The most important question for Republicans now is whether the members of the Freedom Caucus will find themselves newly emboldened in ways that may bring the new president more defeats — or whether Mr. Ryan will do what former Speaker John A. Boehner could not, and find a way to shred their influence for good.

“If you are defined by your opposition to leadership, it’s hard to be part of a governing coalition,” said Alex Conant, a onetime aide to Senator Marco Rubio, the Florida Republican who was once a Tea Party star. “Their opposition to Trump’s health care bill should surprise nobody who’s paid attention for the last six years. Even the world’s best negotiator can’t make a deal with someone who never compromises.”…

But after years of opposing power — both in the White House, which was occupied by a Democrat, and in the leadership of their own party — the conservatives were offered a chance to negotiate directly with the president and his budget director, a former Freedom Caucus member, over the bill to replace the Affordable Care Act. The members pushed and pushed Mr. Trump to the far right edges of policy, just as they have done for years on other bills. But they still could not get to “yes,” and therefore became part owners of the expansive health law they were trying to undo.

“They made the perfect the enemy of the good,” said Representative Roger Marshall, Republican of Kansas. “I don’t know how they can go back home and tell people they voted to keep Obamacare, voted to keep funding Planned Parenthood.”