit ‘maintain entire communities and forums’ devoted ‘to posting online pornography.’” So Texas’s law won’t actually stop anyone from seeing online porn, it will just shift their porn consumption from Pornhub to Reddit. And so, even if age verification apps work as Texas says they do, this particular law still violates the First Amendment and should be struck down for failing to satisfy strict scrutiny. Should the Court decide to follow this path, which is the only path consistent with existing law, it could also make clear that a better-drafted law might survive strict scrutiny — again, assuming that it is actually possible to construct age gates around online pornography without threatening the privacy of adults. In any event, there is no need to overrule decisions like Ashcroft, or to pretend those decisions can be ignored like the Fifth Circuit did, in order to uphold age-restrictive laws.

25 things we think will happen in 2025

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For the sixth year in a row, the staff of Future Perfect convened in December to make predictions about major events in the year to come. Will Congress pass a tariff bill that makes President-elect Donald Trump happy? Will the H5N1 bird flu become an honest-to-god pandemic? Will the war in Ukraine stop? Will a major sports figure get caught up in a gambling scandal? It’s fun to make predictions about the future, which is part of the reason why we do it so often. But this isn’t just blind guessing. Each prediction comes with a probability attached to it. That gives you a sense of our confidence (high in the case of, say, Charli XCX’s Grammy chances, less so in the case of Iran’s nuclear plans). And don’t make the same mistake that people seem to make every presidential cycle. Even a probability as high as 75 percent or 80 percent doesn’t mean we’re sure something will happen. Rather, it means we think that if we made four or five predictions, we’d expect three or four of them to come true, respectively. And as we have every year, we’ll be keeping track of how our predictions fared over the course of 2025, and report back to you at the end of December. You can check out how we did in 2024 here. And we’ve done something new this year in partnering with the prediction platform Metaculus. You can check it out here to see how the community there came down on a number of our predictions — and even compete in a prize pool — and click on the individual questions with links to go directly to them on Metaculus. We’ve also added the Metaculus community’s aggregated forecasts as of December 31 for the questions they’ve taken on. —Bryan Walsh The United States Congress passes a major tariff bill (20 percent) Donald Trump’s 2024 campaign was perhaps the most pro-tariff of any candidate since William McKinley: He promised 60 percent taxes on imports from China, and 10 percent on everywhere else. In victory he’s only gotten bolder, calling for 25 percent tariffs on Canada and Mexico, in flagrant violation of the United States-Mexico-Canada Agreement, a free trade deal made by some past president named Donald Trump. The bad news for consumers and the world economy is that Trump has substantial discretion to impose tariffs as president without consulting Congress. But that discretion isn’t unlimited, and probably doesn’t permit the kind of 10 percent across-the-board tariff Trump promised. Plus, Republicans want a revenue source to help offset the cost of making Trump’s 2017 tax cuts permanent before they expire at the end of next year. This raises the question: Will Congress pass a tariff measure on its own that not only implements Trump’s ideas, but lets them endure under future presidents? My guess is no. There was a time in the distant past, let’s call it “2015,” when Republicans were the party of free markets and free trade, and some members of Congress haven’t forgotten that. Early reporting suggests that many GOP figures in the House and Senate are hostile to the idea of including tariffs in a tax package. Republicans can only lose three senators and two House members out of their caucus and still pass bills, which gives them very little margin for error, and makes it very difficult to pass legislation that splits the caucus like tariffs. Two caveats, though. One, I’m predicting about a tariff bill and not new unilateral tariffs from Trump because I think the odds that Trump does new tariffs using presidential authority are nearly 100 percent. Two, the only reason my estimate isn’t lower is that there’s been some bipartisan interest in a “carbon border adjustment,” or a sort of carbon tax that only applies to imported goods. The idea has gotten