Washington secures court victory protecting gender-affirming care under the Affordable Care Act

Attorney General Nick Brown and a multistate coalition secured a major victory on Friday protecting gender-affirming care from federal overreach.

The U.S. District Court for the District of Massachusetts struck down a key provision of a Trump administration final rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the Affordable Care Act (ACA). Essential health benefits are subject to the ACA's financial protections, including limits on out-of-pocket costs.

"The federal government tried to illegally deny promised health coverage that Washingtonians rely on," said Brown. "As this administration tries to make health care more expensive and difficult to access, we will fight to keep it as affordable and accessible as possible in Washington."

The final rule at issue - the "Marketplace Integrity and Affordability" rule - was proposed by the Trump administration in March 2025 to curb alleged ACA enrollment fraud and reduce federal spending on subsidies that help consumers afford ACA coverage. Among other changes, the rule would have removed certain types of gender-affirming care from the ACA's 10 essential health benefit categories.

If the rule had gone into effect, insurers in Washington would have continued to cover gender-affirming care as required by state law. However, the state would have needed to defray the expense of these medically necessary insurance benefits. Defeating the rule will save state taxpayers about one million dollars annually.

In July 2025, Brown and the coalition filed a lawsuit challenging nine separate provisions of the final rule, arguing that they would make it harder for consumers to get coverage through the ACA, increase costs for states, and weaken key ACA protections. Seven were later vacated in separate litigation, City of Columbus et al. v. Kennedy et al., in the U.S. District Court for the District of Maryland. On Friday, 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.

Read the order.

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