Press Release  AG Campbell Urges U.S. Department Of Health And Human Services To Protect Affordable Health Coverage From Federal Attack

BOSTON — Massachusetts Attorney General Andrea Joy Campbell co-led a coalition of 22 attorneys general in issuing a comment letter to the Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) regarding a proposed rule that would undermine the Affordable Care Act (ACA), making it more difficult and expensive for individuals to enroll in health coverage on federal and state exchanges. The proposed changes would also prevent DACA recipients from purchasing health insurance on the exchanges. 

“No one, regardless of their demographic, should go without healthcare coverage and high-quality care," said AG Campbell. "The federal administration’s proposed ACA rule changes are contrary to federal law, and would cause millions of people to lose their health insurance coverage, eventually at state expense.”

If allowed to take effect, the proposed rule will cause between 750,000 and two million Americans to lose health insurance coverage in 2026 and will create significant health and economic damage to the states as more people are forced to go without health care, driving up costs for everyone. 

The proposed rule would force all state ACA exchanges to shorten their open enrollment periods and eliminate special enrollment opportunities for low-income people, making enrollment far less accessible. The rule would also impose burdensome enrollment verification requirements. In addition, the rule would change how premiums are adjusted each year, affecting the limits on cost-sharing and out-of-pocket maximums. As a result of this change, premiums are expected to rise by about 4.5%, and Massachusetts will likely see its state subsidy costs increase by about $10 million in 2026. 

In 2024, the CMS released a Final Rule increasing patient access to state and federal exchanges under the ACA. This rule allows DACA recipients, also known as Dreamers, who are allowed to live and work in this country pursuant to deferred action, to purchase affordable health insurance on ACA exchanges.

The proposed rule seeks to undo this expansion and would remove access to ACA marketplace insurance for DACA recipients who depend on this coverage. If these residents lose access to preventive medical care via their insurance, they may need to seek more expensive emergency room care, harming public health and economic well-being for communities across the Commonwealth. 

Additionally, the rule would allow health insurance plans to deny enrollment to anyone who missed a past payment for a health insurance premium, no matter how long ago the missed payment occurred. The rule does not require insurers to notify their consumers if they implement this policy—meaning consumers could be denied coverage without notice or an explanation. In previous rulemaking, the federal government understood that nonpayment could be due to a variety of factors and that insurers currently have sufficient methods to collect past-due payments.

The rule would also prohibit states from including coverage for gender-affirming care as an “essential health benefit”, which are ten categories of treatments that must be covered by state benchmark plans under the ACA. The proposed rule ignores the benefits of this critical care and the important role it plays in patients’ lives, representing a dangerous intrusion into the practice of medicine. To support this change, the Trump Administration claims, without evidence, that gender-affirming care is rarely covered in employer-based health plans. In fact, surveys indicate that coverage for these benefits has expanded significantly, with 72% of Fortune 500 companies offering gender-affirming care in 2024, up from 0% in 2002. 

This response is the latest action AG Campbell has taken to protect access to affordable health coverage. In March, AG Campbell led a coalition of 17 attorneys general in filing an amicus brief in the U.S. Supreme Court, urging the Court to recognize Medicaid recipients' individual right to receive care from the qualified provider of their choice, including Planned Parenthood. In February, AG Campbell and a coalition of attorneys general filed another amicus brief in the U.S. Supreme Court to protect a provision of the ACA that guarantees access to preventative care for millions of Americans.

Joining AG Campbell in filing the letter, which she co-led with California Attorney General Rob Bonta and New Jersey Attorney General Matthew Platkin, were the attorneys general of Arizona, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Illinois, Maryland, Maine, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Wisconsin.  

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