Overview

• A coalition of Democratic-led cities—Baltimore, Chicago and Columbus—and advocacy groups Doctors for America and Main Street Alliance filed suit in Maryland federal court to vacate the rule before its late-2026 implementation.
• The June 25 ‘Marketplace Integrity and Affordability’ rule shortens open enrollment to Nov. 1–Dec. 15, ends a monthly special enrollment period for low-income applicants and imposes stricter income verifications with added fees.
• HHS estimates the policy could reduce ACA exchange enrollment by 725,000 to 1.8 million people while asserting the changes are needed to curb improper sign-ups and protect federal subsidies.
• The lawsuit argues the administration violated the Administrative Procedure Act and the ACA by rushing the rulemaking process and failing to address thousands of public comments.
• City leaders warn the restrictions will drive up uninsured rates and place greater financial strain on municipal health and social services.