New York City Mayor Bill de Blasio (D) on Tuesday issued a bold guarantee of affordable health care for every resident, thrusting the nation’s largest city to the forefront of debates over universal health coverage and immigrant rights.

The promise is aimed at 600,000 New Yorkers who lack insurance because they can’t afford it, believe they don’t need it, or can’t get it because they are in the country illegally.

The announcement makes New York the second U.S. city to attempt to provide health care to everyone living there, coming about a dozen years after San Francisco pioneered the idea with a more limited promise. 

After dismissing for years the idea that Democrats’ health care plans would lead to a government takeover, new House Budget Committee Chairman John Yarmuth on Tuesday asked Congress’ top economist to sketch out the options for a government takeover. The Kentucky Democrat also implicitly sketched out the political game plan: enact socialized medicine before patients and taxpayers understand what they’ll be losing.

Even here in the United States, government-run health care programs such as those of the Veterans Administration and the Indian Health Services have appalling records of patients dying while waiting for care.

For anxious mothers like me who don’t want to wait three days for results from a lab culture while my child suffers, government-run health care doesn’t promise speedy service.

House Democrats used their new majority on Thursday to squeeze Republicans on health care, taking the first step to intervene in a court case in which a Texas judge has ruled the Affordable Care Act unconstitutional.

That move will be followed by a vote next week designed to force GOP lawmakers into a political corner: agree to defend a law many members have spent years reviling or appear to oppose popular ACA protections for millions of Americans with preexisting medical conditions that many have pledged to uphold.

Thursday’s authorization was part of a collection of rules the House adopted to guide its operation in the new Congress. It gives Pelosi permission to intervene in the Texas court case and allows the chamber’s counsel to work on the litigation.

What will Nancy Pelosi do now once she is back in the Speaker’s chair? In light of Judge Reed O’Connor’s recent ruling that Obamacare is unconstitutional and that the entire law must be scrapped, there is likely to be strong pressure to pass some sort of legislation to improve protections for people with pre-existing conditions. Of course, Rep. Pelosi also will face pressure from those who want to resurrect the idea of a public option—an idea she supported during the fierce debates of 2009-2010, but which foundered for lack of votes in the race to the finish line. And with various progressives jockeying for position in the 2020 race, there likewise will be a vocal minority urging a push for Medicare for All. To her credit, Rep. Pelosi has wisely desisted from endorsing that singularly bad idea. But it would be a shame if Nancy Pelosi squandered this opportunity by merely re-arranging deck chairs on the Titanic. By now it is manifestly clear that Obamacare—like so many ambitious government programs before it–has massively overpromised and underdelivered.

When a federal judge recently ruled that the Affordable Care Act is unconstitutional, many in the media were caught off guard. Little attention had been paid to the case, which was brought by the attorneys general of 20 states and by the Texas Public Policy Foundation (representing individual clients who have been harmed by Obamacare).

But when U.S. District Judge Reed O’Connor handed down his ruling, he suddenly had everyone’s attention. What has followed has been an exercise in opinion-forming and prediction-making—based on too little information and even less understanding of how we got here.

After a federal judge in Texas declared Obamacare unconstitutional on what I saw as shaky legal grounds, I declared the decision an ” assault on the rule of law.” On Wednesday, I met with Rob Henneke, a lawyer for individual plaintiffs in the suit, who said that myself and other critics “missed the mark” in our analysis, and he explained why. Henneke, general counsel at the Texas Public Policy Foundation, who has been serving as attorney for the individual plaintiffs, has advanced an alternative theory that sees the requirement to purchase insurance (the mandate) as separate from the tax on going uninsured. All major differences flow from the way one views that distinction.

The new Democratic majority in the House will hold the first hearings on Medicare-for-All legislation, a longtime goal of the party’s left, after Speaker Nancy Pelosi lent her support for the process.

“It’s a huge step forward to have the speaker’s support,” said Rep. Pramila Jayapal (D-WA), who will be the House sponsor of the legislation, usually denoted as HR 676. “We have to push on the inside while continuing to build support for this on the outside.”

The commentariat of the health law and policy world scrambled the jets and armed their opinion weapons on Friday night when news broke: A federal district court judge in Texas had ruled the Affordable Care Act’s individual mandate had, once again, been found unconstitutional and declared the remaining provisions of the law inseverable and therefore invalid. (The first holding actually has happened three times before, in other federal district courts, followed by different mixes of full inseverabilitypartial severability, and full severability, respectively.)

Senate Republicans on Wednesday blocked a vote on a resolution that would have allowed the Senate to intervene in a federal lawsuit against ObamaCare.

Sen. John Barrasso (R-Wyo.) objected to a vote on the resolution and accused Democrats of playing politics. Only one senator needs to object to block a unanimous consent motion.

“Regardless of what happens in this legal process, we look to protect people with pre-existing conditions,” Barrasso said.