As the Republican Party’s grand plan to repeal and replace Obamacare went up in flames on Friday last week, the finger-pointing began.
Nothing during President Obama's eight-year stint at the White House had engendered as much opposition as the Affordable Care Act, the healthcare policy known as Obamacare.
The pledge to dismantle Obama's signature legislation was a key promise of the Trump campaign; Republicans in Congress voted to repeal and amend the Act more than 50 times during the Obama era.
When their big moment came, they fumbled. House speaker Paul Ryan and President Trump were forced into ignominious retreat last week, withdrawing the Bill ahead of a vote when it became clear they did not have sufficient support in Congress.
Cold feet
How did it all go wrong?
Many blamed House speaker Paul Ryan, the leading figure behind the replacement plan. Others pointed out that the timescale was too ambitious from the start – there had been howls of protest from Democrats for weeks that the Bill was being rushed through without sufficient scrutiny and costings.
By the time the Congressional Budget Office announced two weeks ago that 24 million people would be uninsured under the replacement plan by 2026, many Republicans were getting cold feet.
The healthcare debacle was the first real test of Trump's congressional support and his fabled ability to strike deals. As a man not known for his love of detail, he left much of the heavy lifting to Ryan and his budget director Mick Mulvaney, only rolling up his sleeves in the final week as he tried to convince wavering Republicans.
Up to the 11th hour he was defiant, with press secretary Sean Spicer insisting the vote would go ahead even as it was evident on Capitol Hill that the support was not forthcoming. Trump's deal-making skills deserted him as the American Health Care Act came tumbling down.
Predictably for a man who built a career on clamping down on opponents, Trump shot back, blaming first Democrats and then the 35-strong group of right-wing Republicans known as the Freedom Caucus who opposed the healthcare Bill on the grounds that it represented excessive use of government funds.
‘Fifth-grade’ tactics
His fury intensified during the week, as he threatened to punish the defiant group by withholding support in next year's mid-term elections. Freedom Caucus members fought back, with representative Justin Amash telling reporters Trump's tactic would be "constructive in fifth grade. It may allow a child to get his way, but that's not how our government works".
The very public spectacle of a US president sparring with his own party over Twitter is a measure of the difficulties facing the Republican Party as they adjust to their new leadership role and the prickly relationship between congressional Republicans and the man in the White House.
Trump has found himself the unlikely leader of a party peppered with people who opposed his candidacy. The result is that, while facing a barrage of constraints from the legal system, individual states and the intelligence services as he has tried to bulldoze through his policies, he now has the added barrier of pushback from members of his own party.
Ironically, many of the House Freedom Caucus group are in fact true Trump supporters – most of the president’s policies chime with the ideology of a group which emerged from the right-wing Tea Party movement.
Trump’s vow to “fight them” in the 2018 mid-term elections has meant he has picked a fight with a group of Republicans he should have expected to count on.
The threat of being “primaried” by Trump in the mid-terms is unlikely to keep Freedom Caucus members awake at night. Most were comfortably elected in safe Republican seats.
While Trump does have a strong support base in their constituencies, the House Freedom representatives are likely to be applauded, not punished, by their constituents for taking a stand on healthcare.
As Freedom Caucus member David Brat of Virginia said at the height of the healthcare drama: "There's 800,000 people back home and we represent them."
Doing the math
Trump may have also miscalculated in terms of congressional arithmetic. Given that a 218-majority is needed to pass a Bill in the House, he cannot afford to “fight” both the Freedom group and Democrats.
With only 237 seats in the 430 house, the support of the 35-strong group is essential if Republicans are to get laws passed without Democratic support.
Since his inauguration, Republicans have quietly backed their president, refusing to stand up to Trump’s more audacious statements and actions, much to the fury of Democrats.
Whether that support will continue in the coming months as the battles over tax, trade and Russia begin, will be crucial to Mr Trump's survival as president.