A federal judge struck down a key provision of a Trump Administration rule that would have excluded certain types of gender-affirming care from essential health benefits under the Affordable Care Act, according to a decision secured by California Attorney General Rob Bonta and the attorneys general of Massachusetts and New Jersey.
The rule in question, the Trump Administration's "Marketplace Integrity and Affordability" rule proposed in March 2025, was designed to curb alleged enrollment fraud and reduce federal spending on subsidies helping consumers afford coverage. It would have removed certain types of gender-affirming care from the ACA's 10 essential health benefit categories. Essential health benefits are covered by the ACA's financial protections, including limits on out-of-pocket costs.
In July 2025, Bonta and the coalition filed a lawsuit challenging nine separate provisions of the rule. The U.S. District Court for the District of Massachusetts ruled that the Trump Administration unlawfully modified the categories of essential health benefits without following the proper procedures the ACA requires. Seven other provisions were vacated in separate litigation in the U.S. District Court for the District of Maryland.