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Oregon Attorney General Dan Rayfield cheered a Friday ruling by the U.S. District Court for Massachusetts that says gender-affirming care must still be covered by under the Affordable Care Act.
The ruling by U.S. District Judge Nathaniel Gorton, who was appointed by former President George H.W. Bush, struck down a provision in the Trump administration’s Marketplace Integrity and Affordability rule, which the Trump administration finalized in June 2025 in an effort to combat fraud. Rayfield joined 20 other states in a lawsuit filed in July 2025 alleging that the rule would also remove “medically necessary treatments” for transgender individuals from the ACA’s essential health benefit categories. The effort was led by attorneys general in California, Massachusetts, and New Jersey.
California attorney general Rob Bonta said in a statement that the latest ruling meant that gender-affirming care would qualify for the ACA’s financial protections in “many states,” and that transgender people would be able to afford care.
“This rule would have made it harder for people to get the care they need and pushed costs onto families who are already managing serious health decisions,” Rayfield said in a statement. “Those are decisions that belong between a patient and their doctor. This court ruling shows that Trump can’t use health care laws to engage in discrimination.”
The ruling addresses one provision of nine that attorneys general took issue with in their July 2025 lawsuit. The lawsuit takes broad issue with the Marketplace Integrity and Affordability rule, alleging that changes to eligibility and enrollment could cause close to 2 million Americans to lose their insurance.
The lawsuit alleged that decreases in enrollment would also increase overall healthcare costs, and make healthcare more difficult to access among vulnerable populations. Seven other provisions the coalition challenged were vacated in a separate ruling in June, says Jenny Hansson, a spokeswoman with Rayfield’s office.
The U.S. Department of Health and Human Services did not immediately respond to a request for comment from WW.
The ruling is the latest victory around gender-affirming care for Rayfield, who in April led a separate multistate lawsuit that successfully challenged an HHS proposal that would have blocked hospitals that provide gender-affirming care to children from accessing Medicare and Medicaid funding.
Oregon legislators in 2023 passed House Bill 2002. That bill prohibits health insurers in the state, both public and private, from denying claims for medically necessary gender-affirming treatment.
