| |Photo by Marek Studzinski on Unsplash
NEW YORK – New York City Mayor Eric Adams and NYC Corporation Counsel Muriel Goode-Trufant announced on August 7 that NYC is leading a coalition of local governments in a legal challenge to defend the Affordable Care Act (ACA) against a newly finalized federal rule that threatens healthcare access for millions.
The coalition includes 21 Democratic attorneys general who filed an amicus brief in Massachusetts federal court and is co-led by California, Massachusetts, New Jersey, Illinois, plus 16 other Democratic-led states. The coalition’s amicus details the harmful effects of the rule and supports the states’ effort to stop the U.S. Department of Health and Human Services (HHS) from implementing the rule on August 25.
“Access to health care is a human right codified into law by the historic passage of the Affordable Care Act, which has provided health coverage to millions of Americans. At a time when too many New Yorkers and people across the country are struggling with high costs, stripping away that coverage will only take us backwards,” said Adams.
Added Adams: “Government should do everything in its power to provide and expand access to health care and other essential services, not restrict it, but this federal rule only serves to jeopardize health coverage for New Yorkers and Americans all across the nation. New York City is proud to lead this coalition of localities fighting to protect health coverage for the people we represent.”
What’s the Legal Fight About?
The case, California v. Kennedy et al, challenges a federal rule issued by the U.S. Department of Health and Human Services (HHS) that restricts ACA enrollment, especially for marginalized communities; excludes gender-affirming care from essential health benefits; and shifts medical costs from federal coverage to already-strained public hospitals.
Adams and Muriel Goode-Trufant argue that the rule is unlawful, violating the Administrative Procedure Act and other federal statutes, including the Separation of Powers doctrine and the Spending Clause. Also, it is retrogressive, undermining public health and increasing financial burdens on local governments.
“The sweeping regulatory changes to the Affordable Care Act adopted by the federal government are unlawful and a major step backwards for public health,” said Goode-Trufant. “As detailed in our brief, this misguided new federal rule will cause millions of people to lose their health insurance and force them to turn to severely strained public hospitals for care, exacting a tremendous human and financial cost on us all.”
Why New City Leads the Coalition
The City is leading the effort because it treats hundreds of thousands of uninsured patients annually, facing over $1 billion in uncompensated care. The City’s public hospitals are already grappling wth staffing shortages, rising costs, and surging demand.
Attorney General Aaron Frey of Maine emphasized the rule’s harm to over 65,000 Mainers who rely on ACA coverage. Governor Josh Shapiro has joined multiple lawsuits this year targeting federal rollbacks on healthcare and housing.
This legal action reflects a growing trend of local governments stepping up to defend federal protections when national policy shifts threaten community health. It also highlights the intersection of health equity, LGBTQ rights, and immigrant access to care. The role of cities in shaping national healthcare debates, especially amid federal retrenchment.
Suppose the new rule is allowed to take effect. In that case, some safety-net providers will surely buckle under the burden of caring for millions of newly uninsured people and billions of additional dollars in unpaid bills.
Also joining the City of New York and NYC Health + Hospitals in filing this amicus are Santa Clara County, California, and King County, Washington, as well as the city and county of San Francisco, California
