Health care industry executives here are gazing into a murky crystal ball as they try to plan and budget for changes in the coming year, amid new major players entering the market and the possibility of the federal Affordable Care Act being abolished or dramatically altered.

That uncertainty hasn’t brought a halt to the construction of sizable health care projects or the planned opening of additional small clinics in Spokane and Kootenai counties, as the demand for health care services keeps rising and as consumer preferences for how they’re offered keeps changing. Projects totaling more than $100 million that won’t be completed until next year or later are planned or under construction.

Perhaps the biggest change unfolding in the local health care arena in the coming year, separate from the impacts of any nationwide ACA changes, will be the debut of Tacoma-based MultiCare Health System. It announced in November that it plans to buy the assets of Rockwood Health System, Spokane’s second-largest provider network, from Tennessee-based Community Health Systems Inc., and it made clear that it wants to foster positive changes here in health care delivery. 

“We are excited to bring Rockwood Health System into the MultiCare family. We are continuously looking for like-minded organizations dedicated to improving the health of communities that can join us on our journey to strengthen,” said Bill Robertson, MultiCare’s president and CEO, in a press release. “Together, we will contribute to the health and vitality of the community in greater Spokane and across Washington state.”

The $425 million transaction is expected to be completed in the spring, and details about what changes it will trigger here have yet to be announced.

Elaine Couture, chief executive of Spokane-based Providence Health Care, the Inland Northwest’s largest provider network, expressed a generally upbeat outlook for the coming year in a recently published interview with the Journal. Her comments were tempered, though, by industry concerns about the future of the ACA, which president-elect Donald Trump has criticized.

“Our focus in 2017 won’t be much different than this year,” she said. “We want to continue providing access to quality care regardless of insurance, looking at ways to keep that care affordable and eliminate duplications.”

Providence Health Care, too, though, is going through organizational changes, following the July merger of parent Providence Health & Services, based in Renton, Wash., with Irvine, Calif.-based St. Joseph Health. The two formed Providence St. Joseph Health, which is now the third-largest nonprofit health care system in the country.

Couture says Providence Health Care is facing greater financial challenges, with reduced revenues and increased expenses that have led to cost-cutting measures, including recently eliminating 26 full-time positions.

However, it’s partnering with Kirkland-based Fairfax Behavioral Health to develop and operate a $37 million, 100-bed psychiatric hospital near its downtown campus, with that hospital expected to open next year.  Couture says Providence also plans to open several Express Care retail clinics in the Spokane area next year.

In other large health-care projects planned or underway in the Spokane-Coeur d’Alene area, Kootenai Health earlier this year launched a $45 million second phase of expansion on the heels of a recently completed $57 million first phase of a master plan for its flagship hospital. It also has been working on a multimillion-dollar expansion at its Post Falls campus. Some of the expansion work isn’t expected to be completed until 2018.

Also, the Spokane Mann-Grandstaff Veteran Affairs Hospital disclosed six months ago that it plans to erect a mental health and education building on its campus in northwest Spokane to kick off a few projects in the works there with a combined value estimated at nearly $35 million.

Along with the $7.9 mental health and education building, which is expected to take more than a year to complete, the projects include a $16 million boiler plant, a $10 million primary care clinic, and a $1 million computed-tomography unit expansion.