Republican support because while it does acknowledge that global warming is real, it also sticks it to foreigners. That’s a tariff, and I think the likeliest kind to make it into a tax package (though I still bet against it). —Dylan Matthews Metaculus aggregated forecast: 7 percent Trump dissolves the Department of Education (5 percent) Something I love and hate about American politics is that big weighty-seeming questions, like “Can Donald Trump fulfill his campaign promise to abolish the Department of Education?” turn out to hinge on much weirder and more technical questions, like “Will the Senate parliamentarian rule a departmental reorganization as ineligible for the reconciliation process under the Byrd rule?” The Department of Education, whose main duties are administering student loans and financial aid for higher-ed institutions and distributing funds (around $39 billion in 2023) to local schools under programs like Title I (for poor districts) and IDEA (for disabled students), was created in a 1979 act of Congress. Passing a normal bill repealing that act would require 60 Senate votes to break a filibuster, which means winning over seven Democrats to the idea, which isn’t going to happen. So legislation abolishing the department (already written by GOP Sen. Mike Rounds of South Dakota) would have to pass through budget reconciliation, which lets certain legislation pass with a mere majority in the Senate. But reconciliation has strict requirements limiting the content of legislation that can be passed that way, and in particular provisions of bills that are only “incidentally” related to the overall level of spending or taxing tend to be struck down by the Senate parliamentarian as contrary to the Byrd rule, the main governing principle behind the reconciliation process. Rounds’s bill, notably, doesn’t eliminate the Department of Education’s actual functions. It just moves them around. Student loans, for instance, would go to the Treasury Department, and the Department of Labor would get vocational programs. This strikes me as an archetypal example of a change that is merely incidental to the actual level of spending, and that can’t be done with reconciliation. Will the Senate parliamentarian disagree with me? Possibly. But also, in part because this move is so much more about reorganization than the actual substance of the department’s programs, I am very skeptical that Republicans are going to go to the mat on this one. If they can only win so many fights with the parliamentarian, are they going to prioritize changing the mailing address of the student loan office? I doubt it. —DM Metaculus aggregated forecast: 4 percent The Affordable Care Act is repealed (30 percent) From the moment the Affordable Care Act was signed into law on March 23, 2010, the Republican Party has been obsessed with repealing it. They even shut down the government over it. Then, in 2017, the dog finally caught the car: Republicans had both houses of Congress and the presidency, and in theory the opportunity to repeal the law. They didn’t. Sure, the tax law that year eliminated the individual mandate to get health insurance, but that turned out to not be as important to getting people coverage as the ACA’s authors thought. The rest of the bill — its dramatic Medicaid expansions, rules protecting people with preexisting conditions and letting young adults stay on their parents’ insurance, subsidies for individuals to buy health insurance if their employer doesn’t provide it — remained intact. Even “skinny repeal,” a bill that zeroed out only a handful of provisions of the law, failed to pass the Senate when John McCain made his famous thumbs-down gesture, but matters had only even gotten to that point because several other senators didn’t want to vote for sweeping Medicaid cuts, like those entailed by simply repealing the ACA in its entirety. Will they try again in 2025? I’m skeptical. And here, by “repeal Obamacare,” I don’t even necessarily mean repealing all of it. To qualify as repeal, a bill has to do at least three of the following five things: Eliminate or reduce the ACA’s Medicaid eligibility or federal funding Eliminate or reduce ACA health insurance tax credit eligibility or amount Eliminate or curtail the mandate for certain employers to provide health coverage for employees. Reducing the penalties will also be considered to be relaxing the mandate. Make it so that ACA subsidies are no longer limited to plans that satisfy the requirements specified in the ACA, including allowing ACA subsidies to be contributed to health savings accounts or similar accounts Eliminate or curtail medical underwriting restrictions, like the ban