Healthcare reform is causing unease in the industry, as health officials wonder what exactly will change. So says a report in Market Watch, which cites the number of healthcare initial public offerings (IPOs) at their lowest level since 2012.

The "uncertain nature of healthcare under the Trump administration" is the likely cause, the report says, but it could be a number of factors well beyond the current administration — even tied to the fact that the Affordable Care Act is facing troubles. Perceived risk is another factor, apparently.

Market Watch details just 12 IPOs in healthcare so far, citing a report by Renaissance Capital. The peak in the healthcare IPO market came with 42 in 2014, but they have since been on a downward slide. Biotech firms had been leading the sector, but analysts have said that's no longer the case.

"Interest in healthcare IPOs has declined since then due to uncertainties surrounding the possibility of regulating pharma prices and the repeal of the (Affordable Care Act)," Kathy Smith, principal at the firm, told Market Watch.

To this point, there have been 27 IPOs (in all sectors) priced up 137.5 percent since last year, according to Renaissance. The largest, at $3.24 billion, was the public debut of Snap Inc.

Healthcare Dive suggests that payers are especially "bothered" by the anxiety about healthcare reform, as they try to bear the turbulence of the ACA exchanges.

"Payers are worried that Republicans may stop funding cost-sharing reduction subsidies that help cover poorer Americans in exchanges," the site reports. "Without that help, payers warn that rates will rise and could lead to insurers leaving the exchanges. Payers have deadlines next month to set rates on ACA exchanges plans."

Driving digital health M&A is the desire, on the part of many companies, to be part of the growing U.S. healthcare spend, which is estimated to reach roughly 20 percent of GDP within a few years. The Affordable Care Act and MACRA have introduced new data-sharing requirements and care coordination mandates, which in turn has increased the need for solutions that improve care quality and outcomes while lowering costs. Many large companies and investors see healthcare as a necessary part of their portfolio.

Interestingly, healthcare-based acquisitions and mergers seems to be on the rise. Those organizations not driven by the payer market or reimbursements are somewhat protected from any speculated shakiness in the market.

Volume and values are up, though value has not risen as much as volume, Rock Health says. Digital health is still quite popular from an investor perspective. Digital health has been attracting more and more investors, but experts argue they are just warming up. Rock Health says that in the first quarter there were 71 digital health deals totaling more than $1 billion.

As of the first quarter, healthcare leaders said they were planning to focus on controlling costs, investing in analytics to improve data integration, and increasing patient engagement and utilization of telemedicine. The top six themes with the most deals per category received nearly half of the $1 billion invested in digital health: analytics and big data, care coordination, telemedicine, hospital administration, healthcare consumer engagement, and wearables and biosensing.

Former IPO darling Fitbit was trading at 25 percent below its 2017 opening price and 70 percent below its 2015 IPO price at the end of the first quarter even though it is expected to sell $1.5 billion in devices in 2017.

Even with IPOs diminishing, the rest of the health sector is producing jobs at a healthy rate for this point in the year, though futures will likely determined by the future of healthcare and any possible regulation forthcoming.

Perhaps a more obvious takeaway here is that while one side bemoans the rise of companies enjoying the benefits of a capitalist system when the opposite occurs and there are fewer of these IPO entrants in the market there are just as many of these naysayers demanding to know why the market is not supporting them.