The confusion and anxiety unleashed by Republican efforts to repeal and replace the Affordable Care Act are unlikely to be put to rest anytime soon, despite the collapse of the Senate leadership’s repeated attempts to secure enough support to enact a bill undercutting President Obama’s signature domestic achievement.

After the Republican-controlled chamber failed to pass repeal and replace legislation and a subsequent attempt to annul Obamacare, with a pledge to come up with a substitute down the road, senators, in a dramatic late-night session, rejected by a 51-49 vote a so-called Skinny Repeal bill that would have eliminated the individual mandate to purchase health insurance and given large employers the option of not providing coverage for their workers.

Three Republican senators — Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona — joined all of the Democratic members in turning back the measure. McCain, who returned to Washington to take part in the debate after he underwent surgery that resulted in a diagnosis of brain cancer, cast the decisive vote.

Openly critical of the process that Senate Majority Leader Mitch Mc­Con­nell used to bring the three repeal and replace measures to the floor, McCain said, “One of the major failures of Obama­care was that it was rammed through Congress by Democrats on a strict party-line basis without a single Republican vote. We should not make the mistakes of the past.”

In a subsequent tweet, he added that Skinny Repeal faltered because it didn’t offer “meaningful reform” of the ACA.

McCain’s analysis, together with comments by McConnell and Senate Minority Leader Chuck Schumer of New York, offer some reason to hope that the two parties might be able to work together to develop solutions to a number of significant problems that plague the ACA, including rising premiums, high deductibles and a lack of competition among insurers in a number of markets.

On the other hand, the ideological divide over health care policy among members of both the House and Senate is vast, and President Trump remains steadfast in his opposition to the ACA, tweeting after the failure of Skinny Repeal, “As I said from the beginning, let Obama­care implode, then deal. Watch!”

The administration has a number of means at its disposal that could hamstring the ACA. The possibility that Trump will give the order to use them, coupled with the insistence of many Republicans that the party deliver on its long-standing promise to repeal and replace Obamacare, is likely to result in more unpredictability for patients, heath care providers and third-party payers.

It has been said in this space before but bears repeating: Retail pharmacy operators and their customers are fortunate to have a powerful voice in Washington during these turbulent times. The National Association of Chain Drug Stores has been vigilant in monitoring the health care debate, defending the position of pharmacy, and advocating for the profession’s ability to do more to help solve the problems of access, quality and cost.

Long a strong presence in the nation’s capital, NACDS has established relationships with relevant decision makers in the Trump administration and members of the 115th Congress.

In addition to ongoing staff work, in recent months NACDS president and chief executive officer Steve Anderson has met with Department of Health and Human Services Secretary Tom Price, and Anderson; Alex Gourlay, current chairman of the association and co-chief operating officer of Walgreens Boots Alliance; and several NACDS board members — including CVS Pharmacy president Helena Foulkes; George Riedl, president of health and wellness at Walmart; and Mark Panzer, senior vice president of pharmacy, health and wellness at Albertsons Cos. — met with key legislators on Capitol Hill.

At a moment when there’s so much at stake — sooner or later health care, which accounts for almost 20% of the nation’s economic activity, touches the life of every individual — it is good to see that NACDS and its members are more active and engaged than ever.