On July 17, 2025, a coalition of 20 state attorneys general and the governor of Pennsylvania, co-led by California Attorney General Rob Bonta, Massachusetts Attorney General Andrea Campbell, and New Jersey Attorney General Matt Platkin, filed suit against Health and Human Services (HHS) Secretary Robert F. Kennedy and others in the Trump administration for unlawfully enacting rule changes related to the Affordable Care Act (ACA). The ACA rule changes would create significant barriers to Americans seeking healthcare under the ACA and impose high costs on states. 

Under the rules that HHS and the Centers for Medicare and Medicaid Services are attempting to impose, the Trump administration estimates that up to 1.8 million people will lose their health insurance due to onerous paperwork requirements and an abbreviated insurance sign-up period. Others would see increased insurance premiums and out of pocket costs. States would bear the brunt of these changes by covering increased emergency care costs for newly uninsured residents. 

The rule changes would also exclude gender-affirming care as an essential health benefit.  

The attorneys general assert that these rule changes are unlawful, arbitrary and capricious, exceed the agency’s statutory mandate, and violate the Administrative Procedure Act. They have asked the court to postpone the effective date of the rule changes, to enjoin enforcement in the plaintiff states while the case is being litigated, and, ultimately, to invalidate the rule changes.   

On October 1, 2025, the district court declined to block the rule while the case moves forward.  

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. These sweeping changes would impose onerous verification requirements, junk health insurance premiums for some consumers, shorten enrollment periods in federal and state healthcare exchanges like Covered California, deprive up to 1.8 million Americans of health insurance, drive up out-of-pocket healthcare costs and so much more. It’s unlawful and it’s wrong – we’re meeting the Trump Administration in court to defend Americans’ healthcare coverage. Attorney General Rob Bonta