on considering preexisting conditions Yes, Trump’s budgets and those that his past and future budget chief Russ Vought prepared during the Biden years did propose undoing the ACA’s coverage expansions, and then cutting Medicaid still further. I anticipate they will continue to make these proposals. But I am doubtful that with a much narrower House majority than they had in 2017, and an equally narrow Senate majority, Republicans will be able to pass cuts on a scale that they couldn’t get off the ground eight years ago. —DM Metaculus aggregated forecast: 10 percent Jerome Powell is still Fed chair (90 percent) Here are the facts: Jerome Powell’s term as chair of the Federal Reserve expires on May 15, 2026. He has pledged to stay on as chair until that time, though not necessarily to remain as a member of the Board of Governors until his term there expires in 2028. Donald Trump has said he does not plan to fire Powell before that time. Powell has insisted that the president does not legally have the power to fire him before his term is up, and that he will refuse to obey such an order. In many ways, 90 percent seems too low, because the odds that a 71-year-old man dies in the next year are only 2.9 percent, and I have an easier time envisioning Powell dying in office than acquiescing to a firing. But I should also fess up to a personal bias here. Jay Powell is, by a wide margin, the greatest chair of the Federal Reserve that the institution has ever had, and perhaps the greatest central banker in any nation of modern times. He prevented Covid from spiraling into a global financial crisis, oversaw an astonishingly rapid recovery of employment and economic growth in the pandemic’s aftermath, and managed a “soft landing” that ended an inflationary episode without having to spark a recession. He is a miraculous figure who we do not deserve, and for my own sanity I need him to stick around. —DM Metaculus aggregated forecast: 8 percent Trump will have a positive favorability rating (25 percent) Americans have a charming habit of deciding to like the newly elected president as soon as the election’s over, and Donald Trump’s favorability rating has gone from 8.6 points underwater on Election Day to only 1.9 points negative on December 19. (By “favorability rating,” I mean the difference between the share of voters saying they view him favorably minus the share saying they view him unfavorably. Once he’s president, I’ll count this prediction as resolving to “true” if either his favorability or job approval ratings are positive; while similar, these aren’t exactly the same question.) But how long do presidential “honeymoon” periods last? Not very long, as it turns out. Back in 2022, FiveThirtyEight’s Geoffrey Skelley and Jean Yi crunched the data and found that Obama, Trump I, and Biden alike all saw their approval ratings dip below 50 percent by the end of the first year (Trump was never even above 50 when he started!): The two exceptions on the chart are Bill Clinton, who saw a curious fall and then recovery over 1993 that I don’t really understand, and George W. Bush, whose first year included 9/11. I think the odds of another 9/11 are mercifully low, and the trend appears to be toward lower approval for presidents in their first year in recent times. Moreover, Trump is unusually loathed by a huge segment of the population and is promising massive tariffs that I suspect will prove unpopular once they start raising the prices of everyday household items. So I feel pretty good predicting Trump will be below water at year’s end. —DM Metaculus aggregated forecast: 17 percent Elon and Trump are still friends at the end of the year (40 percent) “Still friends” is obviously a subjective category but I like the prediction markets guru Nathan Young’s proposed definition: if one or the other publicly and unambiguously disparages his counterpart at least three times. Luckily for us, Trump and Musk are not subtle or taciturn men, and when they dislike someone they have a tendency to scream that loudly many, many times, so I don’t anticipate it being hard to decide where they stand at the end of 2025. The list of one-time Trump allies who eventually came to denounce him is too long to include in full here, but let us briefly remember, say, 10: Anthony Scaramucci; Mike Pence; John Kelly; John Bolton; HR McMaster; Stephanie Grisham; Alyssa Farah Griffin; Betsy DeVos; and of course Michael Cohen. It does not seem like an ambitious prediction that Musk will eventually join their ranks. His role as the head of the new Department of Government Efficiency seems guaranteed to put him on a collision course with Trump’s Cabinet officials and with