Washington — President Donald Trump's renewed push to undo the Affordable Care Act is being criticized by Democrats and some Republican lawmakers in Michigan, who say the move could strip people of health care protections they depend on.

The decision came as Democrats in the U.S. House introduced legislation to improve President Barack Obama's health care law, following failed GOP attempts to repeal the law known as Obamacare that proved a motivating issue for Democrats in the midterm elections.

Congressional Republicans said they were caught off guard by Trump's announcement this week, with Rep. Fred Upton saying it "doesn’t appear it was well thought out."

"A couple years ago, we all figured he could not end the ACA abruptly because you need meaningful coverage for those with pre-existing illnesses, kids in college, as well as states that expanded Medicaid like ours would be left in the soup on Day 1," said Upton, a moderate from St. Joseph.

"We’ve now had ACA for nearly a decade. You simply cannot take what would be millions of people off coverage without a backup plan ready to go. And there is none."

More conservative Republicans insist Trump's move was justified because the law has fallen short and its weaknesses are unsustainable, including affordability problems.

Rep. Paul Mitchell, R-Dryden, disagreed that anything "precipitous" could happen if a federal appeals court strikes down Obamacare. "Nothing's going to happen overnight," he said.

"Frankly, we’ve had a responsibility since I came here to deal with the issues of the ACA — most pressing is both its effectiveness and constitutionality," Mitchell said.

"It’s just another reminder to Congress here that we should address the health care issues we have here in America. We passed something last term that failed in the Senate by one vote."

Defending the law

The Department of Justice this week told the federal court it wants the entire Affordable Care Act struck down.

Such a decision, if it comes, would roll back requirements for employer health plans and render millions uninsured, including the nearly 690,000 Michigan residents covered through the Medicaid expansion adopted as a result of the 2010 law. Medicaid covers mostly low-income residents.

Michigan Attorney General Dana Nessel is trying to preserve the law as part of a group of states intervening in the lawsuit.

"When we look at the administration’s latest attack on the Affordable Care Act, it’s another example of dysfunctional government," said freshman Rep. Haley Stevens, D-Rochester Hills.

"More chaos and confusion, not only in the marketplace but also in individuals’ lives who are counting on that stability and that reassurance that they are going to have affordable health care."

The Department of Justice's court filing last Monday was a departure from the administration's previous legal strategy of fighting only parts of the statute.

Trump, who campaigned on a promise to “repeal and replace” Obamacare, told rally-goers in Grand Rapids on Thursday that Republicans would "always protect patients with pre-existing conditions — always."

"We have a chance of killing Obamacare," Trump said, predicting the case would go to the U.S. Supreme Court.

"We're going to get rid of Obamacare, and I said it the other day — the Republican Party will become the party of great health care."

Some suggested Trump's court maneuver on health care stepped on his winning message this past week after Attorney General William Barr said special counsel Robert Mueller found no evidence of collusion between the president and Russia.

"Rather than relish in that win, it brought a new issue to the forefront that’s going to be real trouble, particularly if you take millions of people to the brink without a backup plan," Upton said.

"If the Dems are smart, they would bring up a bill that reversed those protections and all voted against it. See where people stood. I don’t know what their plan is, but this added a whole other element to an already complex situation."

Election implications

Upton noted he supported prior "responsible" efforts to repeal the Affordable Care Act but always with a replacement plan ready. Democratic challengers aggressively attacked him in last year's campaign for his role in those efforts, and he won re-election with his smallest-ever margin.

"The vice president’s office is saying there’s going to be a plan in place by the end of the year, but how do you get that through a Democratic House and narrowly divided Senate?" said Upton, former chairman of the House Energy and Commerce Committee.

"I think it’s fair to say you wouldn’t see any type of replacement plan in this Congress, in all likelihood."

Democrats jumped at the chance to point out the difference between Trump's efforts to dismantle Obamacare with their plans to shore it up.

A package that dropped Tuesday reinforces coverage protections for pre-existing conditions and expands the financial assistance people receive under the law.

"The cost of health care is still what people pull me aside in the grocery store to talk about," said freshman Rep. Elissa Slotkin, D-Holly, who co-sponsored the bill along with Stevens.

Slotkin decided to run for Congress in part because of her late mother's struggle to afford insurance due to a pre-existing condition.

"The ACA did one really amazing thing, which is say people with pre-existing conditions should be covered," Slotkin said.

"But a lot of people in my district, in our state, they are paying too much money. Their premiums are really high, and their deductible is really high. They technically have insurance, but they can't really access the care."

The legislation expands eligibility for premium tax credits beyond 400 percent of the federal poverty line and increases the size of tax credits for all income brackets, according to a bill summary. It would also fund a national reinsurance program to help cover high-cost patients.

"This was just a cleanup bill to try and improve the ACA," Slotkin said. "And it just so happened it came out on same day that White House and Department of Justice said they believe the entire ACA is illegal and unfounded. The contrast was really very clear."

The Democrats' bill merely aims to "prop up" the Affordable Care Act when it requires an overhaul or outright repeal, Mitchell said.

"Let’s stop trying to put lipstick on the pig, and let’s deal with the problem. Let’s not try to prop up something that didn’t work, didn't fulfill the promises that were made," he said.

"We need to address the clear problems with it, and just throwing more money at it ... that is just nonsensical."

Republicans have said an alternative to the Affordable Care Act would incorporate its popular provisions such as coverage for pre-existing conditions and for children on their parents’ plan until they turn 26.

Mitchell also wants to see lawmakers prioritize measures that increase competition in the health care marketplace and rein in prescription drug prices.

"It's important that we deal with something that creates a competitive health care marketplace that in many, many areas of our state and across the nation no longer exists," he said.

"And we should avoid disrupting private employer plans and association plans that are providing the health insurance and health care that most people want."

mburke@detroitnews.com