In a move that's sparked widespread reactions, Illinois Attorney General Kwame Raoul has joined forces with a robust coalition of attorneys general across the country to sue the Trump administration over a contentious health coverage rule. This multi-state legal confrontation targets the administration's latest regulation, anticipated to create substantial roadblocks to insurance access under the Affordable Care Act (ACA). According to the lawsuit, these changes are not only unwarranted but also illegal.
The lawsuit, as stated in the Illinois Attorney General's announcement, challenges the final rule issued by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). Among other contentious points, the rule aims to exclude gender-affirming care from the essential health benefits under the ACA, a provision that could deny critical healthcare to some of the most vulnerable populations. Raoul expressed his concerns, "Illinois’ most vulnerable residents would be most impacted by the Trump administration’s rule, and they can least afford the resulting obstacles that will make it significantly more difficult to obtain health insurance under the Affordable Care Act."
The coalition, which includes attorneys general from California, New York, Oregon, among others, claims that the rule would impose unnecessary and expensive paperwork requirements, shrink enrollment opportunities, and up cost-sharing limits. The rule's anticipated effects are stark: the administration's figures suggest that up to 1.8 million individuals may be left without insurance, with countless others facing heftier premiums and out-of-pocket expenses. For Illinois alone, an estimated 14,000 residents could be left uninsured, causing ripple effects on hospital revenue and operations, particularly within safety net and critical access hospitals.
These barriers aren't just about numbers; they represent a backward step for health coverage progress. Since the ACA's inception fifteen years ago, the plaintiff states have witnessed a steadfast climb in enrollment, culminating in more than 24 million signups in 2025, including millions from the plaintiff states themselves. Raoul and his peers argue that HHS’ final rule carves out changes to the ACA marketplaces that could dismantle this hard-fought progress. They are seeking preliminary relief to halt the disputed portions of the rule before they take effect in plaintiff states—an effort to protect access to affordable health care for millions.
With the open enrollment period for the 2026 plan year on the horizon, these legal actions underscore a commitment to safeguarding health insurance coverage. As Raoul stated, "I am proud to join my fellow state attorneys general to oppose this arbitrary and illegal rule, and we will continue to use all the tools at our disposal to fight the Trump administration’s continued unlawful orders." The lawsuit's outcome may well determine the trajectory of health care affordability and accessibility At a time when the nation grapples with the ongoing challenges of managing healthcare costs and delivering equitable care.
