Congressional Republicans, especially in the House, are hamstrung by their lack of legislative experience. Many of them have never served under a president of their own party or passed major policy reforms that require at least token bipartisan support, and remain in chin-out oppositional mode.

Most of the health care bills they have passed were largely symbolic gestures that they knew would be vetoed by President Obama. But those bills, including a root-to-branch repeal vote in 2015, came back to haunt them, creating expectations with the party’s base that they were unwilling to revisit once in power.

“The Republicans were never really forced in their years of opposition to come up with a coherent alternative,” said Peter Wehner, a director of the White House Office of Strategic Initiatives under President George W. Bush. “There was no human cost in those artificial votes, and that did not force them to come up with a real governing alternative.” He added, “As the years went by the Affordable Care Act’s roots grew and it became entwined in the health care system. It was an extremely complicated legislative task to undo it.”

Republicans built no coalition around their bill, choosing instead to alienate the sorts of groups they said were simply paid off by Democrats when they passed the Affordable Care Act, in particular insurance companies. Absent that coalition, Republicans needed one another to counter the voices of doctors, hospitals, disease groups, the AARP and others who attacked their efforts. But even as the bill was about to be voted on, after Democrats came to the floor to give passionate speeches urging its failure, few Republicans came to its defense.

In the end, Senator Mike Enzi, Republican of Wyoming and chairman of the Senate Budget Committee, was reduced to running out the clock as he read some notions about health care from a podium, refusing to take questions from heckling Democrats.

The most consistent voice on the bill was that of Senator Susan Collins, Republican of Maine, but her voice was raised in perpetual opposition to both the process involved in drafting the bill and its substance. Ms. Collins, no fan of the current law, still gave persistent voice to a repeal’s most likely losers, who also happen to greatly populate her home state — the old, the poor and those living in rural areas.