Attorney General Bonta: No One Should Have to Choose Between Their Health and Their Financial Security

OAKLAND – California Attorney General Rob Bonta co-led a coalition of 22 attorneys general in submitting a comment letter opposing a proposed rule by the U.S. Department of Health and Human Services (HHS) that would make over a dozen amendments to rules governing federal and state health insurance marketplaces, such as Covered California, established by the Patient Protection and Affordable Care Act (ACA). In the letter, the coalition argues that these changes undermine the core mission of the ACA, which is to “increase the number of Americans covered by health insurance and decrease the cost of healthcare.” Instead, the proposed rule would cause millions to lose their health coverage and millions more to pay increased insurance premiums and out-of-pocket costs.

“No one should ever have to go without the care they need due to cost or other barriers surrounding health insurance,” said Attorney General Bonta. “At the California DOJ, we are committed to ensuring that all Californians have access to quality and affordable health care regardless of their circumstances.”

California has nearly 1.8 million ACA plan enrollees, the third highest of any state. The proposed rule by HHS would make substantial changes to the operations of the ACA, including shortening the open enrollment period for accessing the ACA marketplace, ending coverage for millions of individuals nationwide, and stripping Deferred Action for Childhood Arrivals (DACA) recipients of ACA insurance eligibility. The proposed changes also prohibit coverage of gender-affirming care as an Essential Health Benefit (EHB) on federal exchange plans, leaving states responsible for paying any increase in premium as part of the premium subsidies if they require such coverage.  

In the letter, the attorneys general assert that the proposed rule:

• Shortens the Open Enrollment Period, denying Californians greater access to the ACA marketplace and eliminating California’s historic flexibility to extend the Open Enrollment period, which in prior years has driven large enrollments in Covered California.
• Fails to accomplish its purported goal of combatting fraud and increasing marketplace efficiency, as it increases premiums and out-of-pocket costs, leaving enrollees with less comprehensive coverage.
• Makes coverage unnecessarily difficult to obtain as the proposed changes create additional hurdles that will significantly restrict eligibility and diminish enrollment.
• Bars DACA recipients from access to state and federal ACA exchanges, harming California and other states’ economies, public health, and welfare by increasing the number of uninsured residents.
• Unlawfully excludes coverage for gender-affirming care as an EHB, violating the Equal Protection Clause and Section 1557 of the ACA.

Attorney General Bonta is committed to safeguarding access to affordable healthcare for all. In January 2025, Attorney General Bonta, as part of a multistate coalition, filed a motion to intervene in defense of a rule expanding healthcare access for DACA recipients by making them eligible to participate in the Affordable Care Act's insurance marketplace. In February 2025, he co-led a coalition in filing an amicus brief in the U.S. District Court for the District of Maryland challenging President Trump’s Executive Orders 14168 and 14187, which target transgender individuals and attempt to strip federal funding from institutions that provide life-saving gender-affirming care for individuals under the age of 19. The same month, Attorney General Bonta joined a coalition in filing an amicus brief with the U.S. Supreme Court in support of the ACA’s preventive care mandate, which requires private insurers to cover at no cost certain preventive services as determined by the Preventive Services Task Force.

In sending the comment letter, Attorney General Bonta joins the attorneys general of New Jersey, Massachusetts, Arizona, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Illinois, Maryland, Maine, Michigan, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Wisconsin.

A copy of the letter can be found here.