~~ recommended by loren bliss ~~
August 15, 2025 10:23 AM CDT By Mark Gruenberg
BALTIMORE—Faced with yet another looming GOP threat to trash the Affordable Care Act, the cities of Chicago, Baltimore, and Columbus, Ohio, marched into U.S. District Court in Baltimore on Aug. 14 to save the ACA—and health care for millions of people.
Their lawsuit says right-wing Republicans, led by President Donald Trump and his Health and Human Services Secretary, Robert F. Kennedy Jr., are trying to kill the ACA, also known as Obamacare, by a sneak attack through the regulatory back door. They’re rewriting ACA’s rules to make it, more expensive, less comprehensive, and tougher to get.
The cities and their pro bono lawyers of Democracy Forward caught on. They seek an injunction to halt the Trump-Kennedy scheme in its tracks. If they fail, the ACA-trashing rules take effect Aug. 25.
The outcome of this case is vital for virtually everyone in the U.S. The aim of the rule changes is to make it tougher and more expensive for people to sign up for the health exchanges the ACA established and to reduce the ACA’s coverage for those already in the system.
If Trump wins this anti-ACA deregulatory juggernaut, the new HHS rules would accomplish the aim of 60 failed GOP attempts to kill the health care law during the first decade after Democratic President Barack Obama, a barely Democratic Congress, and organized labor all pushed it through. After losing 60 times and in the face of the ACA’s increasing popularity, congressional Republicans halted their attacks.
But the radical right and its corporate backers kept trying. Trump tried the same backdoor sneak attack during his first term when Congress didn’t dump the ACA, the lawsuit notes. That same gambit, in that same federal court, failed. The judges threw out Trump’s plan as illegal, “arbitrary, and capricious.”
The Trump-RFK health care rule would raise ACA’s prices and leave millions of people uninsured and at the mercy—or lack of it—of rapacious, rich, and greedy insurers who put profits before people.
The “Marketplace Integrity and Affordability” rule which Kennedy, acting for Trump, imposes “new fees, weakens coverage standards, and sets barriers that will make it harder—and in some cases impossible—for people to get and stay covered by insurance,” Democracy Forward said in an e-mail warning about the case and the Aug. 14 court hearing.
“This new rule is projected to cause 2.2 million people to lose health insurance, with particularly devastating effects on low-income families and communities of color,” Democracy Forward said. “For a typical family of four, the rule is projected to increase the cost of coverage by at least $714 per year, even if they keep the same plan.
“Among other effects, the rule raises the cost of coverage by manipulating formulas so people will pay more in deductibles and copays and reduces benefits in ‘silver’ plans,” the most-common plans selected. That combination means “people will pay more for less, and allows insurers to refuse to enroll people over old debts as low as $10,” Democracy Forward adds.
Considering hospitals have sent their own lawyers after debtors to seize entire bank accounts—including one from an elderly Baltimore woman who had $85 to her name—the “old debt” threat is real. The lawsuit says that one change about old debts could un-insure 180,000 people.
Democracy Forward and the cities are, to say the least, upset. “This unlawful rule…does nothing to help people–and instead harms Americans’ health and safety across our country,” said Democracy Forward CEO Skye Perryman in a joint statement.
“Americans deserve a government that protects their health, not one that puts it at risk. We will continue to hold this administration accountable, and are proud to represent a broad coalition in pushing back to defend healthcare access for all, including those in vulnerable circumstances.”
“For thousands of Chicago’s working-class families, the ACA isn’t just health insurance. It’s peace of mind,” said city Mayor Brandon Johnson, a Chicago Teachers Union member and former shop steward. “These rule changes put that stability at risk, forcing families to choose between paying rent and seeing their doctor.
“Far too often we see those who work the hardest and earn the least being asked to carry the heaviest load. It’s just wrong.”
Paying more for less a bad deal
“Paying more for less is always a bad deal, but that’s exactly what the president is proposing for health care coverage—a bad deal for working people, families, and cities that rely on the Affordable Care Act to decrease costs and increase accessibility,” said Columbus City Attorney Zach Klein.
Baltimore Mayor Brandon Scott said the Trump-Kennedy ACA rule “isn’t about ‘fiscal responsibility… which this administration clearly doesn’t care about” or “supporting millions of hardworking Americans who will be left uninsured.
“It’s about taking from the middle class and giving to the richest among us—sacrificing affordable, accessible health care to give tax breaks to folks who are too rich to worry about the skyrocketing food prices, housing prices, child care costs, and health care costs of the Trump-Vance agenda. This rule is more of the same from this administration. It’s wrong, it’s illegal.”
The lawsuit explains the exchanges are a key feature of the ACA, designed to get everyone into the pool, so to speak, with younger, healthier and oftentimes richer people helping shoulder the costs of paying for people who are older, poorer and sicker. The cross-subsidies worked, as the number and percentage of people with health care coverage—on the exchanges and/or with private insurance, Medicare, and Medicaid—skyrocketed.
The Affordable Care Act also “requires issuers” of insurance “to renew or continue in force such coverage,” with few exceptions, notably failure to pay premiums, the lawsuit says. And it limits insurers’ yearly cost increases.
Indeed, though the suit doesn’t say so, millions of consumers got rebates in the ACA’s first year from past insurance company overcharges for “overhead.”
And the ACA mandates insurers “must cover a set of ‘essential health benefits,’ such as preventive care. And to protect patients from devastating costs when a medical condition exhausts their coverage, the ACA limits…deductibles and copayments for these essential health benefits.”
Before the ACA, “Insurers were free to deny coverage for people with pre-existing conditions, to refuse to renew such coverage, or even to revoke such coverage after it had been issued. Now, however, the act’s ‘guaranteed issue’ requirement specifies every ‘health insurance issuer that offers coverage in the individual or group market in a state must accept every employer and individual in the state that applies for such coverage,” the lawsuit adds.
The lawsuit notes that for such a major change in ACA rules, Kennedy’s HHS department gave people only three weeks in March to comment, and it got bombarded with opposition. It also shrugged them off. That violated the Administrative Procedure Act, the law mandating not just public comments on new rules, but substantive agency responses, too.
That law-breaking is another reason for the injunction, the three cities and Democracy Forward said. A progressive doctors’ group and a progressive small business group also joined the lawsuit
“The agency received more than 26,000 comments on the proposed rule, despite a shortened 23-day (rather than 30-day) formal comment period. Commenters raised serious concerns with many provisions of the rule, highlighting flaws with the proposed changes to ACA policy,” it notes.
Kennedy’s HHS “provided only surface-level responses to many of the public comments” to its Center for Medicare and Medicaid Services. “In most cases, rather than address the substance of public comments, defendants (HHS) excused themselves from taking account for the burdensome effect of the rule’s provisions by purporting to impose many policies on a temporary basis.”
HHS said eight of its 17 proposed [rules] changes in the ACA “are scheduled to sunset at the end of 2026.” Left unsaid: That’s before the end of Trump’s term.
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