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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
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)