A federal court in Maryland has granted a preliminary injunction blocking implementation of a final rule that revises standards for enrollment in the Affordable Care Act.
In issuing the final rule, the Centers for Medicare and Medicaid Services said it was cracking down on waste, fraud and abuse in the ACA. Plaintiffs who want the rule vacated said it was a continuation of President Donald Trump’s attempts to undermine the ACA, a law enacted under President Barack Obama.
Plaintiff Doctors for America said it would strip healthcare coverage for more than 2.2 million people.
On Monday, Judge Brendan for the U.S. District Court in Maryland stayed the final rule’s implementation as the lawsuit moves through the court system.
The plaintiffs will continue to pursue their case to ensure the rule is permanently struck down, said Doctors for America.
WHY THIS MATTERS
In June, CMS issued the final rule, “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability.” The rule is aimed at strengthening the integrity of the ACA and to provide relief from rising improper enrollment, CMS said.
“But the rule accomplishes the opposite,” said plaintiffs, who sued on July 1 asking for declaratory and injunctive relief.
The cities of Columbus, Ohio, Baltimore and Chicago, as well as the mayor of Baltimore, Doctors for America and Main Street Alliance sued Health and Human Services Secretary Robert F. Kennedy Jr., HHS, CMS Administrator Mehmet Oz and CMS.
The rule’s provisions are in direct conflict with federal law, they said.
The ACA subsidizes the costs of coverage, which leads to younger and healthier individuals to join, improving the risk pool and lowering premiums, the lawsuit said. Also, the ACA guarantees that individuals are not denied coverage due to pre-existing conditions.
The rule would cause at least 1.8 million Americans to lose coverage in the ACA in 2026 alone and result in higher premiums and out-of-pocket costs for the remaining enrollees, it said.
“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,” the lawsuit said.
THE LARGER TREND
The Centers for Medicare and Medicaid Services issued the final rule to stop improper enrollment in Affordable Care Act plans.
The 2025 Marketplace Integrity and Affordability Final Rule is projected to save taxpayers up to $12 billion in 2026 by combating improper enrollments, reining in federal spending and making health insurance markets more affordable, CMS said. Research showed that in 2024, an estimated 5 million people may have been improperly enrolled, costing taxpayers as much as $20 billion.
The rule also lowers individual health insurance premiums by an estimated 5%, CMS said.
Email the writer: SMorse@himss.org