A federal court partially granted a request from a group of cities to temporarily halt the Trump administration’s changes to enrollment on the Affordable Care Act health insurance exchanges, saying they were likely to win the case.
The Centers for Medicare & Medicaid Services released the Marketplace Integrity and Affordability Rule (RIN 0938-AV61) in June, finalizing changes that it estimates could reduce enrollment by as many as 1.8 million people in 2026. The rule is set to take effect Aug. 25.
Judge Brendan A. Hurson of the US District Court for the District of Maryland on Friday ruled that the plaintiffs showed they were likely to succeed in their challenges to the rule’s $5 fee on low-income auto-enrollees who don’t verify their eligibility, a provision broadening the actuarial value of exchange plans, language allowing plans to deny coverage to those with outstanding bills, and measures tightening eligibility verifications.
Hurson refused to pause a provision changing the methodology used to determine cost-sharing limits, and another revoking an optional 60-day extension on a deadline for exchanges to reconcile discrepancies in an enrollee’s eligibility.
Baltimore; Chicago; and Columbus, Ohio, are joined on the suit by physician advocacy group Doctors for America and small business network Main Street Alliance.
They allege the CMS, along with Administrator Mehmet Oz and Health and Human Services Secretary Robert F. Kennedy, Jr., exceeded their authority and failed to adequately explain their reasoning behind the changes under the Administrative Procedure Act.
A group of Democratic-led states are also suing in a similar but separate lawsuit.
The Department of Health and Human Services declines to comment.
The Democracy Forward Foundation represents the plaintiffs.
The case is City of Columbus v. Kennedy, D. Md., No. 1:25-cv-02114, opinion issued 8/22/25.
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