Three federal lawsuits are forming a tapestry of litigation related to the future of the ACA marketplace.
In recent years, CMS has pitched rules focused on promoting marketplace “integrity” by tightening eligibility, altering enrollment periods and narrowing subsidy access, to name a few provisions. Court cases from as early as 2025 have the potential to shake up these ACA rules.
In a conversation with Becker’s, Katie Keith, director of the Center for Health Law and Policy at Georgetown Law, broke down what healthcare leaders and health plans need to know.
Here’s where each case stands and what they mean.
Columbus I
In a Maryland federal court, City of Columbus (Ohio) v. Kennedy — including Columbus, Baltimore, Chicago and other groups as plaintiffs — challenged CMS’ 2025 “Marketplace Integrity and Affordability Rule.”
In an August 2025 preliminary injunction, the judge stayed a $5 premium penalty on automatic re-enrollees, a past-due-premium coverage policy, special enrollment period eligibility verification requirements, the failure-to-reconcile policy, an income verification policy and de minimis actuarial value range changes. However, an update to the premium adjustment percentage survived.
The court then ruled on summary judgment in June 2026, vacating those stayed provisions. The court blocked the shortened open enrollment period leading up to the 2027 coverage year and also reversed course on the revocation of a 60-day extension to resolve income inconsistencies. Shortly after, the appellate court granted a motion to dismiss.
“It is more of a permanent ruling,” Ms. Keith said, adding she would “call it a more resounding decision” compared to the decision in 2025.
The failure-to-reconcile fight, meanwhile, may no longer be relevant by 2028 regardless of how the courts rule, thanks to its inclusion in HR 1.
“I think, beginning in 2028, all the marketplaces will have to do the failure-to-reconcile policy,” Ms. Keith said. “In the meantime, this lawsuit is about whether they’ll have to do it for next year or not.”
Columbus II
Another Maryland federal case — including largely the same plaintiffs — filed in June 2026 focuses on an ACA rule for 2027 and resurfaces similar concerns as the earlier litigation.
“If I was a plan, I would be reading that court decision closely, and then keeping a really close eye on the Baltimore court,” Ms. Keith said.
The 2027 rule brings back the special enrollment period and income verification requirements. It also expands catastrophic plan eligibility, drops the requirement for standardized plans and opens the door to non-network plans starting in 2028, among other provisions.
Arguments on the stay motion will take place July 8. Like Columbus I, Brendan Hurson is the judge.
“Will the Trump administration appeal? Will they appeal quickly? What will that look like? I do think even this first ruling might not be the last word,” Ms. Keith said.
States get in on the action
In a separate action from July 2025, 21 states sued CMS over the same rule as the Columbus I case. Ms. Keith said “the claims were almost perfectly overlapping” between the two lawsuits, but the state case, filed in a Massachusetts federal court, also challenged essential health benefit changes when it came to gender dysphoria.
The case is awaiting a summary judgment ruling after the judge denied relief through a preliminary injunction.
“I’m watching pretty closely to see if you get a different ruling there,” Ms. Keith said, adding that a difference could pave the way for appeals.
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