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When Republicans won in November, it looked as if 2017 would reflect a major legislative shift to the right. But two months into the 115th Congress and six weeks into the Trump administration, progress on fulfilling Republicans’ major domestic policy goals is looking further away, not closer. Plans to repeal the Affordable Care Act have quickly become a quagmire as lawmakers grapple with the risk of millions losing their health insurance. A corporate tax overhaul that has backing from House Republicans is running into serious opposition among Senate Republicans. (Neil Irwin, 2/28)

Obamacare has permanently shifted America’s health care debate, and Donald Trump’s address to Congress proved it. In the speech, Trump laid out five principles any Obamacare replacement must meet. First, “we should ensure that Americans with preexisting conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges.” (Exra Klein, 2/28)

Since President’s Trump’s election, worried centrists and progressives have entertained the hope that the populists in the president’s circle, though scary in their own ways, will nevertheless restrain the more traditional Republicans in the White House. Maybe chief strategist Stephen K. Bannon will convince Trump to invest in infrastructure and defend the social safety net, even as Vice President Pence and chief of staff Reince Priebus discourage the president from embracing the alt-right. (Stephen Stromberg, 3/1)

President Donald Trump's on-the-job training continues. On Monday he revealed to reporters that he had learned a valuable lesson about reforming Obamacare: It's hard. "It's an unbelievably complex subject," he told reporters Monday in the White House. "Nobody knew health care could be so complicated." (Clarence Page, 2/28)

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance. (Michael F. Cannon, 2/28)

In the letters nearby Bill Hazel, Virginia’s secretary of health and human resources, takes issue with our recent editorial on Medicaid expansion. We’re grateful for the chance to advance the discussion. The editorial pointed out that Congress might slash the federal reimbursements to states that expanded Medicaid — precisely what Virginia Republicans warned might happen. Hazel correctly points out that this has not yet occurred, and possibly never will. Fair point. His others? Not so much. (2/28)

Last week, Marsha Blackburn, a conservative lawmaker from Tennessee, held a town hall in her district. Citizens confronted her with pointed questions about the GOP plan to repeal the Affordable Care Act (ACA). Blackburn, a prominent member of the president’s transition team, responded by, uh, prevaricating her head off. (Steve Almond, 3/1)

Federalism has become a watchword in the acrimonious debate over a possible replacement for the Affordable Care Act (ACA). Missing from that debate, however, is a theoretically grounded and empirically informed understanding of how best to allocate power between the federal government and the states. For health reform, the conventional arguments in favor of a national solution have little resonance: federal intervention will not avoid a race to the bottom, prevent externalities, or protect minority groups from state discrimination. Instead, federal action is necessary to overcome the states’ fiscal limitations: their inability to deficit-spend and the constraints that federal law places on their taxing authority. A more refined understanding of the functional justifications for federal action enables a crisp evaluation of the ACA—and of replacements that claim to return authority to the states. (Nicholas Bagley, 2/14)