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LAWSUIT SEEKS TO BLOCK ACA RULE

THAT COULD STRIP COVERAGE FROM MILLIONS


On July 1, 2025, the cities of Baltimore, Chicago, and Columbus, Ohio, filed a federal lawsuit in the U.S. District Court of Maryland to block the implementation of new federal rules they claim would drastically undermine the Affordable Care Act (ACA). The regulation in question—dubbed the "Marketplace Integrity and Affordability" rule—was issued by Health and Human Services Secretary Robert F. Kennedy Jr. and is scheduled to take effect on August 25, 2025.

At the center of the lawsuit are several key provisions. The new rule shortens the ACA's open enrollment window for 2026 coverage to just six weeks, from November 1, 2025, to December 15, 2025. It also imposes a $5 fee on individuals who are automatically re-enrolled in plans with full subsidies—a move advocates argue could deter low-income enrollees. Additional measures include tighter income verification requirements, provisions allowing insurers to deny coverage to individuals with unpaid premiums, and a policy excluding approximately 100,000 Deferred Action for Childhood Arrivals (DACA) recipients—commonly referred to as "Dreamers"—from purchasing coverage on the marketplace.

The cities, joined by advocacy groups including Doctors for America and Main Street Alliance, argue that the regulation was enacted unlawfully. They contend the Department of Health and Human Services (HHS) violated the Administrative Procedure Act by implementing the changes without sufficient notice, public comment, or evidence-based justification. The lawsuit describes the changes as "death by a thousand paper cuts," intended to quietly dismantle the ACA and erode the healthcare safety net relied on by millions.

Analysts warn that the new ACA rules could lead to an estimated 2 to 2.2 million fewer enrollees in the 2026 coverage year. Public health experts and local officials argue that any rise in the uninsured population will directly impact the nation's most vulnerable communities, particularly low-income residents and immigrants.

The plaintiffs are seeking an emergency injunction to halt the regulation before it takes effect in late August. The case could have sweeping implications for the authority of future administrations—Republican or Democratic—to reshape federal health policy without going through Congress.

 

Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability

H.R.3590 - Patient Protection and Affordable Care Act

Full legal complaint (PDF)

Doctors for America

Main Street Alliance

 

2025 Marketplace Integrity and Affordability Final Rule (The Centers for Medicare & Medicaid Services, 6-20-25)

Coalition Sues to Block Trump Administration’s Affordable Care Act Rollback that Threatens Health Care Access for More than Two Million Americans (Democracy Forward, 7-1-25)

Mayors, doctor groups sue over Trump’s efforts to restrict Obamacare enrollment (AP News, 7-1-25)

Cities sue Trump administration over ACA changes (Axios, 7-2-25)