U.S. President Donald Trump and Republican congressional leaders are struggling to come up with enough votes to overhaul the national health care reforms that former President Barack Obama considered as his signature legislative achievement.

A key health care vote is set for late Thursday in the House of Representatives, but conservative stalwarts who contend the legislation does not go far enough to create a new health care policy say they have enough votes to thwart their leaders’ and Trump’s plan. Conversely, some moderate Republican members of Congress oppose the overhaul effort for fear that too many Americans would lose their insurance coverage if the legislation is enacted.

Trump has been meeting with Republican holdouts, both on Capitol Hill and at the White House, trying to sway them to vote for the plan.

“Big day for healthcare. Working hard!” Trump said on his Twitter account Wednesday.

Trump and Republicans have long railed against the Affordable Care Act, the seven-year-old law popularly known as Obamacare. Now, however, even as Republicans control the White House and both houses of Congress, House leaders and Trump are having trouble convincing enough lawmakers to vote for their version of a health care overhaul.

The independent Congressional Budget Office last week concluded that 24 million Americans would lose their health care coverage over the next decade if the Republican plan is approved. Trump and Republican leaders contend their plan, unlike Obamacare, will give people access to buy the insurance coverage that meets their needs and that they can afford.

Trump met with the House Republican caucus Tuesday, promising political retribution against opponents if they do not vote to overturn the law and advance it to the Senate, where its fate is also uncertain because of conservative foes of the overhaul.

“I’m going to come after you, but I know I won’t have to, because I know you’ll vote yes,” Trump told one House repeal opponent, Congressman Mark Meadows, leader of the Freedom Caucus of the most conservative Republicans. “Honestly, a loss is not acceptable, folks.”

The president warned holdouts that if they vote against the measure they could lose their seats in the 2018 congressional elections because supporters in their home districts would be angered by their not following through on their long-held promise to overturn the Obama law.

Obamacare has added 20 million Americans to the insurance rolls, but Republicans contend that the cost of premiums and individual medical procedures not covered by the insurance has risen so much that many Americans can no longer afford to pay for the care they need.

The Republican health care plan would rescind the Obamacare requirement that all Americans buy health insurance or pay a penalty if they do not, but it would retain two popular provisions. One would let young people remain on their parents’ policies until they turn 26, while the other bars insurance companies from denying coverage to people with pre-existing medical conditions.

No House Democrats have said they will vote for the overhaul, leaving Republicans alone to amass a majority of their lawmakers to approve it.

They cannot lose more than 21 of the 237 Republican votes for the overhaul to pass before the measure is sent to the Senate.

Meadows says he counts 27 Republicans who are opposed to the measure or leaning against it, but House Speaker Paul Ryan says he remains confident he will have enough votes to approve the plan.

“This is the one chance we have to actually repeal Obamacare and replace it with the stuff we believe in,” Ryan said. “The president is all in, we all made this promise, and that’s why I’m confident. People will realize, I’m not going to go home and face voters reneging on my word.”

Trump, staking the early months of his presidency on meeting his campaign vow to overturn Obamacare, told lawmakers this was their best chance to overhaul the measure.

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