The modifications of Medicare via the ACA were the closing of the "donut hole" and others. What was not addressed in the ACA was the fact that under Medicare Part D it is illegal for the American government to negotiate prices for the prescription drugs covered under Medicare and that you and I still cannot buy less expensive prescription drugs from Canada, England or any other country. That is what Murkowski was and is a prime supporter of. Oh and did I mention that the Bush administration didn't fund a dime of Medicare Part D? They simply added it the estimated $800 Billion to the national debt. That was the days of Cheney saying Reagan proved that deficits don't matter. Remember those days Jim? I'll never forget them. The Democratic House did not approve of the negotiations between Pharma and the White House so I'm not sure what happened in the end. What I do know is that under the original Medicare Part D  the law prohibits drug price negotiation and Lisa supported that concept.