California Attorney General Rob Bonta, along with the attorneys general of Massachusetts and New Jersey, has filed a lawsuit against a new rule from the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS). The rule is said to create obstacles to obtaining healthcare under the Affordable Care Act (ACA). According to estimates by the Trump Administration, this rule could lead to 1.8 million people losing their health insurance and increase costs for millions more.
Attorney General Bonta stated, “Far from delivering on their promises to drive down costs and ‘make America healthier’ the Trump Administration’s HHS and CMS are doing their best to make it harder and more expensive for Americans to obtain health insurance and access care.” He emphasized that these changes would impose verification requirements, increase premiums, shorten enrollment periods, and exclude gender-affirming care as an essential health benefit.
The ACA was enacted in 2010 with the aim of increasing health insurance coverage among Americans while reducing healthcare costs. Enrollment has doubled over five years, with over 24 million people signing up in 2025. However, the new rule threatens this progress by creating barriers that could deprive many of insurance coverage.
California alone has about two million ACA plan enrollees. The final rule would introduce bureaucratic hurdles, automatic charges on reenrolled consumers with $0 premiums, shorter enrollment periods, and other changes making coverage less affordable nationwide. While gender-affirming care would be excluded as an essential benefit in federal plans, California’s availability of such care remains unaffected.
The lawsuit argues that the HHS and CMS rule is unlawful and harmful to states and residents. It claims that marketplace changes will negatively impact consumers and state governments through increased paperwork requirements, limited sign-up opportunities, higher cost-sharing limits, and substantial spending on proving eligibility for coverage.
Joining Attorney General Bonta in filing the lawsuit are attorneys general from Arizona, Colorado, Connecticut, Delaware, Illinois, Maryland, Maine, Michigan, Minnesota, Nevada, New Mexico, New York Oregon Rhode Island Vermont Washington Wisconsin as well as Pennsylvania Governor Josh Shapiro.
