Republican Senators Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia, and Rob Portman of Ohio, quickly emerged as political flashpoints after voicing their opposition to a repeal-only bill. Three of those four senators—Capito, Murkowski, and Portman—had supported the same repeal-only bill in 2015.

In a statement last Tuesday, Capito defended her change of heart by saying she “did not come to Washington to hurt people.” And Murkowski and Portman both expressed concern that repealing the law without an immediate replacement would cause confusion.

Conservatives who have advocated for Obamacare repeal since its inception in 2010 feel like the rug has been pulled out from under them. They are dismayed that they can’t pass the same repeal-only bill they sent to Obama’s desk in 2015, despite having both a legislative majority and a Republican president to sign it into law.

“When you talk about not being a team player, it’s Susan Collins and company,” said David Bozell, the president of For America, a conservative action group, said in an interview. “Obamacare repeal has basically been the defining domestic issue of our time. To go against what the party has preached, at its most critical moment, is a real-head scratcher for a lot of folks.” The “liberal Republicans” who voted against repeal will pay a political price, he said, but it won’t simply be conservative groups going after them: “It’s going to be the conservative base staying home.”

For the past several election cycles, Republicans have campaigned and fundraised on Obamacare repeal, and conservative grassroots activists have dedicated years advocating for it. “This has been the main issue since I got into politics in 2010,” said Jon Meadows, press secretary for the conservative action group FreedomWorks, which sent out a “Fraud Alert” on Twitter after this afternoon’s vote. “I thought we were all supposed to be against it.”

The two organizations, along with several others, have spent the last few weeks pressuring legislators to stick with their campaign promises to repeal Obamacare. They’ve posted video mashups of senators’ contradictory quotes on social media. And two groups, Tea Party Patriots and Club for Growth, recently launched a website called Traitorous Republicans, targeting Capito, Murkowski, and Portman and urging people to call their offices and demand they vote for repeal.

Voting against repeal-only legislation is, according to Meadows and other conservatives, a vote against the GOP—and the entire party will pay for it in 2018 and 2020. He calls it “the greatest political fraud” in American history.

But according to strategists on the ground in some of these local districts, that’s just political speak from groups representing the Washington donor-class.

“These people don’t live in West Virginia,” said Tom Susman, a Charleston-based strategist, told me in a recent interview. Susman thinks Capito’s position will actually end up helping her in the state, where nearly one-third of the population is enrolled in Medicaid, many of whom gained coverage under the ACA’s Medicaid expansion. West Virginia is also the epicenter of the nation’s worsening opioid crisis, and people are using Medicaid to receive addiction treatment.