It is hard to overestimate the damage the Freedom Caucus has done to the fledgling presidency of Donald Trump, and to the country. By blocking the American Health Care Act of 2017, the conservative group has guaranteed that Americans will struggle forward under the burden of Obamacare. In the next few months insurers will announce their premium hikes for the coming year; chances are, given the continuing withdrawal of major companies from the marketplaces and the ongoing failure of the bill to attract enough young and healthy participants, the new rates will not be pretty. Last year premiums went up 25%; it’s likely the increases will be higher this year.

Republicans will own those higher rates. Their failure to repeal the financial underpinnings of Obamacare and start replacing that failing program with an approach that encourages competition and that embodies numerous other common sense reforms will mean that families hit by ever-higher costs will blame the GOP. Voters elected Donald Trump and a GOP Congress to get this job done – the number one promise of every Republican campaign since 2010.

Now the Republican Party inherits the Sisyphean task of managing Obamacare’s inevitable decline. They are no longer critics; they are now the producers of the show. It is unlikely that House Speaker Paul Ryan or Trump will have the political will and patience to return to the drawing board and attempt to craft a brand new bill. They have made other commitments to voters, and so Obamacare, as a defeated Paul Ryan admitted after withdrawing the AHCA, is the law of the land. Live with it.

Of course, the damage is not limited to healthcare reform. The undermining of the House leadership is profound and clouds prospects of tax reform, infrastructure spending and other important jobs to be done. If Ryan cannot be counted on to herd the cats on healthcare, how do we know he can round up votes on tax reform?

It is the young Trump presidency, however, that takes the biggest hit here. Trump was elected because people across the political spectrum thought he could fix some of our problems. He was the businessman who could import common sense to Washington, and the deal maker who could bring people together. He made big promises; a country tired of stalemate and disappointment believed that he could bring back jobs, reduce our debt, build the wall, find a better healthcare solution.

His credibility and credentials now lie in tatters. All that optimism that has stoked the stock market and boosted investment plans – all that may fade.

Who is to blame? House Speaker Paul Ryan will be dragged through the mud for failing to win enough votes. He will also be criticized for concocting an arguably complicated and overly cerebral approach to the mission at hand. The AHCA was only part of the solution; Ryan vowed to press forward with more changes – like allowing insurers to compete across state lines, expanded health savings accounts and Medicaid reforms – in future legislation. It was a complex three-step approach; framing a sales pitch was all but impossible.

He was hemmed in by the strictures of reconciliation, through which Obamacare was to be dismantled but even so, it was a hard story to tell. Once the CBO published their score, showing that 24 million would lose coverage by 2026, Nancy Pelosi and her colleagues were off to the races, souring the country on Ryan’s bill. Few noted that subsequent measures would make the numbers significantly more appealing. Negative polling encouraged those keen to defeat it, and defeat it they did.

Nancy Pelosi mocked Trump for bringing the bill to the floor before he had the votes; that won’t sit well with a president who likes winning. So far, he is blaming Democrats, but he will doubtless find others – including perhaps the Speaker – to chastise for the loss. That will be unfortunate. As an outsider, President Trump has to rely on some seasoned hands to move bills through Congress; notwithstanding this recent defeat, Vice President Pence, chief of staff Reince Priebus and Paul Ryan are an excellent and necessary team. Relying on executive orders, as Obama did, produces unsustainable measures easily overturned by the courts.

Outraged Republicans should save most of their ire for the Freedom Caucus. The group of 30-odd conservatives are patting themselves on the backs this evening; joining their celebration are Nancy Pelosi and Chuck Schumer. Hillary Clinton declared the failure a victory, while disgusted Republicans across the country wonder how it went so wrong.

Caucus leader Mark Meadows, who hails from western North Carolina, may find himself under scrutiny. People may wonder why the American Society of Anesthesiologists was one of the top five funders of Meadows’ campaign and why health professionals were among the top five industries donating to his reelection in 2016. Medical groups typically like Obamacare, which provides healthcare services to an expanded population. Did they count on Meadows undermining Obamacare repeal? Did they know that thanks to his efforts, Obamacare would carry on?

Meadows could well find himself with a primary challenger in 2018 who promises to support Donald Trump. After all, Trump carried North Carolina, and especially the western regions.

And Meadows may not be alone. The National Republican Congressional Committee has been hauling in record amounts of money these past few months – money that can go to fielding candidates that support the White House. The Chair of the NRCC is Ohio’s Steve Stivers, who was a yes vote for the AHCA. His predecessor at the NRCC was Oregon Representative Greg Walden, who campaigned all-out for the AHCA. It’ unlikely either Stivers or Walden will champion the reelection of Meadows or his colleagues.

The Trump White House is apparently going to move on to the other items on the agenda. The country will watch to see if the administration can bring tax reform about. With Democrats obstructing every move, nothing will be easy. But with Democrats and the Freedom Caucus standing in the way of the Trump agenda, nearly everything becomes impossible.