There is much discussion about eliminating the health insurance exchanges, but very little has been said about the parts of the Affordable Care Act (ACA) that focused on actual healthcare delivery reforms. The GOP "Obamacare Repeal and Replace" Policy Brief, issued Feb. 16, 2017, makes no mention of what happens to value-based payment reforms, the CMS innovation models or Accountable Care Organizations (ACOs).

In addition to health insurance reform, the ACA authorized Medicare to move from fee-for-service payments to value-based reimbursements, created ACOs for the Medicare Shared Savings Program and established the CMS Innovation Center to test innovative payment and delivery models. These payment reforms were aimed at encouraging needed care coordination among hospitals, physicians and other providers to enhance the quality of the care and reduce Medicare expenditures. Although many of these payment reforms would likely continue because of the private insurance sector interest, it is unclear what happens to Medicare payment reform and care innovation if the ACA is repealed under the new administration.