In March of 2013, when the Affordable Care Act (ACA) was signed into law, I was not a big supporter. I had worked in healthcare for long enough that I feared the change required by providers to address the fundamental underpinnings, such as value-based care, was more than they could handle. I’m happy to say that I was wrong. Although many providers still have a long way to go to adopt a truly value-based care model, the progress has been much greater than I ever imagined.

Now, four years after the ACA was signed into law, we have a federal government controlled by one political party for the first time in 10 years. The party in control opposed the ACA long before it was signed into law and continues to oppose it today. It’s likely the ACA will see dramatic changes in the next year or so … maybe not a full-blown repeal, but there will certainly be change.

With more than 20 years in the healthcare industry, I’m certain of one thing: uncertainty is a major impediment to progress. Just when providers and payers are really beginning to get their heads around the implications of the ACA and making positive changes in how care is delivered, many are once again paralyzed by uncertainty. Meanwhile, the fundamental problem with the US healthcare system remains: The cost of delivering care is just not sustainable.

My concern is that, depending on how much of a departure the Republican plan is from the ACA, we could be starting over. Or, if it takes too long for plan details to be unveiled, the progress that has been made may stall. The last thing the healthcare system needs is for the financial, organizational and system investments made by provider organizations to not align with the new administration’s healthcare plan. That’s a setback that would be difficult to overcome, and the reason why I have come full circle on the ACA. Now I fear dramatic changes to a plan I wasn’t initially in favor of.