By Susan A. Davis

Since passage of the Affordable Care Act (ACA) nearly a decade ago, we have seen 20 million Americans gain access to health coverage coupled with slowing the rise of premiums.

A majority of Americans support the landmark law and want improvements made to it. The question is will we listen.

Instead of Democrats and Republicans working together to build on this landmark law, opponents have worked to bring it down legislatively, administratively, and judicially.

The legislative efforts to repeal the law have failed, including a 2013 shutdown of the federal government to defund the law.

Administratively, President Donald Trump has undermined the law by ending outreach and education efforts, cutting subsidies to help Americans afford health coverage, and allowing junk health plans that provide less coverage.

In the courts, the Supreme Court upheld the new law citing the authority of Congress to levy taxes. The tax penalty is what gave the law teeth to enforce the mandate that Americans buy health insurance.

The chaos and uncertainty created by these attacks on the ACA have resulted in rising premiums, insurers leaving the marketplace, and this year — for the first time since it was enacted — more people will lose coverage than gain it.

My constituents are nervous and frustrated. I’m hearing from people who say the ACA helped them become entrepreneurs and start their own business. Now they aren’t sure they can maintain those businesses.

Others say rising premiums are pricing them out of the market making health coverage unaffordable.

Repeatedly, the top concern of my constituents is health care, especially when it comes to costs. And with this uncertainty, who can blame them.

When Trump signed into law a massive tax cut for corporations, it included a provision to repeal the tax penalty used to encourage people to sign up for the ACA.

This set the wheels in motion for yet another assault on the ACA in the courts. Last year, a federal judge in Texas ruled that with the tax penalty gone the entire law is now unconstitutional.

While the Obama administration’s Justice Department defended the law in court, the Trump administration has refused to do so.

In fact, it has gone so far as to file briefings in support of the legal attack on the ACA.

In filings to the court, the administration originally argued the law’s provisions protecting Americans with pre-existing conditions should be overturned while the rest of the law should stand.

As the case moved to the appellate court, the Justice Department — under the direction of President Trump — reversed itself and recently filed a briefing in support of overturning all of the ACA.

According to the Urban Institute, 17 million Americans would lose health coverage if the law were struck down.

This would mean those with pre-existing conditions could be kicked off their plans and denied coverage in the future.

Seniors who get help paying for prescription drugs would no longer get that assistance.

The millions of low-income families who received health care through the expansion of Medicaid under the ACA would lose coverage.

Parents who can keep their children on their health care plans until the age of 26 — one of the more popular provisions of the ACA — would no longer be able to.

Many states, including California, have been defending the ACA in the courts.

With the start of the new Congress, the House of Representatives has joined the fight to protect the health care law. The House Counsel is now defending the law before the courts.

Where do we go from here? Ultimately, improvements must come on the legislative front, and the House is taking the lead.

There are a number of Democratic proposals to rein in costs, increase access, and lower prescription drug prices.

The recently introduced Protecting Pre-Existing Conditions and Making Health Care More Affordable Act will protect Americans with pre-existing conditions, lower health insurance premiums, and stop junk health care plans that lack basic coverage.

It would also require this and future administrations to engage in open enrollment outreach, education, and helping people navigate the health insurance system.

The House this month also passed a resolution calling on the administration to end its efforts to undermine the ACA and join in protecting the health care of the American people.

Hopefully, we can get to a point where Democrats and Republicans will come together to expand health care coverage and lower costs associated with it.

Improving our health care system is a priority for the American people and all of their representatives in Congress should be listening to them.

 — Congresswoman Davis represents central San Diego, including the communities of Old Town, Kensington, Mission Hills, University Heights, Hillcrest Bankers Hill, North Park, South Park, Talmadge, Normal Heights, as well as La Mesa, Lemon Grove, Spring Valley and parts of El Cajon and Chula Vista.