congressional Republicans, and probably also with his cochair Vivek Ramaswamy. Trump might side with Musk each time — but he’s always been more pragmatic about spending policy than the cut-happy Musk seems, and there are ripe opportunities for conflict. What if Musk wants to slash Medicare and Social Security, which Trump has promised to defend? What if he wants defense cuts and Trump wants a tougher posture toward China? What if Musk pushes for reconciliation with China, with whose government he is extremely close (Ramaswamy once called Musk “a circus monkey” working for Xi Jinping)? I won’t predict the exact inciting episode that causes Trump and Musk to fall out. But I feel like I know how these guys operate, and I think it’s more likely than not that they will fall out. —DM Metaculus aggregated forecast: 35 percent The National Highway Traffic Safety Administration’s preliminary estimates of US car crash deaths for 2024 will be lower than 40,000 (70 percent) Last year, I correctly predicted that more than 40,000 Americans would be killed by cars in 2023 (according to the National Highway Traffic Safety Administration’s estimates, which are released with a lag the following year). Since the 1960s, the US has seen rapid, dramatic progress in cutting its car fatality rate, and 2007 was the last year that over 40,000 Americans were killed by our car-dependent transportation system — until the Covid-19 pandemic. You would think that fewer people driving would mean fewer car crash deaths, but not so in America, where our dangerously designed roads lead to more speeding and death when there’s less traffic. Ever since, America’s rate of death by cars has sat at levels that should honestly be humiliating for such a rich country. These numbers are slowly starting to come back down. NHTSA recently estimated that for the first half of 2024, car crash deaths were down 3.2 percent from 2023. If the same trend from 2023 carries over to the second half of 2024, total 2024 car fatalities will come in at a hair under 40,000. It’s far from guaranteed, because car crash patterns vary significantly across different seasons. And that number would still be nothing to write home about — but in a country so thoroughly built around automobiles, getting deaths back under 40,000 would be a milestone worth celebrating. —Marina Bolotnikova Metaculus aggregated forecast: 81 percent The world Benjamin Netanyahu is still Israel’s PM at the end of November 2025 (75 percent) What a difference a year makes. In December 2023, Israeli Prime Minister Benjamin Netanyahu was incredibly unpopular, his image severely damaged by his government’s total failure to anticipate the deadly October 7 attacks by Hamas. Polls indicated his Likud party might win only 17 of 120 seats in Israel’s Knesset. Israel was on its way to becoming an international pariah because of the destructive way it was waging its war in Gaza, and Israelis were furious about the government’s failure to rescue the hostages held by Hamas, even after a November 2023 deal to bring some home. Oh, and Netanyahu was only a few months removed from massive street protests and was facing corruption charges. Fast-forward to December 2024, and polls suggest Netanyahu’s Likud party would win 25 seats if elections were held today, more than any other party. Israel has all but destroyed Hezbollah, by far its most capable opponent, and has isolated Iran, arguably its most existential threat. After the sudden fall of Syria’s Bashar al-Assad, Israel has even captured territory formerly under the Syrian government’s control. And President Joe Biden, who at least occasionally pushed back against Netanyahu, is about to be replaced by President-elect Donald Trump, who has signaled that he will happily give Israel a freer hand in Gaza. Netanyahu has been prime minister of Israel for roughly 17 of the past 28 years. Every time it seems like he’s in an unwinnable position, he seems to find a way to wriggle out of it. I have every expectation that will continue in 2025. —BW Metaculus aggregated forecast: 75 percent Argentina’s yearly inflation is below 30 percent (20 percent) Americans got pretty upset about inflation in the aftermath of the Covid pandemic, but we’ve got nothing on our Argentinian friends: !function(){"use strict";window.addEventListener("message",(function(a){if(void 0!