Democratic mayors and national doctor groups have filed a lawsuit against the federal government over new rules that limit access to Affordable Care Act (ACA) coverage. The new policy, introduced by the Trump administration, shortens the sign-up period and adds new barriers to eligibility.
The changes, announced last month by the Department of Health and Human Services (HHS), are expected to impact nearly 2 million people. That’s almost 10% of those currently enrolled. Critics say the new restrictions will increase the number of uninsured Americans and put pressure on local services.
The mayors of Baltimore, Chicago, and Columbus have joined forces to challenge the rules. Their lawsuit says the policy undercuts the ACA’s core mission—to offer affordable health insurance to all. They argue that instead of helping people, the new system will push many off their health plans.
Doctors for America and the Main Street Alliance, two nonprofit health advocacy groups, are also part of the legal action. They say the rules will especially harm lower-income families and small business workers.
The new ACA enrollment rules shorten the federal sign-up window to just six weeks, from November 1 to December 15 in 2026. Under the Biden administration, this period had been extended, making it easier for more people to get coverage. That move led to a record 24 million sign-ups.
In addition to the shortened window, other rule changes will tighten income checks and add a $5 monthly fee for people who are automatically re-enrolled in zero-premium plans. Insurance companies will also have more power to deny coverage if people missed past premium payments.
Another part of the rule stops about 100,000 immigrants—those brought to the U.S. as children—from joining the ACA. However, the current lawsuit does not challenge that particular section.
The federal government says the changes will make the ACA marketplace more stable. In a statement, HHS spokesperson Andrew Nixon said the rules are about fairness and accountability. He said they will help prevent misuse of subsidies and keep costs lower for eligible users.
Nixon also said the rules close loopholes and protect taxpayer money. But local leaders and health advocates disagree, saying there was not enough time for public input before the policy was finalized.
“This unlawful rule will force families off their health insurance and raise costs on millions of Americans,” said Skye Perryman, president of Democracy Forward, the group representing the plaintiffs. She said the policy harms Americans’ health and safety rather than helping them.
During the Biden administration, expanding ACA access was a key goal. Thanks to the Inflation Reduction Act in 2022, generous subsidies helped increase coverage. But former President Trump has long criticized the ACA. He argues that without big subsidies, the plans are too expensive and don’t work well.
ACA enrollment dropped during Trump’s first term. Supporters of the new lawsuit fear that the recent policy changes could lead to a repeat of that trend, with more people left without basic health insurance.
The case may take months to resolve, but it reflects deep political divisions over the future of health care in the United States. The final decision could affect millions of people, especially those with limited incomes who rely on federal health coverage.
