In June 2025, the Trump-Vance administration finalized the “Marketplace Integrity and Affordability” rule through the Centers for Medicare and Medicaid Services (CMS). The rule imposes surprise fees, undermines premium subsidies, and creates new barriers to accessing coverage under the Affordable Care Act (ACA). It will raise costs for millions of Americans and cause an estimated 2.2 million people to lose coverage.

On July 1, 2025, a coalition of cities, doctors, and small business advocates, including the City of Columbus, City of Chicago, Mayor and City Council of Baltimore, Doctors for America, and the Main Street Alliance, filed a lawsuit challenging the rule. Represented by Democracy Forward, the plaintiffs argue that the rule violates the ACA and will disproportionately harm low-income families, communities of color, and patients with serious medical needs.

The rule introduces unjustified “junk fees” on people who auto-enroll in no-cost plans, undermines tax credits, and allows insurers to deny coverage over old debts. A typical family of four could see their annual costs rise by more than $700, despite no change in plan. Rather than promoting affordability, the rule destabilizes the insurance market and penalizes vulnerable families.

On August 22, the U.S. District Court of Baltimore granted the plaintiff’s motion for preliminary injunction, blocking the rule.

The case is City of Columbus et al. v. Department of Health and Human Services et al.