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BALTIMORE, MD — As part of a multistate coalition, Attorney General Anthony G. Brown secured a major victory after the U.S. District Court for the District of Massachusetts struck down a key provision of a Trump administration final rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the Affordable Care Act (ACA). Essential health benefits are subject to the ACA’s financial protections, including limits on out-of-pocket costs.
“The Trump Administration tried to make essential care unaffordable for transgender Marylanders by stripping it out of the Affordable Care Act’s cost protections,” said Attorney General Brown. “We fought to keep that care covered, and we won. My Office will always defend Marylanders’ right to the care they need.”
The final rule at issue — the “Marketplace Integrity and Affordability” rule — was proposed by the Trump administration in March 2025 purportedly to curb ACA enrollment fraud and reduce federal spending on subsidies that help consumers afford ACA coverage. Among other changes, the rule would have removed certain types of gender-affirming care from the ACA’s 10 essential health benefit categories.
In July 2025, Attorney General Brown and the coalition filed a lawsuit challenging nine separate provisions of the final rule, arguing that they would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections. Seven were later vacated in separate litigation, City of Columbus et al. v. Kennedy et al., in the U.S. District Court for the District of Maryland. The U.S. District Court for the District of Massachusetts ruled that the Trump administration unlawfully modified the categories of essential health benefits without following the proper procedures the ACA requires.
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