Maryland Attorney General Anthony G. Brown joined a coalition of state attorneys general in opposing proposed federal changes to the Affordable Care Act that they argue would reduce access to health coverage, including for DACA recipients, and increase healthcare costs.
“The Trump Administration’s proposals would make healthcare more expensive, limit Marylanders’ access to plans that cover essential medical services, and cause millions of people to lose their health coverage altogether,” said Attorney General Brown. “All Marylanders, regardless of their immigration status or gender identity, should be able to access insurance that meets their needs and allows them to live safe, healthy lives.”
In 2024, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) released a Final Rule increasing patient access to state and federal exchanges under the ACA. This rule allows DACA recipients, also known as Dreamers, who are allowed to live and work in this country pursuant to deferred action, to purchase affordable health insurance on ACA exchanges.
However, last month, the Trump administration initiated the process of trying to undo this rule. If allowed to go into effect, the plan would deny DACA recipients access to insurance, even in the middle of the year, when they are counting on this insurance for their medical care. Removing such access harms states too; if these residents lose access to preventive medical care currently covered by their insurance, they may need to seek more expensive emergency room care, thereby harming both public health and the economic well-being for communities across the State.
Other proposed changes are equally disturbing. For instance, the rule would force all state ACA exchanges to shorten their open enrollment periods and would allow health insurance plans to deny enrollment to anyone who has ever missed even a single payment for a health insurance premium regardless of how long ago the missed payment occurred. Moreover, insurers would not be required to notify their consumers if they implement this policy, which means that consumers could be denied coverage without being aware that their denial is based on a past-due premium. In previous rulemaking, the federal government understood that nonpayment could be due to a variety of factors and that insurers currently have sufficient methods to collect past-due payments.
In addition, the rule would prohibit states from including coverage for gender-affirming care as an essential health benefit, representing a dangerous intrusion into the doctor-patient relationship. The Trump administration claims, without evidence, that gender-affirming care is rarely covered in employer-based health plans. In fact, surveys indicate that coverage for these benefits has expanded significantly, with 72% of Fortune 500 companies offering gender-affirming care in 2024, up from 0% in 2002.
Joining Attorney General Brown in signing the letter are the attorneys general of California, New Jersey, Massachusetts, Arizona, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Illinois, Maine, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Wisconsin.”