Federal Judge Blocks Key ACA Marketplace Rule Changes

August 22, 2025 — A federal judge has issued a temporary injunction blocking significant portions of the Marketplace Integrity and Affordability Rule, which was scheduled to take effect on August 25, 2025 (Reuters).

Why the Court stepped in

U.S. District Judge Brendan Hurson, presiding in Baltimore, sided with challengers including the cities of Chicago and Baltimore, as well as public health advocates, who argued the rule would strip health coverage from over 2 million Americans, particularly low-income residents. Judge Hurson concluded that the plaintiffs presented sufficient evidence under the Affordable Care Act (ACA) to warrant halting these provisions while litigation continues (AP News).

“Judge Hurson’s pause on the Marketplace Integrity and Affordability Rule prevents sudden disruption to health coverage for millions of Americans, especially low-income enrollees,” said Chicago Mayor Brandon Johnson.

Which provisions were paused?

The injunction temporarily blocks nearly all of the contested rule components, including:

• A new $5 monthly fee for low-income enrollees in zero-premium plans who fail to confirm eligibility during annual renewal.

• Stricter income verification requirements, eliminating self-attested income in certain cases.

• Elimination of a special enrollment period (SEP) that allowed continuous access for some low-income individuals.

• A new methodology for calculating maximum out-of-pocket costs, which would raise financial burdens.

• Allowing insurers to deny coverage based on outstanding premium debt.

These measures were viewed by critics as detrimental to access and affordability for vulnerable populations and have been paused pending final judicial resolution.

Provisions still moving forward

Judge Hurson allowed certain provisions to stand, including changes to cost-sharing limits methodology and the elimination of a 60-day extension for resolving eligibility discrepancies.

Administration’s position

The Centers for Medicare & Medicaid Services (CMS), which finalized the rule in June 2025, said the changes were intended to safeguard the integrity of ACA marketplaces, reduce improper enrollments, and curb misuse of federal funds (CMS).

Why this matters for the industry

For health insurance sales and lead generation companies, the ruling creates near-term stability in the ACA marketplace. By blocking provisions that would have restricted enrollment or added new financial burdens for low-income populations, the decision helps preserve a larger pool of eligible consumers—many of whom rely on outreach to understand their options.

Outbound health insurance advisors and contact centers, including many that use platforms like Convoso to reach prospective policyholders, benefit from:

• Steadier demand for marketplace plans, since fewer people are being pushed out of coverage.

• Reduced consumer confusion, as abrupt mid-year changes often create skepticism or hesitation to engage with enrollment outreach.

• Continued year-round opportunities to connect with individuals who might otherwise lose access under stricter rules.

By preventing sudden disruptions to ACA coverage, the ruling helps sustain the sales opportunities and lead pipelines that drive much of the industry.

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