Ultraconservative House members tore into the proposal as a warmed-over version of the law it seeks to replace with some added giveaways to the insurance industry—a “stinking pile of garbage ” in the words of Kentucky Rep. Thomas Massie.

Key outside groups that GOP leaders will need as conservative validators likewise trashed the bill, with the Club for Growth, FreedomWorks, Heritage Action, and the Koch-backed Americans for Prosperity all giving it a thumbs-down.

Ditto rightwing media: Breitbart News led its site Tuesday afternoon with a story headlined, “Obamacare 2.0 Guts Enforcement, Gives Illegal Aliens Healthcare Through Identity Fraud;” radio personality Laura Ingraham piled on; and the Drudge Report, a typically reliable cheerleader for Trump’s agenda, remained conspicuously silent.

And while most industry groups so far are hugging the sidelines, a pair of key healthcare stakeholders have already voiced objections. The AARP, the hugely influential seniors’ lobby, came out against the bill, declaring it would imperil Medicare’s solvency. And the American Hospital Association said it couldn’t support the proposal in its current form.

Veteran Congress-watchers note that major legislative endeavors sometimes have to collapse several times before they revive and pass into law. But the repeal-and-replace measure’s immediate future carries profound implications for the rest of Trump’s agenda. For one, as Trump noted ruefully during a Tuesday meeting with the House Republican whip team, he can’t turn to tax reform until healthcare is done—“unfortunately, because of the way our system works.”

Then there’s the matter of Republican unity. Conventional wisdom since the election has held that the Trump team would only need to worry about the Senate. Most business in the upper chamber will require the GOP to poach at least eight Democrats to reach the 60-vote threshold for cutting off debate. In the House, on the other hand, a bare majority rules. So GOP leaders there have expected they could count on their 22-seat edge—and, if needed, some strong-arming from the White House—to jam through the wish list Trump shares with Speaker Paul Ryan.

The early response to the healthcare package from the House Republican’s hard-right flank presages a different dynamic. It’s one that looks similar to last year’s, when GOP leaders needed to draw Democratic votes to pass two major spending bills because the conservative bloc abandoned them. If Tuesday was any indication, conservative firebrands in the House are in no mood to fall in line now simply because the president calls himself a Republican. That could empower House Democrats—and further complicate Trump’s sweeping legislative plans, from healthcare to taxes, infrastructure and beyond.