Any conversations between healthcare providers and their design partners regarding capital projects were colored by a marked sense of uncertainty leading up to passage of the hotly contested Affordable Care Act (ACA) in 2010. It continued until the U.S. Supreme Court ruled the law constitutional in June 2012 and then upheld it against another challenge in 2015.

However, clarity did finally emerge, and building slowdowns have been replaced by a slew of projects in the works to address new, pressing challenges: aging infrastructure, technology in care delivery, and shifts to outpatient environments.

But that uncertainty of old is creeping back into the picture once again, as a Trump presidency brings with it questions regarding the president-elect’s voiced support of repealing and replacing the ACA. While recent reports indicate that some portions of the law, such as coverage for individuals with pre-existing conditions, would remain, there’s yet to be a plan proposed for exactly how the legislation may be altered or what might come of 20 million newly insured Americans.

I reached out to our Editorial Advisory Board members to weigh in on what the current state means from their unique perspectives. Here’s what a few of them had to say on what’s ahead and, more specifically, the opportunities that exist for design partners to provide support to providers during the interim:
“Since the approval of the ACA, healthcare providers have been in reactive mode trying to adjust their operational models. In many cases, this has caused healthcare providers to be very conservative in capital expenditures as it relates to facility projects. The architectural, engineering, and construction industry calls this ‘analysis paralysis,’ which means much-needed projects and infrastructure improvements have not been approved. Once we know the result of the promised ACA changes, it is anticipated there will be a surge of facility projects approved and implemented by healthcare providers.”

—Gary L. Vance, planner and architect, Vance Consulting
“In our firm, we’ve been trading thoughts amongst the partners as to what the impact might be. In the short term we see a potential pause in spending related to building new or upgrading existing infrastructure as our clients grapple with the uncertainty of the current situation and how it will affect their bottom line. We saw a similar impact with the Balanced Budget Act of 1997. In the long term, if what we move to is a more market-based model that looks for increased value at lower cost with payments linked to outcomes, then that can only enhance the need for services from design professionals providing evidence-based solutions.”

—Bill Repichowskyj, partner, E4H Archtecture


“It is clear that healthcare providers were finally getting comfortable with ACA requirements and were beginning to invest in facility infrastructure again after several years of lower investment strategies. I believe we will now have another period of uncertainty and project deferrals with the prospect of the new administration’s promise to repeal the ACA. In other words, it looks like we are going to experience another setback in the progress of healthcare facility innovation due to decreasing investment.”

—Mark Patterson, corporate health practice leader, SmithGroupJJR


“Healthcare clients are reluctant to move forward on major initiatives in times of financial uncertainty— significant policy upheaval is bad news for our industry. Despite the ‘repeal and replace’ rhetoric, the inevitable changes to the ACA will take time to legislate and implement. As healthcare planners, we must advise our clients on what projects are wise investments that can bridge changes in the reimbursement climate, such as facilities that capture new markets, improve productivity, or accommodate technology. With this marketplace upheaval, I expect projects to be fewer, smaller, and more targeted in the coming year.”

—Sheila Cahnman, president, JumpGarden Consulting
What are your thoughts on where we’re heading, how long it might take, and what best practices should be in place to ease the transition? Share in the comments section below, or email me directly at