Washington (CNN) Donald Trump's election changed a whole heck of a lot about American politics -- and especially the Republican party. One thing it doesn't appear to have changed: The inability of anyone to lead congressional GOPers.

For the second time in as many months, a White House-led push to pass legislation that would begin the process of reforming and replacing the Affordable Care Act failed on Thursday.

This time the sticking point was Republican moderates who were concerned about changes made to the bill's provision restricting the ability of insurance companies to avoid covering people with pre-existing conditions. The adjustments made to the bill were done at the behest of the Freedom Caucus, the most conservative bloc in the party and the sticking point on the first version of the bill.

So, all House Republicans did between the first failed attempt to pass healthcare legislation and the second is lose a different bloc of their coalition. And draw lots (and lots) of attention to the fact that they simply cannot all agree on legislation that every single one of them -- from Trump on down -- insisted would be their first order of business upon taking the reins of power in Washington.

Which is the same story of virtually every major piece of legislation since Republicans took control of the House in the 2010 election. It's the same thing that led to the 2013 government shutdown. And the farm bill debacle on the House floor. And the botched handling of the fiscal cliff. And, well, virtually every other major debate that's come before the House GOP over the past six-plus years.

It's what triggered then-Speaker John Boehner's decision to resign abruptly -- throwing up his hands at the unwillingness of the Freedom Caucus to play ball on much of anything.