(CN) - The city of Baltimore and a coalition of health care professionals and small businesses sued the Trump administration on Tuesday, challenging a new Health and Human Services rule under the Affordable Care Act they warn will force nearly 2 million Americans off health insurance.
Baltimore - joined by the city governments of Columbus and Chicago, along with Doctors for America and the Main Street Alliance - filed the suit in the U.S. District of Maryland and requested a federal judge block the rule before it take effect on August 25.
They asked a federal judge to declare provisions of the new rule arbitrary and capricious under the Administrative Procedure Act and block President Donald Trump's administration from implementing the provisions. Alongside U.S. Department of Health and Human Services and its secretary, Robert F. Kennedy Jr., the cities and groups also named the Centers for Medicare and Medicaid Services and its administrator, Mehmet Oz.
The administration claims that the new rule, "Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability," will address waste, fraud and abuse in the Patient Protection and ACA eligibility and enrollment systems as well as rising "improper enrollment and health care costs."
"The 2025 Rule does not spring from nowhere; rather, it is a clear continuation of the prior Trump administration's yearslong effort to undermine the ACA," the coalition wrote in the 30-page suit. "Now, the Trump-Vance administration returns with another 'death by a thousand paper cuts' approach to the ACA. Cloaked in the pretense of government efficiency and fraud prevention, the 2025 rule creates numerous barriers to affordable insurance coverage, negating the ACA's goal of extending affordable health coverage to all Americans, and instead increasing the population of underinsured and uninsured Americans."
According to the coalition, the rule would impact the ACA's health insurance marketplaces, which allow individuals otherwise not eligible for Medicare or Medicaid to obtain insurance independent of their employment.
Certain states, like Maryland, created their own marketplaces, also known as exchanges; others like Illinois created marketplaces on the federal healthcare.gov platform while it transitions to a state-based exchange like Maryland. Meanwhile, states like Ohio have an exchange operated by the Centers for Medicare & Medicaid Services. In 2025, over 24 million people are enrolled in marketplace coverage.
Dr. Janet Krommes, of Doctors for America, said in a statement that the Congressional Budget Office estimated over 2 million Americans could lose access to routine health care as a result of the rule change.
"This rushed ACA Marketplace rule claims to fix enrollment abuses, but instead of cracking down on predatory brokers, it punishes families," Krommes said. "It makes coverage harder to get, more expensive, and less comprehensive - with higher co-pays, steeper deductible and fewer benefits."
The new rule would: create a monthly $5 fee for low-income enrollees until reaffirming their zero-premium plans in 2026; increase annual out-of-pocket limits on cost sharing by 15% and average premiums by 4.5%; increase premiums on an exchange plan up to $714 per year for an average family; allow insurers to refuse to enroll certain individuals with debt; shorten enrollment periods by two weeks starting in 2027, among other changes.
Baltimore Mayor Brandon Scott said in a statement that the changes were a clear effort to use purported concerns of "fiscal responsibility" to gut the ACA.
"It isn't about supporting the millions of hardworking Americans who will be left uninsured by this rule," Scott said. "It's about taking from the middle class and giving to the richest among us - sacrificing affordable, accessible health care in order to give tax breaks to folks who are too rich to worry about the skyrocketing food prices, housing prices, childcare costs and health care costs of the Trump-Vance agenda."
The coalition noted that Trump made a similar effort during his first term in office after vowing to "watch Obamacare go down the tubes." In a 2019 rule, the first Trump administration made proposals that would have eliminated many of the ACA's guarantees, deterred consumers from enrolling in health insurance plans and increased out-of-pocket costs.
That rule was partially struck down by U.S. District Judge Deborah Chasanow of Maryland in 2021, where the Bill Clinton appointee vacated and remanded portions of the rule as arbitrary and capricious.
Tuesday's lawsuit comes as the Senate passed - thanks to a tie-breaking vote by Vice President JD Vance - Trump's "One Big, Beautiful Bill," which the Congressional Budget Office has estimated would result in nearly 12 million Americans losing their health insurance by 2034, with over $930 million in cuts over a decade to Medicaid, Medicare and the ACA.
Source: Courthouse News Service
