Federal Judge Blocks Key Trump-Era ACA Rule Provisions Impacting Coverage

A federal judge in Baltimore has issued a ruling to suspend key provisions of a Trump-era Affordable Care Act (ACA) regulation that were set to take effect in August 2025. These provisions included enhanced income verification requirements, the ability for insurers to exclude enrollees with unpaid premiums, and a $5 premium charge for some consumers pending verification of federal premium subsidy eligibility.

The suspended rule changes were estimated to risk the loss of health coverage for approximately 1.8 million Americans. The judge's ruling supported arguments from Democratic-led cities that the Centers for Medicare and Medicaid Services (CMS) exceeded its authority in enacting certain parts of the rule and that these measures would impose significant harm on city health budgets and services. The decision emphasized that increased uninsured rates would raise costs for insured individuals and reduce care quality for those losing coverage, impacting public health interests.

CMS finalized the rule to reduce improper enrollments and maintain ACA exchange integrity but has declined to comment on ongoing litigation. A related case by Democratic state attorneys general is pending in Massachusetts, awaiting judicial review. The ruling highlights tensions around regulatory authority and the balance between controlling fraud and maintaining broad ACA coverage.