Donald Trump has told his fellow Republicans they must not go off on their summer holidays without sending him an Obamacare repeal bill to sign.
The president summoned Republican senators to the White House to give them his demands face-to-face, and they responded by vowing to revive legislative efforts left for dead twice already this week.
The meeting came as the Congressional Budget Office estimated that the Republican bill erasing but not replacing much of President Barack Obama's health care law would mean an additional 32 million uninsured people by 2026.
The report from Congress' nonpartisan budget analyst said the measure would cause average premiums for people buying their own health insurance to double by 2026.
During last year's presidential campaign Mr Trump had declared repeatedly it would be "so easy" to get rid of the Obama law.
On Tuesday the latest Republican health care plan collapsed in the Senate, leading Mr Trump himself to say it was time to simply let Mr Obama's law fail.
Majority Leader Mitch McConnell had indicated he was prepared to move on to other issues including overhauling the tax system.
But in an apparent change of heart, in keeping with his erratic engagement on the issue, Mr Trump pressured Mr McConnell to delay the key vote until next week, and he invited Republican senators to the White House for lunch.
There, with the cameras rolling in the State Dining Room, Mr Trump spoke at length as he cajoled, scolded and issued veiled threats to his fellow Republicans.
"For seven years you promised the American people that you would repeal Obamacare. People are hurting. Inaction is not an option and frankly I don't think we should leave town unless we have a health insurance plan," he said.
It was not clear that the White House lunch would change the mathematics in the Senate, where Mr McConnell has failed repeatedly to come up with a bill that can satisfy both Republican conservatives and moderates.
Two different versions of repeal-and-replace legislation fell short of votes before coming to the floor, pushing him to announce on Monday night that he would retreat to a repeal-only bill that had passed Congress when Mr Obama was in office.
But that bill, too, died a premature death as three Republican senators announced their opposition on Tuesday, one more than Mr McConnell can lose in the closely divided Senate.
"This is more than just a health care debate," said Senator Pat Roberts of Kansas as he left the meeting.
"It really means, can we come together as a conference, can we come together as a Republican Party, can we come together on a signature piece of legislation we've talked about for seven years.
"If we don't, I think it's pretty clear the political consequences are staring us right in the face."