WASHINGTON — 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 today 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.

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. He and other GOP leaders are urging senators to at least vote in favor of opening debate, which would open the measure up to amendments. And GOP leaders express optimism that they are getting closer to a version that could pass.

“It’s in the best shape it’s been in so far,” said Sen. Roy Blunt of Missouri. “Now that members actually have paper in their hand they can look at what is likely to be very close to the final bill.”

McConnell said the 172-page legislation is the senators’ opportunity to make good on years of promises.

“This is our chance to bring about changes we’ve been talking about since Obamacare was forced on the American people,” he said.