Four cities sue Trump administration over ACA rollback

Four major U.S. cities sued the Trump administration Thursday over its regulatory dismantling of the Affordable Care Act, claiming that federal actions are already overtaxing their health departments.

Baltimore, Chicago, Cincinnati and Columbus, Ohio, joined liberal advocacy groups in the suit, filed in a U.S. District Court in Maryland, alleging that President Donald Trump and his administration "are deliberately trying to make the (ACA) fail." They maintain that these efforts will drain city budgets and resources to manage public health as coverage rates are predicted to drop.

The cities said the Trump administration actions have led to a greater burden on their community health centers and ambulance systems, plus they're increasing the overall costs of a sicker population. The complaint alleged the moves have led to a "slow trend upward" of the uninsured rate—which dipped to an all-time low of 9.1% in 2015.

"Our Health Department's clinics serve as a safety net for the uninsured and underinsured in Baltimore City, providing essential health services from reproductive health and dental care to HIV/AIDS and addiction treatment," Baltimore Health Commissioner Dr. Leana Wen said in a statement. "By intentionally sabotaging the ACA, the Trump administration is directly increasing the number of uninsured and underinsured Baltimoreans. This will increase demand for our services, without additional resources."

The lawsuit names Trump, HHS, HHS Secretary Alex Azar, the CMS and CMS Administrator Seema Verma as defendants.

The cities claim that policies from Trump and his top health deputies are discouraging enrollment in comprehensive insurance plans, raising prices and reducing choices within the individual market, and misappropriating funds Congress earmarked for Obamacare.

"The Trump administration's strategy: to deceptively shift the blame from their own actions to the (ACA) itself," the complaint said. "Their objective: to pressure Congress to repeal the (ACA) or, if that fails, to achieve de facto repeal through executive action alone. The administration's actions are unlawful."

The Trump administration this week issued a final rule that will allow up to three years of enrollment in short-term, limited-duration plans that typically offer bare-bones coverage. Officials are touting the change as offering more and cheaper choices for younger people who weren't opting into the higher-priced, robust coverage on the Obamacare exchanges, but critics say it will undermine the risk pool and raise costs for people with pre-existing conditions.