==a.data["datawrapper-height"]){var e=document.querySelectorAll("iframe");for(var t in a.data["datawrapper-height"])for(var r=0;r<e.length;r++)if(e[r].contentWindow===a.source){var i=a.data["datawrapper-height"][t]+"px";e[r].style.height=i}}}))}(); Here in the US, we’re such babies that we’ll complain about 6 percent to 7 percent inflation. In Argentina, double-digit annual inflation rates were normal even before the pandemic. Annual inflation hit triple digits and started what looked like an exponential climb, still ongoing when left-wing Peronist Alberto Fernández left office. Javier Milei, a chainsaw-wielding self-described anarcho-capitalist who named his dogs after the libertarian economists Milton Friedman, Murray Rothbard, and Robert Lucas, initiated shock therapy upon taking office this year, eliminating price controls and subsidies for things like fuel and food, as well as massively devaluing the peso. That made prices surge even more massively at first (which you can see in the chart above). But since then they’ve been subsiding. The price surge had the salutary effect of easing the government’s debt burden, and the nation’s budget went into surplus for the first time since the 2008 financial crisis. This has come at a considerable cost, with poverty and unemployment spiking, and the economy as a whole in recession for much of the year. But now that the recession is over and the country is seeing both cooling inflation and a growing economy, a sadly unusual combo down in Buenos Aires. That said, I don’t think we’re going to see the country get down to a 30 percent annual inflation rate in 2024. The 12-month inflation rate in November 2024 was 166 percent, down 27 points from the month before. If the rate keeps falling at that pace, the country will hit the 30 percent mark in five months. But I think progress against inflation will slow as the initial shock of Milei’s policies subsides and pressure for wage hikes intensifies in a country that’s finally growing again. The IMF anticipates annual inflation hitting a low of 45 percent next year, and I think that’s a reasonable guess. —DM Metaculus aggregated forecast: 55 percent There will be a ceasefire in Ukraine (75 percent) The war in Ukraine is just short of its third anniversary. The very fact that Ukraine has continued to fight this long defies most early prognosticators, many of whom expected the government in Kyiv to collapse not long after the Russians invaded. (An exception there, as Future Perfect readers know, is the State Department’s perspicacious Bureau of Intelligence and Research.) But the longer the war goes on, the more Russia’s sheer size and willingness to sacrifice unbelievable numbers of soldiers has outweighed Ukraine’s ability to fight back, even with the material support of the US and European allies. President Biden has mostly been a steadfast ally, but he’ll be leaving office on January 20, replaced by Donald Trump, who has made no secret of the fact that he has little interest in continuing to support Ukraine. Both sides are still fighting hard to gain and protect territory, but it seems clear that’s being done by both Ukraine and Russia to put themselves in the best possible position before expected peace talks. Exactly what form that will take is difficult to predict, and a ceasefire doesn’t mean a permanent peace. But I would be shocked to not see a durable pause in the fighting some time in 2025. —BW Metaculus aggregated forecast: 44 percent Iran gets nuclear weapons (30 percent) For the purposes of this prediction, “getting nuclear weapons” means producing enough fissile material to fuel a nuclear weapon. Actually producing a usable nuclear weapon — including miniaturizing a warhead enough to fit on a missile — might take another several months to a year or more, and thus probably falls outside the 2025 time frame. Iran is already on the brink of sufficient enrichment — estimates are that it would only take about a week for Iran to enrich enough uranium for five fission weapons. So the question here is primarily one of international politics. Iran had a terrible 2024. It directly attacked Israel with missiles twice, only to see both salvos largely neutralized by missile defense systems, while Israel’s own retaliatory attack on Iran was far more successful. The Lebanese militia Hezbollah, Iran’s most powerful proxy, was all but annihilated by Israel, which continues to operate in parts of southern Lebanon. And the return of Donald Trump brings a president into office whom Iran has been accused of trying to assassinate. Put that all together, and the Iranian regime finds itself in a very insecure place, and may look to nuclear weapons as a way to level the playing field. At the same time, relatively new Iranian President Masoud Pezeshkian has made overtures to the West and seems to understand that the only path to economic relief for his country is a new deal that limits the nuclear program in exchange for easing economic sanctions. The Iranian regime’s