By Erica Werner and Alan Fram

Associated Press

WASHINGTON (AP) — Republican leaders have revised their health care bill in an increasingly desperate effort to deliver on seven years of promises to repeal and replace former President Barack Obama’s overhaul. They immediately lost two pivotal votes, leaving none to spare as the party’s own divisions put its central campaign pledge in serious jeopardy.

President Donald Trump said this week that failure would make him “very angry” and that he would blame Senate Majority Leader Mitch McConnell, R-Ky. “After all of these years of suffering thru ObamaCare, Republican Senators must come through as they have promised!” Trump said in a tweet Friday while in Paris.

Earlier in the week, while flying to France, Trump had acknowledged the challenges lawmakers face.

“I’d say the only thing more difficult than peace between Israel and the Palestinians is health care,” Trump told reporters traveling with him. “But I think we’re going to have something that’s really good and that people are going to like.”

Trump is waiting and eager to sign health legislation: “I will be at my desk, pen in hand!” he tweeted on Friday.

The reworked bill McConnell presented to fellow Republicans on Thursday aims to win conservatives’ support by letting insurers sell low-cost, skimpy policies. At the same time, he seeks to placate hesitant moderates by adding billions to combat opioid abuse and help consumers with skyrocketing insurance costs.

But it was not clear whether the Republican leader has achieved the delicate balance he needs after an embarrassing setback last month when he abruptly canceled a vote in the face of widespread opposition to a bill he crafted largely in secret.

Moderate Sen. Susan Collins of Maine told reporters she had informed McConnell she would be voting against beginning debate on the bill, citing in part cuts in the Medicaid health program for the poor and disabled. Sen. Rand Paul of Kentucky, who has repeatedly complained that McConnell’s efforts don’t amount to a full-blown repeal of Obama’s law, also announced he was a “no.”

That means McConnell cannot lose any other Republican senators. With Democrats unanimously opposed in a Senate split 52-48 in favor of the GOP, he needs 50 votes, with Vice President Mike Pence breaking the tie, to get past a procedural hurdle and begin debate on the bill.

The showdown vote is set for next week, though McConnell could cancel again if he’s short of support.