This is an archived article that was published on in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

There's no denying the drama of the Thursday night vote — Friday morning, in D.C. — cast by Arizona Sen. John McCain that dashed the Obamacare repeal hopes of Republicans, at least for now.

The senator, undergoing treatment for brain cancer, returning to the Capitol and, after being relentlessly lobbied by Senate Majority Leader Mitch McConnell, Vice President Mike Pence and seemingly every other member of the body, he still cast the "No" vote.

Less noted, but equally crucial, were the votes cast by Maine Sen. Susan Collins and Alaska Sen. Lisa Murkowski, but their votes seemed to be less up-for-grabs than McCain's.

The significance of the latest Republican setback isn't just that Obamacare will survive for a few more weeks or months, maybe longer. It's that now, after having exhausted every tactic to jam a repeal through by brute force, Republicans have to negotiate, a lost art in Congress.

The vote was as much about process for McCain, as the content of the bill. It would not, as he said, improve options and lower costs for Americans.

Having covered McCain in Washington for a handful of years, I suspect that, had the bill actually included a viable replacement and had it seen a Senate hearing, the outcome would have gone the other way.

"The vote last night presents the Senate with an opportunity to start fresh," he said in a statement Friday.

And he's right. It doesn't take a genius to know that Obamacare is imperfect, and neither was the process Democrats used to produce it.

A weary Utah Sen. Orrin Hatch, after Friday morning's failure, told reporters he too was looking ahead.

"I'm disappointed," he said. "But there are things that we all, Republicans and Democrats, agree need to be fixed. So we can't give up."

If Hatch is sincere about that, it's a remarkable shift in tone from the Finance Committee chairman who rejected Missouri Sen. Claire McCaskill's pleas for an open process that includes hearings and amendments and, yes, even input from Democrats.

And there are issues that are begging to be fixed.

One of the biggest flaws is the so-called "coverage gap," a problem created when the Supreme Court ruled states could reject the expanded Medicaid program.

In Utah and other Republican-controlled strongholds that didn't expand Medicaid, it left a huge swath of people in no man's land. They made too much to qualify for Medicaid, but they also didn't qualify for subsidies to buy insurance in the marketplace.

Let's be clear: The Utah Legislature chose to leave residents without insurance by repeatedly refusing Gov. Gary Herbert's proposals to expand Medicaid.

But Congress can solve the problem by expanding the subsidies to cover those now in the doughnut hole, a worthwhile tactic, even if it means reducing the subsidies for those with higher incomes. It would mean coverage for 2.6 million people who now experience the burdens of Obamacare without the benefits.

Utah could also directly benefit if Congress gets serious about addressing the opioid and mental health problems that are not unique to the state, but are apparent as officials try to clean up Salt Lake City's Pioneer Park.

Language in earlier versions of the Republican bill would have steered money to opioid treatment and Utah is seeking approval from the Department of Health and Humans Services to launch a program to use Medicaid funding to expand treatment for people in extreme poverty with mental health and substance abuse issues.

The biggest threat to Obamacare is that insurers have pulled out of some markets. Most Utahns have three insurers to choose from on the health insurance marketplace, but some parts of the country have fewer and some don't have any.

Part of that is because the uncertainty surrounding the future of the law has created instability. The message coming from President Donald Trump and the White House and Congress directly fuels that instability and gives jittery insurers a motivation to pull out of markets.

Bipartisan legislation affirming the future of the insurance exchanges and a toning down of the repeal rhetoric would stabilize the markets and help states that are losing insurance options. The more plans states can keep in a market, the more competition will help control costs and improve services for consumers.

Unfortunately, the Trump administration has gone the opposite direction, trying to undermine insurance markets by withholding cost sharing reduction payments.

It's not surprising. This president appears to be so tied up in petty turf battles, Twitter wars and fending off legitimate questions about Russian election meddling that he doesn't have the bandwidth to focus on solving problems or helping Americans.

The good news is that the Senate doesn't need Trump to engage, at least not yet. Indeed, the Friday drama could move us beyond cynical partisan power plays and set the stage for a new, bipartisan approach to solving health care problems.

The challenge, as McCain noted Friday, will be trust.

"I encourage my colleagues on both sides of the aisle to trust each other, stop the political gamesmanship, and put the health care needs of the American people first," he said. "We can do this."

Twitter: @RobertGehrke