number one priority is its own survival, and my best guess is that they will decide that the risk of going full speed on a nuclear program isn’t worth it, at least for another year. (There’s also the possibility that accelerating its nuclear work could lead to a military intervention by Israel or the US that would stop the program in its tracks.) So I think on balance that Iran won’t join the nuclear club in 2025 — though it’s not a prediction I make with a great deal of certainty. —BW Metaculus aggregated forecast: 8 percent Science and technology The World Health Organization (WHO) will declare H5N1 a pandemic in 2025 (25 percent) First off, some math. While it may feel as if infectious disease pandemics have become a regular occurrence, they still remain highly rare. Since 1918, there have been five influenza pandemics: the Spanish flu of that year, the 1957 Asian flu, the 1968 Hong Kong flu, the 1977 Russian flu, and the 2009 swine flu. That gives a naive percentage of about 5 percent for any given year. But there’s evidence that outbreaks of new infectious diseases are increasing, as the Covid pandemic amply demonstrated. And the H5N1 avian flu has been infecting a growing variety and number of animals, and more recently, people. On December 18, California, where 34 human cases of the virus have been detected, became the first state to institute a state of emergency over bird flu. New research suggests just a single mutation could be enough to potentially increase the virus’s ability to spread from person to person, which would be a prerequisite to becoming a pandemic. (Right now, H5N1 only rarely seems to be able to spread between people, and only in very limited fashion.) So why am I mostly pessimistic about H5N1’s ability to truly break out, which for the purposes of this prediction would mean the WHO officially declaring it a pandemic, which would require sustained human transmission over multiple regions? Not because we’re doing a great job containing it — we definitely are not. Rather, it’s personal experience. I’ve been covering H5N1 since it began really spilling over in Southeast Asia in 2004. I’ve been to backyard chicken farms in Indonesia and virology labs in Hong Kong. I’ve watched this virus as closely as any other subject I’ve covered in nearly a quarter-century as a professional journalist, and I just don’t think H5N1 has it. Call it a hunch, and one I hope will hold true. —BW Metaculus aggregated forecast: 26 percent A major lab will formally claim it has achieved AGI (30 percent) For precision, let me clarify that by “major lab” I mean any of the following companies: OpenAI Anthropic Google (including DeepMind) Microsoft Nvidia xAI Meta/Facebook Mistral Databricks World Labs Safe Superintelligence Hugging Face Scale AI Magic.dev Amazon Apple Netflix IBM This is a purposefully broad list and includes companies that haven’t made it a priority to be on the bleeding edge of deep learning (like Netflix) and ones whose primary business isn’t in developing their own models so much as hosting or enabling models that others create (like Scale or Hugging Face). But, you know, I thought Nvidia wasn’t in this race until it dropped a massive model in October with impressive benchmarks, so a lot of things can change quickly in the world of AI. Artificial general intelligence (AGI) is a vague term, and there is a large and growing literature in which AI researchers seek merely to define it, let alone to predict what it would look like or mean. That said, most definitions rely on an analogy to humans: an AI will be generally intelligent if it can do everything a human being can do, as well as a human being can, including meta-tasks like learning to complete new tasks. This idea itself has holes in it. Different human beings can do different things — I cannot do everything, say, Katie Ledecky can do. Luckily for us, the prediction here doesn’t require us to know what AGI means. It just requires a major firm to claim to have achieved it, accurately or not. One OpenAI staffer took to X this past year to claim that the firm’s models had already gotten there (though, importantly, the company itself has not made claims that grand). So if the bar is that low, why do I think we’ll make it through the year without a company making this claim? Mostly because a) this is a young field where firm reputation matters a ton and being discredited by a premature AGI announcement might make the difference between a company ending up like Apple and ending up like Atari, and b) this is the kind of technology where premature claims can be discredited really, really fast. If a nuclear fusion company claims to have achieved net