Attorney General Dan Rayfield Secures Major Court Victory Protecting Gender-Affirming Care Under the Affordable Care Act

Attorney General Dan Rayfield has won a major court victory protecting access to gender-affirming care under the Affordable Care Act (ACA). A federal court struck down a Trump Administration rule that would have excluded coverage of certain types of gender-affirming care as essential health benefits under the ACA. Essential health benefits are subject to the ACA's financial protections, including limits on out-of-pocket costs.

"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," said Attorney General Rayfield. "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."

The rule at the center of this fight - called the "Marketplace Integrity and Affordability" rule - was rolled out by the Trump Administration in March 2025, supposedly to crack down on ACA enrollment fraud and cut federal spending on subsidies. But buried in the changes was a provision removing certain gender-affirming care from the ACA's essential health benefit categories.

AG Rayfield and a multi-state coalition sued in July 2025, challenging nine different provisions of the rule. Their argument was that these changes would make it harder for people to get covered, drive-up costs for states, and chip away at core ACA protections. Seven of those provisions were already struck down in a separate case, City of Columbus et al. v. Kennedy et al., in Maryland federal court. This week, the Massachusetts court ruled that the Trump administration broke the law by changing the essential health benefits categories without following the proper process.