In these small rural towns that double as ground zero for the type of populist, anti-establishment politics that thrust Donald Trump into the presidency and gave Republicans control of Washington, Meadows remains a hero. He demanded full repeal of Obamacare, more than the failed House bill would have attempted. And his star only shines brighter here after he cost House Republicans their first big win on health care — and their first big win as the governing party.

His constituents — roughly 45,000 of whom, ironically, were covered by the Affordable Care Act in 2016, most with subsidies, according to a Kaiser Family Foundation estimate — now expect him to go back to Washington and pick up the fight to uproot and destroy the law completely.

“I respect him for staying true to his principles,” said Jerry Moore, who runs the Kilwins Chocolates & Ice Cream shop in Highlands, N.C., the hometown that gave Meadows his political start. “Trump promised repeal. That was no repeal.”

That sentiment is echoed all over this town, and it strikes at the heart of the dilemma facing Republican leaders — how to enact big complex legislation without compromising the ideological purity they nurtured for years among lawmakers and voters alike. The Freedom Caucus, which pushed former Speaker John Boehner out in late 2015, now counts more than 30 members. The hardline bloc is powerful enough to derail any Republican bill deemed insufficiently conservative — and it’s backed by voters eager to reward them, even if it means bringing down still more of the GOP hierarchy.