Salem, Oregon – A provision tucked inside a sweeping Affordable Care Act rule could have changed what patients pay for certain gender-affirming care. Now, a federal court has stopped that change from taking effect.
Oregon Attorney General Dan Rayfield announced the court victory after a Massachusetts federal judge ruled against a Trump Administration policy that would have removed certain gender-affirming treatments from the Affordable Care Act’s essential health benefit categories. Those benefits come with key ACA financial protections, including limits on how much patients can be required to pay out of pocket.
“This rule would have made it harder for people to get the care they need and pushed costs onto families who are already managing serious health decisions,” Rayfield said.
“Those are decisions that belong between a patient and their doctor. This court ruling shows that Trump can’t use health care laws to engage in discrimination.”
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The dispute traces back to March 2025, when the Trump Administration introduced its “Marketplace Integrity and Affordability” rule. The administration presented the broader rule as an effort to address alleged fraud in ACA enrollment and reduce federal spending on health insurance subsidies.
Among the rule’s changes, however, was a provision excluding certain gender-affirming care from categories considered essential health benefits under the ACA.
Rayfield and attorneys general from other states challenged the policy in court. The multistate coalition filed its lawsuit in July 2025, targeting nine provisions of the administration’s rule.
The coalition argued that the changes could make health coverage more difficult to obtain, increase costs for states and weaken protections established under the Affordable Care Act.
Much of the rule had already run into trouble in federal court. Seven of the nine challenged provisions were previously struck down in a separate lawsuit, City of Columbus et al. v. Kennedy et al., heard in Maryland.
The latest ruling addressed the gender-affirming care provision. The Massachusetts court found that the Trump Administration violated the law when it changed the ACA’s essential health benefit categories without following the required process.
For Rayfield and the states involved in the challenge, the decision preserves existing ACA protections for the affected care and blocks another piece of the administration’s 2025 health insurance rule.
