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I'm not sure ACA has a huge impact either way.
People who can't afford insurance (especially those with pre-existing conditions) will cut corners on preventative care and "maintenance" meds. Treating an acute condition costs a lot in terms of bed occupancy and staff, but the profits available on the actual medication will be less than for preventative.
If the US centralise purchasing
That's gonna take a massive shift. The time to do that in the US would have been 50-60 years ago, when even the Republican party had a lot more social conscience than today's Democrats.
Emyr
I'm not sure ACA has a huge impact either way. If the US centralise purchasing in the way the NHS does to drive better deals then the world will totally have to re imagine how it is proven that drugs are both safe and effective.