Senator Elizabeth Warren of Massachusetts, a longtime supporter of the Affordable Care Act, commonly known as Obamacare, is now acknowledging the unintended consequences of the healthcare legislation, particularly its impact on industry consolidation and rising healthcare prices.

Warren, who has been a vocal proponent of Obamacare, has recently had what the Wall Street Journal reported as an “epiphany” regarding the consequences of the healthcare law. In a letter addressed to the Health and Human Services Department inspector general, Warren, along with Senator Mike Braun of Indiana, expressed concerns about vertically-integrated healthcare companies potentially increasing prescription drug costs and evading federal regulations.

According to reports from Fox News, the bipartisan letter highlighted issues with the nation’s largest health insurers allegedly bypassing Obamacare’s medical loss ratio (MLR). According to Warren, these insurers, through vertical integration, have manipulated the system, leading to “sky-high prescription drug costs and excessive corporate profits.”

The senators detailed how conglomerates, like UnitedHealth Group, with ownership across various healthcare sectors, could inflate medical payments to pharmacies and, by realizing those payments on the pharmacy side, appear to comply with MLR requirements while retaining more profits.

Moreover, despite the Democrats’ argument that the MLR would benefit patients, it has incentivized insurers to merge with or acquire pharmacy benefit managers (PBMs), retail and specialty pharmacies, and healthcare providers. This, in turn, has made healthcare spending less transparent, as insurers can allegedly shift profits to their affiliates by increasing reimbursements.

Warren, who has consistently voted against Obamacare repeal efforts, notably advocated for a “Medicare for All” proposal during her 2020 presidential campaign. Despite her prior support for the healthcare law, Warren’s recent concerns about its unintended consequences have raised questions about the long-term effects of Obamacare and its impact on the healthcare industry.