President Barack Obama began meeting with prominent Democrats in early January to develop a strategy to keep his signature domestic policy, the Affordable Care Act, intact in the hands of a new administration. Vice President-elect Mike Pence and Republican Congressional leaders have been strategizing and meeting since the election to develop an alternative to the ACA. With both parties gearing up for a political showdown after President-elect Donald Trump’s inauguration, where does this leave the innovative population health projects many EMS agencies have been developing since the passage of the ACA? The ACA gave prominence to two concepts: the Patient-Centered Medical Home and the Accountable Care Organization (ACO). It additionally made the Institute for Healthcare Improvement’s Triple Aim framework an urgent reality for EMS leaders.