Federal government appeals court decision delaying significant adjustments to the Obamacare health insurance marketplace

In a recent development, the Trump administration has filed an appeal against a ruling that blocked several parts of its changes to the Affordable Care Act (ACA) exchange enrollment and eligibility. The appeal, filed on Friday, seeks to overturn a ruling made by Judge Brendan A. Hurson on August 21.

Judge Hurson temporarily blocked most of the contested provisions of the CMS "Marketplace Integrity and Affordability" rule. The rule, which was rolled out in June, aimed to lower individual health insurance premiums by about 5% on average. However, the judge found that plaintiffs are likely to succeed on the merits of their challenges to seven provisions of the rule.

The contested provisions include a $5 fee for low-income individuals auto-enrolled into ACA plans who fail to verify their eligibility, stricter eligibility verification requirements, a provision allowing insurers to deny re-enrollment to individuals with unpaid premiums, and the exclusion of gender-affirming care from essential health benefits.

Plaintiffs in the lawsuit include the mayors of Baltimore, Chicago, and Columbus, Ohio, as well as liberal groups Doctors for America and Main Street Alliance. They allege violations of the Administrative Procedure Act.

One of the rules stayed by Hurson adjusts the allowable ranges of actuarial values applicable to health care plans offered on the ACA exchanges. Approximately 80% of issuers participating in federally facilitated exchanges took advantage of the policy by designing health plans that fall within the expanded "de minimis" ranges of allowable actuarial values. Due to the stay order, these issuers will now need to revise those plans to comply with the narrower 'de minimis' ranges that applied under the pre-Rule regulatory scheme.

Defendants, including the Department of Health and Human Services, HHS Secretary Robert F. Kennedy Jr., Centers for Medicare & Medicaid Services, and CMS Administrator Mehmet Oz, also asked for a stay of the August 21 ruling until the appeal is heard.

John Hilton, Senior Editor of the news website, has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected] and can be followed on Twitter @INNJohnH.

The appeal process, beyond the U.S. Department of Health and Human Services and Robert F. Kennedy Jr., does not seem to involve any specific institutions as of the available search results. The outcome of the appeal could have significant implications for the ACA, particularly for individuals enrolled in health plans offered on the exchanges.

HHS and state agencies will then need to review and approve the revised plans before the 2026 open enrollment begins on Nov. 1. If issuers are unable to comply with this regulatory change or if their plans are not approved in time, Exchange customers may have fewer plan options to choose from.

As the appeal process unfolds, it is crucial to monitor the developments closely to understand the potential impact on the ACA and the millions of Americans who rely on it for their health care.

Federal government appeals court decision delaying significant adjustments to the Obamacare health insurance marketplace