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But after six months of repeated failures to pass any meaningful legislation during what is traditionally the most productive time for a party with unified control of both the White House and Congress, it is Republicans who are clearly flailing.

The Senate has rejected a scaled-down Republican plan to repeal parts of the Affordable Care Act. The 49-to-51 vote was a humiliating setback for the Senate majority leader, Mitch McConnell of Kentucky.

Once architects of conservative policy, the party appears short of fresh ideas, left to try to find often incoherent compromises between the hard right flank that helped bring it to power and the populist notions that fueled President Trumps victory last year. Republicans talked incessantly about patient-centered health care, but it was a slogan that never had much meaning. Their only coherent argument for excising the health care law was because they said they would for seven years.

This is what you get when you have a president with no fixed principles, indifferent to policy and ignorant of the legislative process, said Charlie Sykes, a veteran Republican operative and former radio host. He added, Theres a difference between whiteboards and legislating in the real world. Its hard to take away benefits once conferred.

Many of the party leaders appear to remain out of step with their own voters, who took seriously Mr. Trumps warm embrace of some government entitlement programs, even as he abandoned those notions in recent months. While some conservative pundits attacked their failure to repeal the health care law this spring, scant protests rose up from the right to counter the thousands of Affordable Care Act supporters who appealed to lawmakers for months to maintain much of the law.

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 partys 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 Acts 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 repeals most likely losers, who also happen to greatly populate her home state the old, the poor and those living in rural areas.

But most Republicans believe that their path to repealing the law would have likely succeeded had it not been for Mr. Trump, whose comments about other topics and inconsistent support for their work he celebrated a House-passed bill in a Rose Garden ceremony only to denounce it as mean weeks later undermined their efforts.

I think this is in good measure Trumps fault, Mr. Wehner said, echoing what many Republicans said privately and increasingly in public. He has no knowledge of public policy and is indifferent to it. To try and get massive reform through Congress, even if you have control of Congress, you need the president to be an asset. He isnt only not an asset, he is an active adversary. He is dead weight for Republicans.

Members of both parties said that the only path forward for health care and indeed any legislation would now have to be a product of bipartisan efforts.

I believe we have an opportunity now to have discussions on durable, sustainable reforms, said Representative Charlie Dent, a moderate Republican from Pennsylvania who opposed the House efforts this year to repeal the law. I think moderate voices will be important in health care just as they already have been on budgets, appropriations bills and anything else that needs to be enacted into law.

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A version of this news analysis appears in print on July 29, 2017, on Page A16 of the New York edition with the headline: After Health Failure, G.O.P. Is Floundering.

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On Health, Republicans Find They Cannot Beat Something With Nothing - New York Times