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How they might accomplish both goals remained unclear.

“There is widespread support for protecting people with pre-existing conditions. There’s also widespread opposition to the individual mandate,’’ said Sen. Susan Collins (R., Maine), speaking on CNN. She said the insurance-purchasing requirement, which is intended to ensure enough healthy people buy policies to make the plans economically viable, was particularly burdensome for low- and middle-income families.

Democrats called for a quick vote to intervene in the federal case, to show the judge in the case that the intent of Congress has been to preserve the law.

Sen. Chuck Schumer (D., N.Y.) said Sunday on NBC that Democrats will press the GOP leadership to hold a floor vote urging intervention in the case. “We have a divided House and Senate,” he said. “I think the courts have to be the first and best way to go.”

U.S. District Judge Reed O’Connor, a George W. Bush appointee, ruled Friday that the ACA is unconstitutional. He sided with the claims of 20 Republican-led states that brought a lawsuit seeking to strike down the law.

The law remains in place for now, and the Trump administration has signaled it plans to enforce it. But its future is uncertain, and the ruling essentially leaves decisions on implementing the law to the states in the near term.

Congress has been unable to pass substantive health care legislation at a time when Republicans control both houses of Congress and the White House. With Democrats taking control of the House next month, the prospects for anything beyond modest legislation are likely to become dimmer.

That could mean the next substantial steps rest on legal action rather than legislation.

The legal staff working for Attorney General Xavier Becerra of California, one of several Democratic-led states moving to defend the health law, spent the weekend examining their legal options. They said they would challenge the decision soon.

House Democrats are gearing up to push legislation introduced in March by Representatives Frank Pallone Jr. (D., N.J.), Richard Neal (D., Mass,) and Bobby Scott (D., Va.) that would blockTrump administration initiatives to roll back the ACA.

Many Republicans said on the campaign trail this fall that they supported some goals of the ACA, most prominently ensuring coverage for people with existing conditions. Now, Republican lawmakers will have to decide whether to support legislation that meets those goals or resume the GOP push to overhaul the health law.

“We’ll sit down with the Democrats, if the Supreme Court upholds,’’ President Trump said on Saturday. He was apparently referring to expectations that the ACA case will reach the high court. “We’ll be sitting down with the Democrats, and we will get great health care for our people. That’s a repeal and replace, handled a little bit differently.’’

Sen. Chuck Grassley (R., Iowa), who will lead the Senate Finance Committee in the new Congress, said the committee would hold hearings on the health law.

A group of Senate Republicans introduced legislation in August that would ban insurers on the individual market from denying coverage to people with past or current medical conditions, or from charging them more. Insurers still would be able to exclude any coverage related to that condition, however, and could vary premiums based on age and gender—all of which are barred by the ACA.

The Supreme Court has upheld the ACA’s mandate that most people carry health insurance or pay a penalty, and also ruled that the government can subsidize health-insurance purchases for lower-income Americans. The pair of decisions preserved key pillars of the ACA.

Last year, a Republican Congress eliminated the monetary penalty for individuals who choose to forgo health insurance. That change opened the door for a group of Republican-led states to mount a new challenge to the law.

Judge O’Connor said the new absence of a penalty undercut the Supreme Court’s reasoning for upholding the ACA. The high court in 2012 said the penalty for going without health insurance could be construed as a tax that Congress had the constitutional authority to levy.

With the tax now at $0 for 2019, the ACA can’t be upheld under Congress’s taxing power, Judge O’Connor ruled. He noted that the Supreme Court in its 2012 ruling already said Congress can’t use its powers over interstate commerce to require people to buy insurance.

—Brent Kendall contributed to this article.

Write to Stephanie Armour at stephanie.armour@wsj.com and Kristina Peterson at kristina.peterson@wsj.com