Baltimore – A coalition of major municipalities and organizations representing doctors and small businesses are asking a court to protect the Affordable Care Act (ACA) from another insidious Trump-Vance administration attempt to undermine the landmark legislation by creating numerous barriers to affordable health insurance coverage.
In a challenge filed today in United States District Court for Maryland, a plaintiff coalition represented by Democracy Forward — the City of Columbus, Ohio; the Mayor and City Council of Baltimore, Maryland; the City of Chicago, Illinois; Pima County, Arizona; as well as Doctors for America and Main Street Alliance — contend that a recent rule published by the Centers for Medicare & Medicaid Services (CMS), on behalf of the U.S. Department of Health and Human Services (HHS), was unlawfully approved without the proper legal process, and that the rule is nothing more than an underhanded attempt to end the quality healthcare coverage the ACA provides. This comes after a preliminary injunction blocked a similar effort by the administration last year.
“The Trump-Vance administration is once again trying to sabotage the Affordable Care Act by jacking up premiums and denying coverage to millions of Americans. This is the third time President Trump has tried to roll back healthcare access for American workers, and the third time we’ve challenged his radical attacks. Let’s all rally behind making access to good quality health care cheaper instead of erecting barriers that destroy quality, increase premiums and make it harder to get insurance,” said Columbus City Attorney Zach Klein.
“For years, the Trump Administration has tried to chip away at the Affordable Care Act, imposing higher costs and reducing benefits, and putting millions at risk,” said Chicago Mayor Brandon Johnson. “Health care must remain affordable and accessible to all our communities. Chicago is proud to join this coalition to once again stop an unlawful attack that would undermine the coverage our residents rely on.”
“Pima County cares about the health of its community. It is a beautiful, vibrant, loving place to live, and so of course the Board of Supervisors has authorized me to go on the offensive to cuts made against our residents’ health care. I am thankful to them, and I am even more thankful to Democracy Forward for giving us the platform to launch this litigation. I look forward to fighting with them in court,” said Pima County Attorney Laura Conover.
“It is shameful that the Trump Administration is—yet again—attempting to strip health care coverage for millions of working people, including many here in Baltimore,” said Baltimore Mayor Brandon M. Scott. “Quality health care should be a basic right for every citizen, and we will continue to fight against any attempt to slash lifesaving benefits under the ACA.”
“The Affordable Care Act has transformed health care in America, helping millions of patients access preventive care, manage chronic conditions, and get the treatment they need without fear of financial ruin. This rule would create unnecessary barriers to coverage, increase costs, and put care further out of reach. Doctors for America is proud to stand with our partners to challenge this unlawful effort and protect the affordable, comprehensive health coverage that patients and families across the country depend on,” said Meenakshi Bewtra, MD, PhD, MPH, President, Doctors for America.
“Small business owners need a healthy workforce and healthy customers to thrive, and the ACA has been a lifeline for both. This rule is a backdoor attempt to strip coverage from millions of Americans, drive up costs, and make it harder for small businesses to attract and retain workers. Main Street Alliance is proud to stand alongside our partners to stop this unlawful attack on the health security that working people and small business communities depend on,” said Richard Trent, Executive Director of the Main Street Alliance.
When the ACA was enacted in 2010, millions of Americans gained access to affordable, comprehensive healthcare, and families were finally able to seek the medical care they needed, when they needed it. One of the ways the ACA has achieved this result was through the establishment of health insurance “exchanges,” where individuals are able to identify and enroll in affordable insurance policies that meet their healthcare needs. To ensure lower costs for more comprehensive coverage, the ACA subsidizes the costs of that coverage, which leads younger and healthier individuals to the insurance market, improving the risk pool and lowering premiums for everyone. And the ACA guarantees that individuals are not denied coverage because of a pre-existing health condition or discriminated against based on their history of insurance coverage.
On May 20, 2026, however, CMS published a rule titled “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program” (2026 Rule). Rather than making coverage more affordable or removing barriers to obtaining quality health coverage, the rule would cause at least 2 million Americans to lose coverage on the ACA’s health insurance exchanges in 2026 alone and will ultimately result in higher premiums in the long term and higher out-of-pocket costs for the remaining enrollees. Many of the rule’s provisions are in direct conflict with federal law, and many of its provisions were approved without observance of the proper procedure, reasonable explanation, or meaningful response to public comments. In the absence of judicial intervention, the rule will go into effect on July 20, 2026.
The new rule is a continuation of President Trump’s years-long effort to undermine the ACA. The first Trump administration attempted to contravene the ACA with proposals that would have eliminated many of the law’s guarantees, deterred consumers from enrolling in quality health insurance plans, and increased out-of-pocket costs. The District Court for Maryland vacated and remanded portions of the rule as arbitrary and capricious. The second Trump administration returned to the same playbook, seeking to impose provisions that would drive up the cost of coverage and throw people off the insurance rolls, and the court again rejected that effort.
“Intervention is needed urgently to stop the Trump-Vance administration from using another underhanded attempt to undermine affordable healthcare for millions of Americans,” said Skye Perryman, President and CEO of Democracy Forward. “The ACA is law and driving people out of their coverage puts public health at risk and strains family budgets. We are honored to work with this impressive coalition of communities, doctors and small businesses, all of which will be severely harmed by the effort to dismantle the Affordable Care Act, to protect access to affordable healthcare for all Americans.”
The case is City of Columbus v. Kennedy and the Democracy Forward legal team working on the matter includes Joel McElvain, Cortney Robinson Henderson and Christine Coogle.
Read today’s complaint here.
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Democracy Forward Foundation is a national legal organization that advances democracy and social progress through litigation, policy, public education, and regulatory engagement. For more information, please visit www.democracyforward.org.
