Filing details Pima County's legal challenge to ACA changes

The Trump Administration's recent changes to marketplace health insurance will strain the public health system here, Pima County claims in a new multi-state lawsuit it agreed to join earlier this week.

The lawsuit filed Wednesday in Maryland District Court focuses on a set of rules the Trump Administration approved in May that impose new regulations for accessing healthcare coverage through the Affordable Care Act. The complaint is two-pronged; first, that the Trump Administration improperly approved new rules, and second that those rule changes make gaining coverage unnecessarily complicated, more expensive, and promote plans with weak coverage.

Pima County alleges the rule changes will cause significant financial strain on county government because more residents will become uninsured or underinsured. The county says its four clinics and four mobile health units will see increased demand for low-cost healthcare services, while also receiving less in insurance reimbursements.

The complaint argues new enrollment mandates, like requiring low-income applicants to submit additional income verification, or removing the ability to self-report annual income will cause many people to lose coverage.

It also claims insurers are now allowed to market less comprehensive plans with higher maximum out-of-pocket costs than previous regulations allowed. They argue some plans leave customers responsible for nearly the same amount of money as not having insurance at all. According to the complaint, the recent changes have also expanded the amount of people eligible to buy "catastrophic" plans, or plans with low premiums, high out-of-pocket costs and limited coverage options.

The left-leaning legal group Democracy Forward is filing the suit on behalf of Pima County, the cities of Columbus, Ohio, Baltimore, Maryland and Chicago, Illinois, and the nonprofits Doctors for America and the Main Street Alliance. It names the Department of Health and Human Services and Secretary Robert F. Kennedy Jr., the Centers for Medicare and Medicaid Services and Secretary Mehmet Oz.

The complaint also argues the Trump Administration violated the Administrative Procedure Acts, the federal law that governs how agencies make and change regulations and policies, and requires them to follow certain procedures when taking administrative actions.

The parties claim the Centers for Medicare and Medicaid Services failed to show why the rule changes were necessary, and did not meaningfully address public comments about increased costs and coverage loss.

Pima County is the first county in the country to challenge the rule changes, said Pima County Attorney Laura Conover in a news release. The Board of Supervisors voted to join the suit in a special meeting Monday, but did not provide details about the case.