energy gain, it is very difficult for me, a non-nuclear physicist, to tell if they’re bluffing. It’s not like I can use the nuclear reactor. But an AGI would presumably come with text, video, audio, and other interfaces that average consumers could try out and use, and it’d be immediately clear if some AI firm claimed to have gotten there when they hadn’t. —DM Metaculus aggregated forecast: 20 percent EVs will make up more than 10 percent of new car sales in the US by the end of Q3 2025 (65 percent) I’m not really a fan of private cars (see my other car-related prediction above), and I wish our solution to climate change was to just have fewer of them. But this is America, so we have to work within the maddeningly car-dependent cage of our own creation. Electric cars are obviously better for society in most respects (though not all — their heavy weight means they’re more dangerous to pedestrians, cyclists, and anyone outside the vehicle), so I grudgingly have to welcome the EV transition that’s finally picking up. By the third quarter of 2024, EVs made up 8.9 percent of new car sales in the US, according to an analysis by Kelley Blue Book. There’ve been reports that electric car sales are slowing, but given their consistent past growth rates, plus the fact that interest rates are coming down, I think we’ll hit 10 percent by the same time this year without much trouble. Donald Trump’s promise to do sweeping tariffs could throw a wrench in all that, but given my colleague Dylan Matthews’s prediction about the unlikelihood of that happening, I won’t calibrate my prediction around it too much. —MB Metaculus aggregated forecast: 67 percent Bitcoin’s price will at some point in 2025 breach $200,000 (70 percent) The digital gold rush probably still hasn’t reached full frenzy, believe it or not. Bitcoin recently topped $100,000 in value for the first time, but we are going to have to think bigger. I think it’s going to double its value in the next 12 months — and I’m not the only one. This is not an endorsement, to be clear; I own no bitcoin. When I read Warren Buffett still believes Bitcoin is a fad, that people do “stupid things” and this will be the latest trend in fiscal speculation to end in failure, I take it seriously. The case for bitcoin remains muddied, at least to me. But Buffett has also compared bitcoin to gambling and, well, the gambling business is booming. Even if Bitcoin is a questionable long-term investment — don’t forget it dropped below $20,000 in late 2022 — people can still get a kick out of the continued accumulation of value, and that’s the basis of any bubble. It helps that Donald Trump and the crew he’s bringing back to Washington have gone all in on the crypto craze; they are likely to do whatever they can to stoke the speculation further. Bitcoin just saw its value more than double over the course of 2024. I think it’s more likely than not it’ll repeat the feat with those winds at its back. —Dylan Scott Metaculus aggregated forecast: 20 percent Elon Musk is still the richest person in the world (55 percent) My source here is the Bloomberg Billionaires Index. Since the 2012 inception of the Bloomberg list, the occupant of the top spot has changed five times. In 2013, surging Microsoft shares enabled Bill Gates to beat out Mexican telecom mogul Carlos Slim, who led the list at its outset. In 2017, Amazon shares put Jeff Bezos ahead of Gates. The massive rally around Tesla led in January 2021 to Elon Musk deposing Bezos. But Louis Vuitton chief Bernard Arnault overtook him in October 2022 in part because Musk had to sell much of his Tesla fortune to finance his purchase of Twitter. But by May of the following year, Musk was back on top. “Will Elon Musk still be the richest person in the world throughout 2024?” is actually two separate questions: one, will he be dethroned by anyone in the next year; two, will he live through the year? Normally the latter wouldn’t be a concern for a 53-year-old man with access to the best health care money can buy, but Musk is, uh, not the most stable person on earth. So I’d put maybe a 5 percent probability he loses the title by way of the Grim Reaper. Five switches in the top ranking over 12.5 years of the Bloomberg ranking existing implies, naively, a 40 percent chance that the top rank will switch in any given year. There’s tons of fluctuation within the top 10 even in a given month, as these net worths are hugely dependent on stock returns. Jensen Huang of Nvidia, currently ranked 12th, gained $73.4 billion in 2024 alone, by far the biggest part of his $117 billion fortune. It's sobering to return to the 2013 article on Gates overtaking Slim, which notes at the