By the Trump Administration’s own estimates, the rule will cause up to 1.8 million people to lose their health insurance

Attorney General Dan Rayfield today and a multistate coalition filed a lawsuit challenging an unlawful final rule announced by the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) that would create significant barriers to obtaining healthcare coverage under the Affordable Care Act (ACA). The Trump Administration’s final rule would make numerous amendments to rules governing federal and state health insurance marketplaces which the administration estimates will cause up to 1.8 million people to lose their health insurance, while causing millions more to pay increased insurance premiums and out-of-pocket costs like copays and deductibles.

The final rule also excludes coverage of gender-affirming care as an essential health benefit (EHB) under the ACA. In the lawsuit, the attorneys general argue that the HHS and CMS rule is arbitrary and capricious, contrary to law, and violates the Administrative Procedure Act (APA). The coalition is also seeking preliminary relief, and a stay, to prevent the challenged portions of the final rule from taking effect in the Plaintiff States before the August 25 effective date.

“Health care is a lifeline, not a privilege. This rule does exactly what the Affordable Care Act was designed to prevent: it throws up roadblocks that will push people off coverage and make care unaffordable for millions more,” said Attorney General Rayfield. “Oregon has worked hard to expand access to health care, and we’re not about to let a federal rule pull the rug out from under families, especially when the administration admits it will cause up to 1.8 million people to lose their insurance.”

Congress enacted the ACA in 2010 to increase the number of Americans with health insurance and decrease the cost of healthcare. Fifteen years later, the Act continues to meet its goals, with annual enrollment on the ACA marketplace doubling over the past five years, resulting in over 24 million people signing up for health insurance coverage in plan year 2025 on the ACA exchanges and receiving subsidies to make such coverage affordable, including millions of people in the Plaintiff States.

Now, with less than four months until open enrollment for plan year 2026 begins, the Trump Administration’s final rule would abruptly reverse that trend, erecting a series of new barriers to enrollment that will deprive up to 1.8 million people of insurance coverage by the administration’s own estimates, and significantly drive up the costs incurred by Plaintiff States in providing healthcare, including increasing state expenditures on Medicaid, uncompensated emergency care, and funding other services provided to newly uninsured residents.

In the lawsuit, the attorneys general argue that the HHS and CMS rule is unlawful, arbitrary and capricious, and would cause significant harm to states and their residents. All of the challenged marketplace changes implemented by the final rule will be harmful to individual consumers and state and local governments. If this rule goes unchallenged, it will likely make it harder for Oregonians to get—and keep—health coverage through the Marketplace. That means more people in Oregon could end up uninsured, which can lead to worse health outcomes. When people don’t have insurance, they’re less likely to get routine care or manage chronic conditions, which can snowball into more serious health issues. On top of that, Oregon hospitals will be left to absorb the cost of providing emergency care to those who can’t pay—care they’re legally required to provide.

In filing the lawsuit, Attorney General Rayfield is joined by the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Maine, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Rhode Island, Vermont, Washington, and Wisconsin, as well as Pennsylvania Governor Josh Shapiro.