Federal judge restores ACA protections for gender-affirming care

A federal judge has struck down a Trump administration rule that would have removed gender-affirming care from the list of essential health benefits under the Affordable Care Act (ACA).

U.S. District Judge Nathaniel Gorton ruled that the Department of Health and Human Services (HHS) exceeded its legal authority when it finalized the 2025 Marketplace Integrity and Affordability rule. The provision in question would have prevented certain individual and small-group insurance plans from classifying gender-affirming procedures as essential health benefits starting in 2026.

Because essential health benefits are tied to federal subsidies and annual out-of-pocket cost caps, removing these services would have stripped patients of significant financial protections. The legal challenge was brought by a coalition of 20 states and Pennsylvania Governor Josh Shapiro.

While the ruling restores these protections, it was not a complete victory for the plaintiffs. Judge Gorton sided with the administration on four other challenged provisions of the rule.