Academic health centers (AHCs) now play major roles in the development, adoption, and evaluation of medical technologies; the provision of advice to other entities involved in medical innovation; and the education of current and future practitioners. However, recent and potential health care reform initiatives could make it increasingly difficult for AHCs to continue to play their historical roles in medical innovation. Policymakers are examining specific options that would explicitly cover the cost of some of these services but could take away some of the autonomy AHCs have enjoyed and could change the role of AHCs in technological innovation.