New federal rule creates unnecessary health coverage hurdles for nearly 300,000 Washingtonians

OLYMPIA, Wash. — The federal Centers for Medicare and Medicaid Services (CMS) released its final 2025 Marketplace Integrity and Affordability rule on June 20, making it harder for consumers who buy health plans through our Exchange, Washington Healthplanfinder, to get and keep affordable health coverage. 

“It’s clear to me that the Trump administration does not care about helping people find and keep affordable, meaningful health insurance,” said Washington state Insurance Commissioner Patty Kuderer. “It wants to restrict both who gets covered and the medically necessary services they can receive. The administration claims it’s needed to combat fraud and abuse, but that is simply not the case in Washington state. Our Exchange has robust safeguards in place to prevent improper enrollments. All this rule does is create widespread consumer confusion, impose complex administrative requirements for states and consumers, and increase premiums and out-of-pocket costs for thousands of people in our state.”

Washington is one of 19 states that runs its own state-based Exchange. Numerous organizations and individuals submitted approximately 26,000 comments on the federal rule that were largely ignored and not reflected in the final language.

The new rule’s changes take effect 60 days after publication, with certain changes scheduled for implementation later in 2026 and 2027. For health plans sold through Washington Healthplanfinder, the rule shortens the open enrollment period, creates unnecessary administrative burdens for states and consumers seeking coverage, and limits who is eligible for premium tax credits. In addition, it restricts states’ ability to select their own benchmark health plans — which is allowed under the Affordable Care Act, — by prohibiting Exchange plans from covering gender-affirming care. 

“During his previous administration, Trump said, ‘No one knew health care could be so complicated.’ This rule adds unnecessary and cruel complications and will make it harder for people to get enrolled and stay insured. Every day we hear from people who are struggling to pay for their health insurance. As a result of this action, combined with the expiration of enhanced federal premium subsidies at the end of this year, I’m worried the burden will be even harder to overcome for far too many people.”