Attorney General Clark and Coalition Secure Victory Protecting Gender-Affirming Care Under Affordable Care Act

Attorney General Clark and a multistate coalition secured a victory after a federal court struck down a key provision of a Trump Administration final rule that would have stripped Vermont of the ability to require health plans on Vermont Health Connect to provide coverage for gender-affirming care.

The final rule at issue - the "Marketplace Integrity and Affordability" rule - was proposed by the Trump Administration in March 2025 to curb alleged fraud and reduce federal spending on subsidies that help consumers afford health coverage on "health care exchanges" under the Affordable Care Act (ACA). States, like Vermont, that operate health care exchanges decide which "essential health benefits" must be covered by plans on the exchanges. Essential health benefits are subject to the ACA's financial protections, including limits on out-of-pocket costs. The rule struck down by the court, among other changes, would have removed certain types of gender-affirming care from the allowable essential health benefit categories, effectively reversing Vermont's decision to include that care as an essential health benefit.

In July 2025, Attorney General Clark and the coalition filed a lawsuit challenging the essential benefits part of the rule along with eight other provisions, 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 struck down in separate litigation, City of Columbus et al. v. Kennedy et al., in the U.S. District Court for the District of Maryland. Last week, 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.