And that could mean the government might spend far more than it would on a traditional Medicaid plan. The HHS remains open to negotiations, but Gov. Haslam seems firm in his proposal. Tennessee's Medicaid program includes Magellan Health Services Inc (NASDAQ: MGLN ) as its pharmacy benefits manager and counts UnitedHealth Group Inc. (NYSE: UNH ) and WellPoint, Inc. (NYSE: WLP ) as its major insurance backers. So investors for those companies should keep an eye on this story. Medicare cuts Turning to the Medicare side of the Affordable Care Act, health plans rose this week on the suggestion that Medicare Advantage rates might see lower cuts than previously announced. Those rates were based on the assumption that Congress will go through with a 25% physician pay cut for next year, which would require the higher insurance rates for balance. But Congress hasn't implemented the pay cut in more than a decade, so the rate cuts haven't been necessary.