Attorney General Aaron M. Frey yesterday joined a multistate coalition of 21 members in filing a lawsuit challenging an unlawful final rule promulgated by the US 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 Administation’s final rule would make changes to federal and state health insurance marketplaces which the administration estimates will cause up to 1.8 million people to lose their health insurance, while causig millions more to pay increased insurance premiums and out-of-pocket costs like co-pays 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 unlawful, violating 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.

“This rule creates unnecessary barriers for the nearly 65,000 Mainers who get their health insurance from the exchange to stay covered,” said Attorney General Frey.  “Not only is the rule not about efficiency or reducing waste, but it is intentionally designed to create more red tape and make enrollment harder.   We know that when people do not have health insurance, they wait until their health issues become worse, more expensive and less treatable.  Once again, ths is a cruel attack on the structures that keep citizens well and my fellow attorneys general and I are fighting to stop this rule from taking effect.”

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.  Annual enrollment on the ACA marketplace has doubled 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.  In Maine, nearly 65,000 residents receive health insurance through Maine’s health insurance marketplace. CoverME.gov  With less than four months until open enrollment for plan year 2026 begins, the Trump administration’s final rule would abruptly reverse the upward trend by 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.  The rule will also 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.

The final rule by HHS would make substantial changes and bureaucratic barriers to the operation of the ACA marketplaces, including adding new verification requirements, imposing an automatic monthly charge on all automatically reenrolled consumers who qualify for $0 premiums, shortening the open enrollment period for signing up for health coverage and making other changes which will make coverage less affordable for mlllions of individuals nationwide  Maine’s Office of Health Insurance Management estimates the rule will cause enrollment to drop by 10 – 15%, cause significantly more work for its staff, and raise premiums.  The final rule would also exclude gender-affirming care as an EHB on federal exchange plans, leaving states responsible for paying for the portion of insurance premiums attributable to any such coverage.

The states in the lawsuit, in addition to Maine, include:  California, Massachusetts, New Jersey, Arizona, Colorado, Connecticut, Delaware, Illinois, Maryand, Michigan, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin and Pennsylvania.

“Who can ever forget President Trump’s first term efforts to end the ACA. His efforts are legendary,” said this blogger.  “That’s largely because of his rage at deceased, war hero and POW Senator John McCain (R) for voting not to scuttle the ACA.” Those efforts  by Trump are detailed in a book published by the Brookings Institution, in 2020, called:  “Trump, the Administrative President and Federalism.”  Brookings is a highly regarded non-profit Washington, DC entity that conducts in-depth, nonpartisan research.