More than five years after enactment of the Affordable Care Act, a measure designed to extend coverage to the uninsured and control expenditures, the turmoil in the U.S. health care system shows no signs of abating.

Millions of Americans are still without health coverage, and health care costs continue to increase faster than the overall rate of inflation and wage growth.

Dissatisfaction with the current state of the health care system is reflected in a variety of recent developments. Efforts by Republicans in Congress to gut the ACA are ongoing. The budget deal passed by the GOP-controlled House last month would no longer require people to obtain health insurance and leave it up to large employers to determine whether they provide coverage to full-time employees. Senate Republicans are at work on similar provisions.

Activists on the opposite end of the political spectrum are taking a far different approach in Colorado, where they have garnered enough signatures to put a proposal for a single-payer health care system on the ballot in November 2016. If voters endorse the measure, Colorado would become the first state in the nation to provide universal health care.

The proposal goes well beyond the provisions of the ACA. If ColoradoCare becomes state policy, a 10% payroll tax, with 6.67% paid by employers and 3.33% borne by workers, would fund the program, whose cost is estimated at $25 billion a year. Participants would be free to chose their health care providers, with all claims sent to the state. Advocates of the single-payer scheme assert that substantial savings would result by vastly reducing administrative costs, which total more than $300 billion a year nationwide.

The political battle over the fate of ColoradoCare will be closely watched by people across the country. The idea of universal health care is anathema to conservatives, but it does have supporters among some liberals, including Vermont’s Sen. Bernie Sanders, one of the two leading contenders for the Democratic presidential nomination.

While members of the Obama administration wouldn’t agree with the forces on the right and the left that want to replace its signature domestic policy achievement, they have acknowledged that more work needs to be done to fix the health care system. Secretary of Health and Human Services Sylvia Burwell earlier this month convened a public forum on pharmaceutical innovation, access, affordability and better health.

In announcing the event, which brought together health care providers, manufacturers, insurers, consumers, and representatives of federal and state government, HHS acknowledged the vital role that pharmaceuticals play in patient care and their contribution to the economy, but voiced concern about the fact that “the high and growing cost of drugs has created hardship for families, employers and states.”

All the intense scrutiny has created an opportunity for retail pharmacy operators, which have done an increasingly skillful job in making the case for their ability to improve patient outcomes and help lower overall health care expenditures. A new study adds to the growing body of evidence.

Conducted by Walgreens Health Services and Outcomes Research, together with IMS Health, the report concludes that pharmacy interventions for patients starting a new medication have tangible benefits, including total cost savings of $164, or 3%, per patient over a six-month period; a 3% improvement in medication adherence; almost 2% lower hospital admissions; and a nearly 3% reduction in emergency room visits, with $38 in lower emergency room costs per patient.

Those results and similar findings by companies involved in pharmacy and third parties support the proposition that a bigger role for the profession would benefit patients and payers. The focus on health care has resulted in an environment where policy makers are open to new ways of doing things.

The National Association of Chain Drug Stores and its members have made the most of the situation, with support for community pharmacy reaching critical mass in Congress. NACDS announced last month that a majority of House members have signed on as cosponsors of legislation that would expand access for Medicare beneficiaries to patient care services provided by pharmacists in medically underserved communities.