Rhode Island Attorney General Peter Neronha joined another challenge to President Donald Trump’s administration on Thursday, aligning himself with 20 other states in a lawsuit against recent federal rules surrounding health coverage purchased via the Affordable Care Act (ACA) marketplaces.
The suit, filed Thursday in U.S. District Court for the District of Massachusetts, argues that a June 25 final rule issued by the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) would make health care harder to access under the ACA, especially for transgender people.
The rule, set to take effect Aug. 25, heightens eligibility requirements and narrows the open enrollment window for health plans purchased through state marketplaces. Some consumers who previously qualified for $0 premiums could possibly see new monthly charges on their health plans.
“We expect these actions will provide immediate premium relief to families who do not qualify for Federal premium subsidies and reduce the burden of improper ACA premium subsidy expenditures to the Federal taxpayer,” the rule reads.
Neronha lambasted the new rule as “unnecessary and irresponsible” in a statement Thursday.
“We should be making it easier, not harder, for Americans to obtain health care coverage,” Neronha wrote. “And yet, this Administration is intent on making life harder for everyday Americans while lining the pockets of the ultra-rich.”
The lawsuit is seeking a preliminary injunction to block the law from becoming active before the Aug. 25 start date. The lawsuit is co-led by Attorneys General Rob Bonta of California, Andrea Joy Campbell of Massachusetts, and Matthew Platkin of New Jersey.
Signed onto the suit are attorneys general from Arizona, Colorado, Connecticut, Delaware, Illinois, Maryland, Maine, Michigan, Minnesota, Nevada, New Mexico, New York, Oregon, Vermont, Washington, and Wisconsin, plus the governor of Pennsylvania.
Neronha performed a hat trick this week, joining three lawsuits against the Trump administration across four days. On Monday, Neronha co-led a case filed in Rhode Island over education funding. On Wednesday, the AG allied himself with a blue state coalition hoping to undo cuts to a disaster preparedness program. Overall, Neronha has joined or co-led 28 lawsuits against the Trump administration since January.
The lawsuit argues that the final rule would cause up to 1.8 million people to lose their health insurance, and it would increase premiums, copays and deductibles for millions more.
“We know millions are already expected to lose health coverage under the President’s recent legislation, which cuts $1 trillion in federal health spending over the next 10 years,” Neronha added. “Now, with this final rule, over a million more could be one medical emergency away from bankruptcy.”
According to Neronha’s office, health insurer HealthSource RI estimates the rule would reduce enrollment in the Ocean State by 3%, or about 1,380 people.
Removing treatment options for transgender people
The CMS rule also strikes drug therapies like hormone or puberty blockers used in gender transition-related care from the federal roster of essential health benefits. That would mean states that decide to subsidize such treatments would need to rely on their own coffers, rather than federal ones, if they mandate coverage among state health plans. These drugs fell under the banner of gender-affirming care in the Biden years, but the new CMS ruling prefers the label “specified sex-trait modification procedure” and distinguishes such medication from other non-pharmaceutical or non-surgical therapies.
The lawsuit argues that the final rule’s “sweeping changes” will remove “States’ substantial autonomy to set their own policies” when it comes to health care marketplaces. It additionally argues that the “abrupt decision to exclude services … on the very basis of gender identity is highly disruptive” and will disproportionately affect transgender and gender non-conforming people.
“Notably, the only individuals who might seek services with the express purpose of aligning their gender identity and their body, and their gender identity differs from their sex, are transgender individuals,” the lawsuit reads, quoting language used in the federal law.
An hour after the attorneys general announced their lawsuit, CMS issued its own press release. Although not specifically in response to the lawsuit, the agency defended imminent changes to ACA plans as measures that will “crush fraud, waste, and abuse in America’s healthcare programs.”
The agency wrote that a recent software-led analysis of historical enrollment data found that, in 2024, nearly 2.8 million Americans were improperly enrolled in multiple public insurance programs, including Medicaid, the Children’s Health Insurance Program (CHIP) plans purchased on ACA marketplaces. The agency says ending duplicate enrollments could save approximately $14 billion annually in taxpayer spending.
“The Biden Administration struggled to ensure that individuals were only enrolled in the single Medicaid or Exchange plan for which they were eligible, that ends today,” CMS Administrator Dr. Mehmet Oz said in a statement. “CMS is restarting these important checks to follow federal law. We are going to work with states to identify individuals enrolled in multiple programs and fix the duplicate enrollment problem to save taxpayers billions of dollars, while minimizing inappropriate coverage loss.”
This story was originally published by the Rhode Island Current.
