Fears that repealing the Affordable Care Act (ACA) would reverse years of efforts to lower cost and improve quality are “overblown,” according to health policy fellows from a conservative think tank writing in Health Affairs.

Billions of dollars went into delivery system reforms after the ACA became law, like accountable care organizations, but some of those efforts haven’t delivered what their advocates claim, according to Joseph Antos and James Capretta of the American Enterprise Institute, which advocates for “limited government.” While they agree rolling back the ACA’s delivery system changes would be unwise, they feel the current healthcare debate may push more initiatives from the private sector.

“There is reason to be skeptical that a federal agency can engineer a higher-value health system relying solely on regulatory carrots and sticks,” Antos and Capretta wrote. “A better approach would combine new provider payment policies with stronger economic incentives for beneficiaries and consumers to seek out lower-cost and higher-value care. This approach would recalibrate, not reject, the delivery reform effort started in the ACA.”

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