Josh Holmes, Mr. McConnells former chief of staff, said, That the White House is asking people to take a tough vote and then running ads against members while were still in negotiations is so dumb its amazing we even have to have the conversation.

Mr. Priebus did not respond to numerous messages seeking comment.

A broad range of Republican senators across the ideological spectrum have indicated their unease with the compromise health bill, which was largely drafted in secret over the last month. But Mr. Trump has few ties with the group, and several Republicans who remain on the fence have tangled with Mr. Trump, either during the presidential campaign or since. As a result, the Republican Senate leadership has made it known that they would much rather negotiate with Mr. Pence than the president himself, according to several White House and congressional officials.

Mr. Trump jumped in only when it became clear Republican leaders were postponing the vote until after the recess, announcing Tuesday afternoon that he was summoning all 52 Republican senators to the White House for some last-ditch diplomacy later in the day.

Top Trump lieutenants like Stephen K. Bannon, his chief strategist, who lobbied members on the House bill, have been all but sidelined. Mr. Priebus has also played a much diminished role.

While Mr. Trump has spoken with several members of the Senate, he has no plans to visit the Capitol, according to an administration official. He spoke with Senator Ted Cruz of Texas, his main rival for the 2016 nomination, over the weekend, as well as Senator Mike Lee of Utah and one or two others, but the pace was nothing like the dozens of calls he made to help pass the Houses health bill, aides said.

Mr. Pence was scheduled to attend the weekly lunch held by the Senate Republicans on Tuesday and planned to engage in conversations with undecided Republicans like Senator Rob Portman of Ohio. The vice president is likely to add other senators to his must-see list, and he plans to host a health-care-related dinner at his house Tuesday night, with Mr. Lee and Senators Tom Cotton of Arkansas, Ben Sasse of Nebraska and James Lankford of Oklahoma, according to a senior administration official. Mr. Sasse has been an understated but strong opponent of the bill as written.

Seema Verma, Mr. Pences former adviser in the Indiana statehouse and now a top administration health care official, has been trying to reassure senators that their states will have flexibility on Medicaid under the bill while Mr. Pences former chief of staff, Marc Short, now the White House legislative affairs director, has been quarterbacking the effort from his hideaway in the Capitol.

Mr. Heller, the only Senate Republican who will face voters next year in a state carried by Hillary Clinton in 2016, is the top target for Democrats facing a Senate map with few opportunities in 2018. And there were already seven groups a mix of health care advocacy organizations and more partisan Democratic efforts on the air in Nevada assailing the Republican health care overhaul, according to a Republican ad buyer tracking the ad traffic.

That an ostensibly pro-Republican group would respond to Mr. Hellers criticism of the legislation he flayed the proposal in harsh terms on Friday but did not rule out eventually backing it by swiftly accusing him of siding with Nancy Pelosi was a shock to Mr. McConnell, who has made no secret of his impatience with Mr. Trumps impulsive style.

It is also caught him off-guard. Neither Mr. McConnells office nor his top outside political advisers were warned about an impending attack on one of their most endangered incumbents. They didnt check in with anybody, Mr. Holmes said. There was no clearing of channels, no heads up, nothing.

The anti-Heller assault began with a digital buy over the weekend, but it was unclear whether the pro-Trump group would follow through with its threat to spend over $1 million attacking the senator. As of Tuesday, the group had reserved just over $250,000 for ads in Las Vegas and Reno, the two largest media markets in the state, according to the ad buyer.

The move against Mr. Heller had the blessing of the White House, according to an official with America First. Mr. Trumps allies were furious that the senator would join Gov. Brian Sandoval, who accepted the Medicaid expansion under the health law and opposes the Republican overhaul, to blast the bill.

But the frustration on Capitol Hill with Mr. Trump and his allies runs far deeper than the ads aimed at the Nevada senator.

While Mr. Trump has taken to Twitter and made phone calls in an effort to lobby his party to pass the health overhaul, he has also provided Democrats with potential weapons, namely his description of the House bill he worked to pass as mean.

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As Trump's Tactics Fall Short, Pence Takes Lead on Health Care Bill - New York Times