The moderate opponents of GOP leadership's bill, many of whom are in districts Hillary Clinton won last fall and are already Democratic targets, were essentially standing against the bill alone.
Their traditional pro-business and leadership allies were supporting the bill. And while their opposition to the legislation made them strange bedfellows with House Freedom Caucus members, the outside groups vowing to defend those conservatives would never offer moderates political cover.
Targets of opportunity Meanwhile, Democrats are already sharpening their knives. They're attacking even Republicans who said they'd vote against the bill, hitting them for supporting it in committee or for taking a procedural vote on the floor allowing debate on the bill to proceed.
Besides the National Republican Congressional Committee, whose mission is to defend incumbents, where will the cover for these moderates come from?
"We'll see," said Terry Holt, a longtime adviser to former Speaker John A. Boehner.
Traditionally, Holt said, even when there have been more conservative factions, there comes a point when the party realizes it needs to have something to show for its majority if it wants to stay in power.
"You got a Republican House, Senate and president, and you can't do anything? That sounds to me like it's got backlash written all over it. Not just for the party, but for individual members," said Holt, a partner at communications firm HDMK.
That's a particular hurdle for political moderates whose seats may be in play next year.
"They're worried they don't have a savior," Gordon said.
Traditionally business-friendly Republicans, including even Appropriations Chairman Rodney Frelinghuysen, found themselves on the opposite side of a speaker who's usually been more sympathetic to their wing of the party than to the rabble-rousing faction. Democrats are targeting Frelinghuysen, as well as other New Jersey Republicans such as Leonard Lance, who also came out against the bill.
Pro-business moderates were even at odds with the U.S. Chamber of Commerce, from whom many of them have near stellar voting records. The chamber threatened to key vote the legislation but that wasn't enough to scare members worried about their constituents losing coverage.
And the super PAC allied with House leadership, the Congressional Leadership Fund, had no tolerance for typically leadership-friendly members who didn't get on board with the bill. The fund reserved air time in Iowa Rep. David Young's district last year and were already invested there this year on the ground but pulled out when he came out against the bill.
"Sometimes, it's not just an interest group here in Washington, it's a very real reflection of what they're hearing back in their districts," Holt said.
"The true concern, and the backing moderates get from other audiences, is a deep concern over what happens to people who become uninsured again," Holt added.
A thankless job? But that doesn't mean moderates are turning on Ryan, even if he's partly responsible for putting them in this position.
No one thinks Ryan should or will move on from the speakership. For starters, it's a job no one else wants. His policy chops are well-respected among the conference, and he's still seen as a political asset who's raised millions of dollars for the party.
Most GOP operatives blame a fractious conference that's adjusting to being a governing majority, not Ryan himself, for the legislative failure.
"You have a great leader in Ryan, but you need followers," said former Virginia Rep. Thomas M. Davis III.
But Davis and GOP operatives concede that leadership did a poor job of messaging the bill, which lost it the support of almost every major outside group.
"You're not communicating with the American people," Holt said. "You're not building political coalitions, buy-in from groups." It took years, Holt said, for Boehner to build a coalition for a welfare overhaul.
Davis, a former NRCC chairman, doesn't see Ryan's failed effort to push the bill inflicting damage on individual members facing tough re-elections.
"Most of them survive on their own," he said. "Ileana Ros-Lehtinen is an an icon. (Virginia Rep. Barbara) Comstock, Frelinghuysen are brands in these districts. They survive on their independence," he said. Even for Colorado Rep. Mike Coffman, a perennial Democratic target who supported the bill, Davis doesn't see any long-term damage.
The real danger, he said, could be to the party brand, with which Ryan is inextricably linked.
If the party base senses they "hired a gang who couldn't shoot straight," that may depress turnout, an advantage that has usually boosted Republicans during midterm elections, Davis said. Paired with an energized base on the left, muted enthusiasm on the right could spell trouble for a party that's trying to hold onto its majority next year.
Republicans, even those critical of Ryan's leadership over the past month, dismissed any idea that as the face of the failed "RyanCare" bill, the Wisconsin Republican could become a pariah on the campaign trail _ unless he struggles to get things done.
But it's clear that repeal and replace, as Ryan pushed it before, is an effort that doesn't have a political base right now.
House Freedom Caucus members, bolstered by the promise of millions of dollars of support from conservative outside groups, aren't likely to cave on their demands. And it's not apparent their constituents, many of whom voted for Trump, are angry with their representatives for not backing the president on this vote.
And on the other side of the same aisle, some moderates facing angry town halls in their districts would rather move on to other issues than succumb to pressure to try again.
"Until you develop a base, why would anyone want to take their flag and post it on that hill?" Gordon said.