Trump cannot strip Obamacare protections from trans people’s healthcare, judge rules

A federal judge has struck down a Trump administration rule that would have prevented some gender-affirming care from being treated as an essential health benefit under the Affordable Care Act.

Senior U.S. District Judge Nathaniel Gorton, who was appointed by Republican President George H.W. Bush, ruled Friday that the Department of Health and Human Services exceeded its authority when it barred insurers from treating certain forms of gender-affirming care as essential health benefits.

A coalition of 20 states and Pennsylvania Gov. Josh Shapiro sued the Trump administration last year over several provisions of the rule. They argued that the changes were unlawful and would increase premiums and out-of-pocket expenses while causing people to lose health insurance. State officials cheered Gorton’s decision to grant them summary judgment on the gender-affirming care provision.

Related: Trump DOJ backs private insurance company that court found discriminated against trans patients

“The federal government tried to illegally deny promised health coverage that Washingtonians rely on,” said Washington state Attorney General Nick Brown. “As this administration tries to make health care more expensive and difficult to access, we will fight to keep it as affordable and accessible as possible in Washington.”

The ruling focused on one provision of the sprawling 2025 Marketplace Integrity and Affordability Final Rule, which the administration promoted as an effort to curb improper enrollment and reduce federal spending. Beginning in 2026, the provision would have barred non-grandfathered individual and small-group insurance plans from treating certain gender-affirming procedures as essential health benefits.

Insurers could still have voluntarily covered the care, and states could have required them to do so. But excluding it from essential health benefits would have stripped the care of important Affordable Care Act protections tied to federal subsidies and patients’ out-of-pocket costs. Gorton vacated that provision, although he sided with the administration on four other parts of the rule challenged by the states.

Related: Federal judge rebuffs Trump administration push to restrict gender-affirming care for minors

Massachusetts Attorney General Andrea Joy Campbell called the Friday order a major court victory for people seeking access to gender-affirming care.

“This victory blocks the Trump Administration’s attempt to make gender-affirming care more expensive and less accessible,” Campbell said. “Gender-affirming care is critical to the emotional and physical well-being of transgender individuals, and the Trump Administration does not have the authority to unlawfully make this care less accessible and more expensive for patients and families. I will continue to fight for the rights of all our residents to have affordable access to essential healthcare.”

The administration has continued its efforts to restrict federal funding for gender-affirming care, including by finalizing a rule last week that cuts off federal Medicaid and Children’s Health Insurance Program funding for gender-affirming medical care provided to transgender young people.