Federal Judge Blocks Trump Rule Limiting Gender-Affirming Care under the ACA

Senior U.S. District Judge Nathaniel Gorton, a Republican-appointed judge, issued a summary-judgment ruling that vacates a provision of the 2025 Marketplace Integrity and Affordability Final Rule. The provision would have barred non-grandfathered individual and small-group insurance plans, beginning in 2026, from treating certain gender-affirming procedures as essential health benefits under the Affordable Care Act. By striking down that provision, the judge found the Department of Health and Human Services exceeded its statutory authority. The decision leaves the remainder of the rule—four other contested parts—intact.

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A coalition of 20 states, joined by Pennsylvania Governor Josh Shapiro, sued the Trump administration over several sections of the rule, arguing the changes were unlawful, would raise premiums and out-of-pocket costs, and could cause loss of coverage for transgender patients. The lawsuit targeted the rule’s attempt to remove gender-affirming care from the ACA’s essential health-benefit protections, which tie coverage to federal subsidies and limit patient cost-sharing.

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• Nathaniel Gorton – Senior U.S. District Judge, appointed by President George H.W. Bush; authored the ruling.

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• Nick Brown – Washington state Attorney General; argued the rule would illegally deny promised health coverage.

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• Andrea Joy Campbell – Massachusetts Attorney General; hailed the decision as a victory for transgender health access.

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Massachusetts Attorney General Andrea Joy Campbell described the ruling as a major victory that blocks the administration’s effort to raise costs and limit access to gender-affirming care, emphasizing the care’s importance to the emotional and physical well-being of transgender individuals.

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• “The federal government tried to illegally deny promised health coverage that Washingtonians rely on,” — Washington

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• “This victory blocks the Trump Administration’s attempt to make gender-affirming care more expensive and less accessible,” — General Andrea Joy Campbell

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