The political fallout from Mr. Hellers high-profile news conference a week ago offers a vivid illustration of the new fault lines on the right in the Trump era. After years of fierce clashing between Republican hard-liners and mainstream conservatives, the purity-versus-pragmatist wars have given way to a new, Trump-centered debate that highlights how fully the president has taken over the party.

On the other hand, Mr. Heller faces enormous grass-roots pressure to stand his ground against the bill. He has clung tightly to his states popular Republican governor, Brian Sandoval, a staunch opponent of the repeal who accepted the Medicaid expansion dollars in the Affordable Care Act. More than 200,000 Nevadans have gained insurance through Medicaid since the passage of the health law.

What angered the Republican rank and file about Mr. Hellers critique was not so much his unease with the compromise Senate legislation a measure that many on the far right are also displeased with but that he would so purposefully undermine the presidents agenda.

And it is not just party activists who are displeased with the senator.

Mr. Adelson and Mr. Wynn, two of Las Vegass leading gambling titans, each contacted Mr. Heller at the request of the White House last week to complain about his opposition to the Republican-written health overhaul, according to multiple Republican officials.

One ally of Mr. Hellers acknowledged that Mr. Adelson and Mr. Wynn were unhappy with the senator at the moment and that their relationship needed some repair work.

Both billionaire donors are close to Mr. Trump, a fellow tycoon. Mr. Adelson played a pivotal role in Mr. Trumps election, showering Republican groups last year with tens of millions of dollars. Mr. Wynn is the finance chairman of the Republican National Committee and oversaw a fund-raiser on Wednesday at the presidents Washington hotel that Mr. Trump said had raised about $7 million for the party committee and his re-election campaign.

Earlier that day, America First Policies held a donor meeting for those who were in the capital for that evenings fund-raiser. Every contributor who raised the issue of the anti-Heller campaign an extraordinary offensive against a vulnerable senator in ones own party expressed approval of the attacks, according to an attendee.

Ronald M. Cameron, a major Republican donor who gave the maximum $5,400 donation to Mr. Hellers re-election campaign this year, said he would consider investing in primary race challenges to Republican lawmakers who oppose the health care bill or other White House legislative priorities.

I might support a challenger, and would certainly withhold support from someone that I thought was against Trumps agenda, said Mr. Cameron, an Arkansas poultry magnate who donated more than $2 million to committees supporting Mr. Trumps 2016 campaign and attended the Wednesday fund-raiser for his re-election.

Mr. Cameron who was solicited by America First but said he had not donated to the group said that he was not familiar with the groups ads against Mr. Heller, but that he did not object to the idea of publicly calling out lawmakers who oppose the health care bill.

They should shape up or get out of the way, he said.

Mr. Trump himself, while acknowledging the complaints of the Republican senators at the White House meeting, has in other private sessions with his aides and allies made clear that he very much approved of the onslaught against Mr. Heller. At the wedding of Treasury Secretary Steven Mnuchin last Saturday and then again in the White House this week, he told advisers that he supported the ad blitz, according to multiple Republican officials who have spoken to the president.

Officials with America First insist that Mr. Trump and the White House staff all supported their decision to target Mr. Heller. But there has been some unease in the administration over the strategy, which created a significant rift with the Senate majority leader, Mitch McConnell of Kentucky, and other Republican senators at the very moment they were trying to forge consensus around the repeal bill.

At least one White House official sought to halt the attacks out of fear that alienating Mr. Heller would carry adverse ramifications well beyond the health debate. The Nevada senator is a crucial vote not only in the chamber where Republicans have a bare two-seat majority but also on the finance and banking committees. The two panels have jurisdiction over legislative priorities like tax cuts and presidential appointments.

Close advisers to Mr. Heller say he is open to eventually supporting the legislation, if significant changes are made.

Megan Taylor, a spokeswoman for Mr. Heller, did not respond to questions about his call with the casino magnates or the prospect of a primary race next year.

In a statement, she said Mr. Heller continues to engage with his colleagues, leadership and the administration to discuss what Nevada needs to see in this bill. But, she said, its not about Senator Heller getting to a yes; its about improving the legislation so that it achieves his goals of lowering costs and protecting Nevadas most vulnerable.

Mr. Trump and Mr. Heller have little in the way of a relationship. The senator never supported the presidents campaign, and Mr. Trump identifies him with a larger group of Nevada Republicans, including Mr. Sandoval, who either remained on the sidelines throughout 2016 or spurned him in the wake of the Access Hollywood tape disclosure last October.

The day after Mr. Trump was revealed to have boasted on that tape about sexually assaulting women, a pair of Republican lawmakers in Nevada made a show of abandoning their party nominee at a rally outside Las Vegas. In doing so, Representative Joe Heck, who was running for the Senate, and Representative Cresent Hardy, who was seeking re-election, enraged Mr. Trumps supporters.

Both lost their campaigns, making Nevada a rare bright spot in an otherwise lackluster year for Democrats.

To Nevada conservatives, it was an instructive moment and one they said Mr. Heller appears not to have learned a lesson from.

Hes making a tragic mistake that I thought had already been learned by the G.O.P. delegation in Nevada, said Wayne Allyn Root, a conservative talk show host and columnist in Las Vegas. When you abandon Trump, you dont get one Democrat, but you lose Republicans.

Both Mr. Root and Chuck Muth, another Nevada-based conservative activist, said they had been inundated with emails and calls from grass-roots Republicans who are angry about Mr. Heller. But whether that fury translates into a viable primary race challenge is far from certain. The senator will have significant financial support from his allies in Washington, and there is no obvious Republican opponent on the horizon. Mr. Tarkanian said he was also eyeing another run for the House seat he narrowly lost last year.

Another potential challenger, the state treasurer, Dan Schwartz, said he was likely to run for governor and has signaled to Mr. Heller through intermediaries that he will not take on the senator.

He will pay some price, but I just dont think its realistic, Mr. Schwartz said, citing the money needed to challenge Mr. Heller. Hes in a tight spot, but I dont think its dire.

Maggie Haberman contributed reporting from New York.

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A version of this article appears in print on July 1, 2017, on Page A1 of the New York edition with the headline: Fury in Nevada for Senator Who Defied President on Health Bill.

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Trump Backers 'Furious' That Senator Stood Against Health Care Bill - New York Times